Poverty's Legacy - Fragile Families, Vulnerable Babies

In the ancient city of London, on a certain autumn day in the second quarter of the 16th century, a boy was born to a poor family of the name of Canty, who did not want him. On the same day another English child was born to a rich family of the name of Tudor, who did want him.... There was no talk in all of England but of the new baby, Edward Tudor, Prince of Wales, who lay lapped in silks and satins ... But there was no talk about the other baby, Tom Canty, lapped in his poor rags, except among the family of paupers whom he had just come to trouble with his presence. From ``The Prince and the Pauper,'' by Mark Twain

IN one corner of the neonatal intensive care unit at Broward General Hospital, a tiny 13-day-old baby sleeps in an incubator that gently rises and falls, reminding him to breathe. Born three months prematurely to a cocaine-addicted mother who received no prenatal care, he weighed just 1 lb., 14 ounces at birth.

Doctors say he is probably blind and suffers from seizures, among other grave complications. He will spend between six and nine months in this ward, at a cost of $1,000 to $1,500 a day.

After that, the infant faces an uncertain future. ``Nobody wants him,'' explains Dr. Brian Udell, director of the unit.

In another corner of the 63-bed ward, doctors are preparing a four-week-old boy for surgery. He is the fourth cocaine baby his mother has delivered in this hospital and the only one to live.

Not far away, a nurse is dressing another infant, a four-pound boy born three weeks ago, who is being discharged today. His mother, who is 15, also has a 10-month-old baby at home.

``He's going to be another toy for her to play with,'' the nurse says sadly. ``It's pointless to try to teach her about parenting. She's not going to do it when she gets home. Her mother will.''

Day after day, in high-tech neonatal intensive care units across the country, heart-rending dramas like these are being played out involving the nation's youngest, most vulnerable citizens. These are babies born on the most unlevel of playing fields. Call them ``welfare babies,'' ``crack babies,'' ``at-risk babies,'' or ``deficit babies'' - by whatever term, they constitute a new ``bio-underclass'' of infants who are disadvantaged almost from the moment of conception.

Like the 16th-century England Mark Twain portrays in ``The Prince and the Pauper,'' late-20th-century America represents a land of stark contrast for babies. At one extreme are the babies of affluence - newborn ``princes'' and ``princesses.'' Planned for and wanted, they are monitored in the womb by sophisticated medical technology, then pampered after birth with $800 imported cribs, $300 strollers, infant gyms, and designer baby clothes.

At the other extreme are the babies of poverty - under-cared-for, often unwanted ``paupers'' who may be born too early and too small. So desperate is their plight that the '80s phrase, the ``feminization of poverty,'' is now joined by another closely related term, the ``infantization of poverty.''

One-fifth of all American children, and 45 percent of black children, live in homes below the federal poverty level, which currently stands at $9,435 for a family of three. Another sobering statistic: An estimated 375,000 babies have been born to substance-abusing mothers in 1989.

In addition, 470,000 of the 4 million babies born this year are the children of teenage mothers, most of them without husbands, job skills, or perhaps even a home. Last year United States taxpayers paid nearly $20 billion to support families begun with a birth to a teenager.

One of those dependent young mothers, 18-year-old Tina, typifies the problems many children having children face. Early in her pregnancy, she dropped out of school and moved from Indiana to Fort Lauderdale with her boyfriend, Steve. When she went into labor she simply showed up at the emergency room of Broward General Medical Center, which accepts indigent patients, and said, ``I'm here. Help me.''

Her daughter, Autumn, was born full-term and healthy. But within weeks Tina and Steve found themselves moving out of a relative's home and knocking on another door for help, this time at Fort Lauderdale's Covenant House, a 104-bed shelter for homeless teenagers.

``I didn't expect to become a parent as soon as we did,'' admits Tina (Covenant House policy prohibits the use of last names). ``After it happens you think about birth control. But we didn't once think about abortion or adoption.''

Steve, a slightly built 18-year-old with a blond mustache, has been working on a construction crew for seven months, trying to save for an apartment. But with rents in Fort Lauderdale averaging $500 a month, the couple will need nearly $2,000 for first and last months' rent, security deposit, and electric utility deposit.

``It might as well be a million,'' says Paula Tibbetts, a Covenant House staff member.

``We just want to live, like, happily ever after, basically,'' says Steve as he nuzzles two-month-old Autumn in the Covenant House cafeteria. ``Just your typical family - that's all we want to be.''

``Happily ever after'' - the old-fashioned phrase used to describe the romantic dream of marriage and family - sounds ironic on the lips of today's ever-younger underclass parents for whom the birth of a baby is too often a random event preceded by little preparation.

A quarter of all pregnant women in the US receive little or no prenatal care - one factor that causes the US to trail 18 nations in its infant mortality rate. Some lack motivation to seek care. Others face daunting obstacles.

``I had to take four buses just to get to the clinic,'' says Shannon, an 18-year-old mother at Covenant House. ``If the buses were late and I missed my appointment, I had to come back another day.''

According to Dr. Michael Katz, chief of perinatal services at Children's Hospital in San Francisco, the consequences of foregoing care are so serious that he suggests paying low-income women to come for prenatal care.

``I want to pay them $40 or $50 a visit,'' he says. ``If a woman doesn't come in, she will cost us thousands.''

But medical technology is not the solution to a social problem, as doctors are the first to admit. Sophisticated prenatal monitoring cannot eliminate the so-called ``diseases of lifestyle'' - drugs, sexually transmitted diseases, fetal alcohol syndrome, child abuse - that are often rooted in poverty and are profoundly altering the structure of young families.

Many cocaine babies go home to what Dr. Udell calls ``bizarre'' family situations. ``When the mother is stoned on cocaine and the baby cries, he doesn't get consoled, and he may get beaten,'' Udell says. ``When mothers are craving the drug they have very low impulse control. You have a very abnormal little person developing.''

Even if the problem is simple poverty, as it was with Mark Twain's pauper, it is no longer so simple. Every Tuesday and Wednesday, a waiting room at Boston City Hospital in Massachusetts fills with malnourished infants and young children whose parents have brought them to a state-funded ``failure to thrive'' clinic. Seventy percent of these babies were born at normal birthweight but became malnourished after birth.

``In most cases people have a fairly intelligent notion of how to feed a child, but they can't afford to do it,'' explains Deborah Frank, director of the program, noting that poor parents often face ``heat-or-eat'' choices in cold weather. Some desperate mothers may overdilute infant formula or buy nondairy creamer.

In an affluent society the failure to feed infants adequately takes on a shameful symbolism - the ultimate shared disgrace. The ultimate hope lies in what Dr. Walter Lambert, director of the child protection team at the University of Miami, calls ``the miracle of love'' - the conviction that ``any child who is loved will do well even if there are problems.''

But love requires commitments. Describing the needs of poor families in terms of ``four H's - health and housing, hunger and Head Start,'' Dr. Frank recognizes some signs of progress, including increases in some states in Medicaid coverage for prenatal care, and ``a little more federal money in WIC [the supplemental nutrition program for women, infants, and children], but nowhere near enough.'' She remains impatient with an attitude of ``playing poor'' on the part of politicians and others who say, ``This is all very worthy, but we have no money.''

Child advocates argue that the care and nurturing of the next generation is a truer test of the quality of a civilization than its military superiority or its competitiveness in the world market.

Will the '90s pass this test - a test of self-interest as well as compassion?

``Until people are willing to invest in children the way they are willing to invest in bombers, I'm not very optimistic,'' Frank says, summing up. ``The real security of this country is more threatened by the destruction of its children than it is by any external threat.''