INFANT MORTALITY IN AMERICA by Michele McDonald

Over 20 percent of children in the United States—one-quarter of those under six— are born into, and live in poverty, according to a new UNICEF report, "The State of the World's Children." This is more than double the rate of most industrialized countries. Poor nutrition, of the mother while pregnant and/or her child, is implicated in over half of all child deaths worldwide, a proportion unmatched since the Black Death, says the study And children who survive often suffer impaired brain growth—low birth weight, for example, can reduce IQ dramatically—and poor physical development. These "social and economic costs strangle development and snuff out hope," says UNICEF.

The United States, the fabled land of plenty, currently ranks 29th in infant mortality. Babies born in Singapore, Slovenia, the Czech Republic, and even tiny Andorra, have a better chance of survival than they do here. In America,the causes, while complex, are invariably related to poverty and racism. Many such children are born into families that belong to the rapidly growing class of the "working poor."

Five years ago, Boston, embarrassed by its high infant mortality rates, especially in a city recognized internationally as a medical mecca, launched a $25 million "Healthy Start" program to help women keep prenatal appointments, develop nutrition programs, and deliver food to hungry families. "Healthy Start" has reduced the city's infant mortality rate to it's lowest level since 1980. Despite this improvement, however, black babies still die in Boston at more than twice the rate of white babies. And federal budget cuts threaten the sustainability of the program. Nationwide, at least 35 states have higher infant mortality rates for children of color than Massachusetts.

Patricia recalls the night her baby died from Sudden Infant Death Syndrome, SIDS. At the time of the tragedy she was homeless, living in a welfare hotel, and sharing her bed with her other three children. Her partner Robert (in the background) was in a different shelter, for homeless men, that night.

The parents of a baby girl who died of SIDS keep a lock of the infant's hair in their Bible, next to a passage they underlined that gives them some comfort. But the mother cannot accept her infant's early death and continues to mourn.

Then eight-months pregnant, Maria and her 12-month-old son traveled from Lynn, Massachusetts to Boston's Codman Square, a journey that can take three-and-a-half hours via public transportation, to obtain prenatal care. She frequently had to make the trip several times a week. Maria (whose name has been changed because she's an illegal alien and fears deportation) went to great lengths to have a healthy baby, and her efforts paid off: Her daughter is thriving.

Roxbury Comprehensive Community Health Center, in Boston, provides health services to a community where even a small budget cut can have major detrimental results. And prevention programs and follow-up care are vulnerable services where benefits aren't always quantifiable or otherwise obvious—authorities cant compute, for example, the number of single teenagers who do not become pregnant and have children. Dexter, almost a year old here, and his sister Tyisha, three, play while waiting for a check-up following his treatment for pneumonia.

The Healthy Start program has nurses and advocates who visit high-risk mothers at home, or in shelters, and who try to assist women with their medical and social needs. Paulette, a nurse with the program, liolds a two-and-a-half-month-old boy while advising a new mother at home. TJie mother had no prenatal care during a previous pregnancy, and was fearful of the racist and. patronizing attitudes she might encounter at community clinics. That changed when she met Paulette, through a neighborhood health clinic.

Jo-Anna, above, a midwife, gives a prenatal check-up. She sees a lot of women who have been written off by society, she says, and believes tJiat America needs a "Marshall Plan" for the inner cities to save the next generation.

Elizabeth's six-month-old son, above, lies in a coffin. Tlie infant is one of many who do not make it to their first birthday. During her pregnancy, Elizabeth says, she did not use drugs, smoke cigarettes, or drink alcohol But she did find Bostons hospitals insensitive and indifferent to her problems—those of an impoverished, Spanish-speaking mother.

Michele McDonald is a freelance photographer from Arlington, Massachusetts, who was formerly with The Boston Globe. In 1997, she was a finalist for the Pulitzer Prize in feature photography.