Detroit’s 60-year deterioration has taken a toll not just on business owners, investors and taxpayers. It’s meant misery for its most vulnerable: children and the women who bear them.
While infant mortality fell for decades across the U.S., progress bypassed Detroit, which in 2012 saw a greater proportion of babies die before their first birthdays than any American city, a rate higher than in China, Mexico and Thailand. Pregnancy-related deaths helped put Michigan’s maternal mortality rate in the bottom fifth among states. One in three pregnancies in the city is terminated.
Women are integral to the city’s recovery. While officials have drawn up plans to eliminate blight, curb crime and attract jobs, businesses and residents, they’re also struggling to save mothers and babies. The abortion patients awaiting ultrasounds at the Scotsdale Women’s Center and the premature infants hooked to heart monitors at Hutzel Women’s Hospital must be cared for before the bankrupt city can heal itself.
“Detroit is a bad place,” said Crystal Cook, 20, as she waited for an appointment at Scotsdale. Men in the city are “out of control. Most of them don’t have jobs, most of them couldn’t provide. Basically in Detroit, women have to do everything themselves.”
The crisis transcends the personal, said Gilda Jacobs, a former state senator from suburban Huntington Woods who heads the Michigan League for Public Policy.
“If you have families that are suffering, who aren’t going to work, who aren’t being trained for jobs, they’re never going to be taxpayers,” she said. “You need a holistic approach to improving a city. You need jobs, you need good infrastructure, you need transportation, you need good schools -- and you need healthy human capital.”
A campaign called Make Your Date begun last month is the latest attempt to prevent premature births, the leading cause of infant deaths, with hormone therapy and counseling.
“We want every kid to get off to a healthy start,” said Mayor Mike Duggan, who ran the Detroit Medical Center before taking office in January. “There are lots of things we’ve got to fix, but this is one that’s important to me.”
The initiative’s co-chairwoman is Sonia Hassan, a doctor who directs a National Institutes of Health research branch on maternal and fetal medicine. Make Your Date seeks to reach every pregnant woman by bringing together hospitals, insurers, foundations and advocacy groups.
“These are the children of Detroit,” Hassan said. “They are the future of it.”
The effort must counter an economic and social slide in the former auto capital that resulted in a record $18 billion municipal bankruptcy.
In Detroit, 60 percent of children live in poverty, according to U.S. census data. Nationwide, 22 percent do.
The city had the lowest rate of adults working or looking for work -- 49.4 percent -- among 41 cities examined in 2012 by the federal Bureau of Labor Statistics. Physically larger than Manhattan, Boston and San Francisco combined, just 700,000 people call it home, down 60 percent from 1950.
Public transportation is unreliable, and 26 percent of households lack a vehicle, compared with 9 percent nationally, according to the Ann Arbor, Michigan-based Transportation Research Institute. That makes for an immobile population, hard for medical workers to reach and with few resources of its own for visiting doctors. Overall life expectancy is the lowest of the top 25 most populous metropolitan areas.
Detroit’s crisis is a foot on the neck of women and children. Mothers’ obesity, diabetes, poverty-related stress and poor nutrition can harm infants even before they are born.
While the raw number of births declined with the population, children have grown more likely to be raised in female-headed households, in high-poverty neighborhoods and to rely on public assistance, according to a 2012 report from the Skillman Foundation, which seeks to improve the well-being of the city’s youth.
Health isn’t determined just by poverty, but by race, which plays a disproportionate role in Detroit. Blacks composed 84 percent of residents in 2010, according to the census.
Black babies in neighborhoods with the lowest poverty level are more likely to die than white infants in neighborhoods with the highest poverty, according to a state report last year. In 2010, non-whites made up 21 percent of Michigan’s population but 43 percent of infant deaths.
“Reducing these disparities requires an explicit focus on the role of race,” the report said.
The end of many Detroit pregnancies is intentional.
In 2012, Detroit women had 5,693 abortions out of 18,249 pregnancies, according to state statistics. The rate rose to 37.9 per 1,000 women that year, up from 27.5 in 2001.
Nationally, increased use of contraception pushed down the rate to its lowest -- 16.9 per 1,000 women in 2011 -- since the procedure was legalized in 1973, according to the New York-based Guttmacher Institute, a reproductive health researcher.
Abortion patients from Detroit said in interviews last week that they were unable to afford birth control.
“I can make ends meet, but have no room to save,” said Cook, who was 12 weeks and four days pregnant.
Her father and two friends helped pay the $275 she owed for the procedure at the Scotsdale Women’s Center on the northwest side, she said, and her sister drove her there.
Cook didn’t graduate from high school, she said, and now travels 90 minutes each way by bus to work at an auto-wire company, earning $9 an hour, about $280 a week after taxes.
She’s the sole provider for her 2-year-old daughter, whose father -- also the would-be father this time -- is jobless. She said she wants to return to school to become a therapist or social worker.
Many women don’t learn about family planning, or are encouraged by peers or relatives to have babies when young or unmarried, said Danita Jackson, a social worker at Cody High School. She recalled a tearful talk with a 15-year-old who bore a second child 10 months after her first.
“A baby having a baby,” she said. “A lot of these young ladies have absent parents or parents that are not really parenting them, giving them guidance.”
Almost half of Detroit women who move forward with pregnancy don’t receive adequate prenatal care, according to the Skillman report. That can lead to premature birth, the leading cause of infant mortality, whose rate hit 15 deaths per 1,000 live births in 2012, state data show. That’s the highest of any U.S. city and more than double the national average.
It also compares unfavorably to Mexico’s 14 deaths per 1,000 live births, China’s 12 and Thailand’s 11, according to the World Bank.
Work began on the Make Your Date campaign, which Hassan called an unprecedented cooperation, before Duggan took office. The goal is to screen all pregnant women for short cervixes, a risk factor for preterm birth. The condition is particularly common in Detroit for unknown reasons, and can be treated with the hormone progesterone, Hassan said.
All women regardless of financial or insurance status are eligible. Participants attend small-group classes, which have been shown to reduce preterm birth among black women by more than 40 percent, Hassan said. The campaign will work with churches, schools and homeless shelters to get its message out to people not already receiving medical care.
Make Your Date joins a catalog of initiatives to give the guarantee of growing up to more children. Governor Rick Snyder, a Republican, has a statewide campaign to curb accidental crib suffocations. The Women-Inspired Neighborhood Network targets Detroit’s poorest areas to mentor pregnant women and educate doctors and nurses about racial disparities.
Paris Rutledge, a social worker reared on Detroit’s east side, is in her 25th year of visiting new and soon-to-be mothers as part of the Infant Mortality Program at St. John Providence Health System, which is participating in Make Your Date. It’s her job to enroll women in parenting classes, test whether their babies are developing on track and connect them with aid if their utilities are about to be shut off.
A recent afternoon found Rutledge near where she grew up, where Sherita Mason, 29, was temporarily living at a friend’s house with her three daughters, including 7-month-old Catalina.
The older two children watched cartoons in the next room as Rutledge peppered Mason with questions: “Does your baby make high-pitched squeals? Does your baby make deep-tone sounds?”
Yes and yes, said Mason. Good news.
Catalina sat on the glass table in front of her mother, her curly hair pulled tight into pigtails, gnawing on a piece of paper, paying the adults no mind.
To contact the editors responsible for this story: Stephen Merelman at firstname.lastname@example.org Mark Schoifet