That the CHILDREN MAY LIVE. The death of children from disease, dehydration, malnutrition, and other causes is a worldwide problem. But in the US (below) and Africa (right), new programs are beginning to make a difference.
Dallas
DEATTRIA MOSELY stands next to the white bassinet in her family's sparsely furnished living room, cradling her three-month-old son, Lemuel. Waking from a nap, Lemuel yawns, gurgles, then coos, drawing a smile from his mother. Just 18 months earlier, Ms. Mosely - a teen-age high-school dropout, had delivered a baby girl who lived only five hours. It was a personal tragedy for Deattria, and one that involved her in what United States health experts and children's advocates consider a national scandal: the high, and in some states increasing, rate of infant mortality.
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According to UNICEF, in 1986 (the most recent year for which data are available) the US tied for 17th place in a ranking of countries based on infant-mortality rates - behind Japan, nearly all European countries, and Singapore - with 10 deaths per 1,000 live births.
In a similar 1985 ranking, the US white population fared slightly better, ranking 14th, but the US black population ranked 28th - with 19 deaths per 1,000 - behind Cuba, Bulgaria, and Costa Rica.
Health care experts say poverty, ignorance about prenatal care, and a dearth of maternal- and infant-health services all contribute to a US infant-mortality rate that is higher than those of most industrialized countries.
More broadly, many experts say the nation's attitude toward children - whether reflected in cutbacks this decade in funding for maternal- and infant-health services, or in expectant mothers' willingness to mix pregnancy and dangerous-substance abuse - is also an important factor.
``Children are just not a priority in this country,'' says Dana Hughes, a child-health specialist with the Children's Defense Fund in Washington. ``With an American culture that says families ought to do for themselves, there has never been a strong policy emphasizing children's needs.''
A recent Columbia University study of 75 countries showed that all but two - the US and South Africa - had a general structure of government policies setting standards for such matters as maternal leave and designed to support families with children.
Federal funding for maternal- and child-health programs and community health centers was cut at the outset of the Reagan administration. Although appropriations have ``crept back up'' in the past year or two, according to Hughes, ``it's hardly been enough to keep up with inflation.''
California, for example, has experienced a rise in premature and underweight babies. Both health experts and many local officials blame the problem on a decline in availability of prenatal care.
In Dallas, which in a recent ranking had the fifth-highest rate among US cities for black infant mortality and seventh-highest for all infants, officials point to a reduction in the number of clinics offering maternal care in the city's poor neighborhoods.
Compounding the effect of inaccessible services is the high incidence of teen-age pregnancies in these same neighborhoods. ``As long as we've got babies having babies, we're going to have lots of problems,'' says Paul Boumbulian, vice-president for strategic planning at Parkland Memorial Hospital in Dallas.
Although older adolescent girls are generally just as able physically as adult women to bear healthy children, other factors common among them - poor diets, lack of maturity, a desire to deny the pregnancy - can lead to complications at birth.
``Access to services and the ability to pay ... are real barriers to providing important preventive care,'' says Betsy Attel, vice-president of maternal and child health at Parkland, Dallas County's huge public hospital. Dr. Attel notes that 16 percent of the nearly 15,000 women who delivered at Parkland last year had no prenatal care whatever.
Nearly 10 percent of Parkland's newborns required admission to the hospital's special-care nursery, for stays that cost the county $4,000 on average.
Yet Attel says that, with studies showing $3 in savings for every $1 spent on preventive maternal care, state and county officials in Texas are beginning to put money into programs designed to reduce infant mortality. One such program, begun three years ago as part of the state's landmark indigent health-care program, is already reaching thousands of expectant mothers annually - including Deattria Mosely.
