The Log The Words The Music The Photos Home

Columbia


 
The Struggle to Get Prenatal Care to Homeless Women in New York City
By Pauline M. Millard
 
NEW YORK _ Samantha Vallane is a tiny blonde girl who wears her hair pulled back in a tight bun. Blue eyeliner rims her eyes and she looks like she couldn’t be more than twelve years old. The world seems to tower over her five-foot frame. She is constantly on the hunt for a cigarette.
 
She lifts up her sweater, exposing her pale belly, bulging ever so slightly.
 
"How far along do you think I am?” she asks, only half rhetorically. “Three months or so?”
 
Her mother, Tina, standing nearby, rolls her eyes. "That’s my-sixteen-year-old," she says, sounding somewhat embarrassed.
 
Samantha is a pregnant mother, one who is eligible for many of the health services offered in New York City for poor women. But like many in her situation, especially when they are new to the shelter system, she isn’t aware of them.
 
The New York Department of Health is quick to tout that the infant mortality rate in New York City is the lowest its it’s been in over 10 years and lower than the national average. In 1999, the last time figures were available from thee department, the rate for all of New York City was steady at 6.9 deaths per 1,000. Anything over 7.0 is considered problematic.
 
This is in sharp contrast to 1991, when the infant mortality rate reached its peak with some sections of the city, like Central Harlem, having rates as high as 27.7. That is similar to a third-world country like El Salvador, which the same year was 28.4. The Upper East Side and the Tottenville section of the Staten Island conversely, has kept a steady rate of 5.3 over that 10-year period. In 2000, Harlem dropped to 10.3, according to figures from the Northern Manhattan Perinatal Partnership, down from 15.5 in 1999.
 
But when the infant deaths were at their peak, New York City and New York state started a progressive new program called the Prenatal Care Assistant Program, or PCAP, that offered free prenatal care to any woman who wanted it. It was federally- funded through Medicaid so no one could be turned away. The logic was that if babies were taken care of well when in utero than they would have fewer problems when they were born and not become a burden on the healthcare system later in life since premature and small birth can lead to many health problems.
 
Researchers who study low birth weight babies have noticed a few trends: the first is that poor women are more likely to have small babies. They also noticed that if a woman was poor and black, the numbers almost doubled.
 
When these babies are born small the National Institute of Health noticed that they are at higher risk for neurosensory, developmental, physical and psychological problems. Incidents of cerebral palsy also go up as birth weight decreases.
 
Studies have also shown that small babies are less likely to score well on intelligence tests later in life. The programs such as PCAP exist, the funding is available and statistics have shown that the babies it aims to help are living well past their first birthday.
 
But for many of the women such as Samantha Vallane, who really need it, the homeless and often times single women, actually getting to the free care of the Prenatal Care Assistance Program is a complicated equation.
 
There are already interest groups, like the New York County Medical Society and the American College of Obstetrics and Gynecologists, that are lobbying to expand the current PCAP program, to one year instead of six weeks after birth. They believe that the more that is invested in prenatal care the less tax dollars will be spent on caring for these children when they have other problems later in life. A recent study in California found that for every dollar spent on prenatal care, $3.33 could be saved in postnatal care and $4.63 in long term complications. For New York state, this could mean saving $5 million a year, according to the New York State Assembly Committee.
 
These groups are also pushing for more outreach and advertising of the services, since studies have shown that when women enroll, they have better birth outcomes. For instance, a 1997 study by the National Bureau of Economic Research found that enrollment in PCAP programs resulted in a 20% increase in enrollment in Women Infants and Children, a program that aims to teach and provide mothers and children about nutrition. It also showed evidence of an increase mean birth weight of 35 grams.
 
