People don't usually think of Memphis when they hear the term "third world."
Most probably think of far away places where children are starving and people drink from the same river they bathe in.
But most people probably don't know that in 2002, when the statistics were last made available, 31 babies out of 1,000 didn't see their first birthday in the 38108 ZIP code alone.
An infant mortality rate like that competes with countries such as Syria, Nicaragua and Vietnam.
More than 200 babies died within their first year here in 2002, ranking Memphis No. 1 out of the country's 60 largest cities for infant mortality.
Out past Wolf Chase Galleria lies the Shelby County Cemetery - an area no bigger than three football fields wedged between two newly constructed neighborhoods on Ellis Road, full of homes that sell for no less than $200,000. This is where many babies from poor families who can't afford a private grave site are laid to rest.
The fields are mostly grass, except where recent graves have been dug. The grass hasn't grown back in those places yet, so the ground is just red clay.
And unlike the private cemetery across the street, where engraved headstones mark final resting places, only numbers on shiny metal disks pinned to the ground by stakes mark the graves at the Shelby County Cemetery. The disks are so close together, it's hard to tell exactly which marker the bouquets, toys or framed letters from parents are for.
Most of the babies buried at the public cemetery come from poor black neighborhoods because, in this city, black babies die almost three times as often as white babies.
The numbers are a testament to the health disparities of Memphis.
Although there are many sources of infant mortality, preterm delivery and Sudden Infant Death Syndrome (SIDS) are two of the leading causes of infant deaths.
But these causes can often be averted if mothers simply know how to properly care for their babies before birth, as well as after.
When it was made known in 1992 that babies should be laid on their backs while sleeping, instances of SIDS dropped by half, according to Marian Willinger, SIDS researcher for the National Institute of Child Health and Human Development.
"But that still means there are over 2,000 (SIDS related) deaths a year," she said. "And the rate is still twice as high for blacks as it is for whites."
In order to improve infant mortality, Willinger said the number of preterm deliveries must be reduced.
Michael Caudle, vice chancellor of Health System Affairs at the University of Tennessee, agrees and said the best way to do that is to increase prenatal care.
"The lack of prenatal care is directly associated with infant mortality," he said.
But many poor women don't understand the importance of seeing a doctor regularly throughout a pregnancy, according to Linda Moses, a doctor at the Shelby County Health Loop Hollywood Clinic.
A doctor might not explain what is happening during a prenatal exam, which could lead the mother to think the doctor wasn't doing anything, she said.
Or a mother might not have health insurance. Or she can't get off from work. Or her car might break down.
"There's not just one big reason why some women don't get prenatal care," Moses said. "If they see an obstacle in getting to the doctor, they can get frustrated."
A crucial part of trying to alleviate the city's high infant mortality rate is improving access to prenatal care, Caudle said.
And having recently taken steps to increase awareness of the prenatal care problem, the state seems to agree.
Gov. Phil Bredesen announced in October that the University of Tennessee Center for Health Services in Memphis would be receiving a grant of $580,766 from the state, which will go towards hiring and training a nurse practitioner and making medical equipment upgrades at three Shelby County Health Loop clinics.
The goal is to improve not only the access to prenatal care, but also the care itself, he said.
"We are very enthusiastic to start making an impact," he said. "It's time to take some action."
The grant comes from a $1.44 million pot that was appropriated by the state legislature.
Part of the $1.44 million will also be used to establish infant mortality coordinators in Memphis, Nashville and Chattanooga.
A separate $5 million was allocated by the governor for a women's initiative to help promote preconceptual health, while infant mortality initiative funds will help create a Community Voices Program and a Fetal Infant Mortality Review (FIMR) team, according to Nancy Lawhead, Wharton's health policy advisor.
The Community Voices program will help fund faith and non-faith based groups that help increase awareness of health education and access in higher need areas, such as North Memphis.
"We need to use people in communities that are already known and trusted by women to help get messages out long before they get pregnant," Lawhead said. "We are talking to churches and youth organizations now to see about their interest."
But the creation of a Tennessee FIMR is the most significant part of the infant mortality initiative, she said.
Modeled after FIMR in Delaware, the program combines data gathering, case reviews and community action to affect changes in community systems.
A death review committee collects data on statewide infant mortality, while a case review team interacts with the family to find out what happened to the child. Then a community advocacy team combines the information.
Still, lack of health awareness and access to health care is not the only cause of infant death - abandonment is another.
In an effort to give mothers of unwanted babies a safe place to leave their children, the Safe Haven Law was passed in July of 2001. The law was aimed at preventing mothers of unwanted children from dumping them in garbage bins and other places where the babies would die or become ill.
The law allows mothers to drop off unwanted children at any medical or emergency facility, such as a fire station, with no questions asked, as long as the child is unharmed and has been born in the last 72 hours.
But getting the word out about the program was necessary, said Shelby County Sheriff Mark Luttrell.
"We are trying to educate the public," he said. "We can make a difference in situations like this, but we have to inform not only the public, but doctors and nurses, so they can inform patients who might be having unwanted babies."