PCAP is an off shoot of the Medicaid program. There are 160 offices of it state wide, the majority, about 100 of them, in the New York City area. In 2000, 110,000 women statewide received their prenatal care through these centers. The New York City Independent Budget Office expects that with the economic downturn welfare caseloads will go up. By September 2002 the office expects 530,000 families in New York City to receive either Family or Safety Net Assistance. Although they expect an eventual drop in cases as the economy recovers, by 2003 it is expected that grant costs will exceed $40 million of the city’s funds. With more people relying on the system for support, there is a chance that funds could be cut for these sorts of programs, although no one at the PCAP offices in Albany would confirm that.
 
The entire Vallane family has been at the Emergency Assistance Unit in the Bronx for four days since they left Staten Island. They had lived in the same apartment for 14 years, paying cash to a landlord who a few weeks ago decided unexpectedly to evict them.
 
The Vallanes needed fresh air from the stifling heat inside the shelter, as well as cigarettes to quell the nerves and frustrations that well up from waiting to be placed in temporary housing. Samantha is pregnant and hasn’t yet had any prenatal care. Otherwise routine health checkups have been usurped by the need to find housing on a daily basis. Tina said that back in Staten Island their lives were orderly, but due to their new circumstances their focus has shifted. The family needs to be together at all times if they want to be considered for housing at the Emergency Assistance Unit. It’s a bit like going to a restaurant and having to wait for your entire party to arrive before being seated.
 
Rocky, the father, sits quietly in his wheelchair suffering silently from a muscular disorder that won’t let him move around much. His son Joe, a schizophrenic, stares off into space and lets the women do most of the talking. He ran out of his meds a few days ago.
 
Tina says that Samantha also has a mood disorder, one that makes her paranoid. She says that she needs to get out of the shelter because Samantha keeps picking fights with people. That, and she needs to get to a doctor. No one at the Emergency Assistance Unit has told them where to go for health care in the Bronx, which is a foreign country to them compared to their native Staten Island.
 
But then again, the Emergency Assistance Unit is under no legal obligation to do anything but house the people that come in, said Kris Allen, a social worker at the Northern Manhattan Perinatal Project in Harlem.
 
"There are no laws that make shelters tell pregnant women where to get care," she said. "Community outreach programs can leave flyers about the their programs inside the shelters, but women need to find it on their own."
 
This isn’t good new for people like the Vallanes who never thought they would find themselves homeless and who are just starting to understand the complex equation of getting benefits. When told about PCAP, Tina seems surprised that such a program exists.
 
"No one here tells you anything except where to sit," Tina says, who seems intrigued by the program.
 
The difference between knowing about programs and not can often mean the difference between life and death for some children, especially when their housing is at the discretion of social workers.
 
Charlene Habersham’s latest home is a shelter on 41st Street and 10th Avenue in the heart of Hell’s Kitchen in New York City. This is the third time since December she and her three children have been moved. The case workers keep telling Habersham that as soon as her Section 8 housing is approved, they will be moved into public housing. But their case worker has been saying that for over a year.
 
Habersham is mostly concerned about the health of her youngest child, a tiny four-month-old named De’Quann. Born a month premature because of complications stemming from Habersham’s gastric bypass a year earlier, he has more than tripled in size from the 3 pounds he weighed when he was born. For the first few weeks of his life Habersham would stay up all night watching the tiny bundle sleep, making sure that his little lungs continued to move in and out.
 
Habersham was one woman who knew enough about the labyrinth of public assistance and Medicaid to seek help for her high-risk pregnancy from the Montefiore Medical Center in the Bronx. Two years ago Habersham and her children lived in a modest apartment in the Bronx. She paid her rent every month in cash. At the time Habersham weighed well over 500 pounds and couldn’t move around or take care of her three other children.
 
"Sometimes there were events at school and my children didn’t want me to come because they thought that people would laugh,” she said.Habersham solved the problem by having gastric bypass surgery, a complicated procedure that shrank the size of her stomach. Apart from her weight problem she was otherwise healthy before the operation and recovered smoothly. She only needed three days in the hospital afterwards when most people need five to seven.
 
"I’m one of those people that likes to move on with things," she said.

next page >>>