Successful Maternal-Child Outreach in Harlem Offers Lessons for Alabama

By Christina Crowe

Mario Drummonds entered the world of infant and maternal care as a businessman looking for a career change. He brought nearly 20 years of corporate experience to the nonprofit Northern Manhattan Perinatal Partnership (NMPP) in the early 1990s, answering the group's call for a CEO in a desire to serve a very familiar neighborhood.

Mario Drummonds"I was born in Harlem in the old Harlem Hospital," says Drummonds, who visited UAB in February to deliver the 2013 Ann Dial McMillan Endowed Lecture in Family and Child Health at the School of Public Health. "I was at a career interlude when I submitted my resume to the NMPP and didn't expect them to call me. I was very honest with the board of directors about my lack of knowledge about maternal health. I made the argument that they didn't need another doctor or nurse, but someone to take the agency to the next level of development."

Since that initial interview nearly 20 years ago, Drummonds has taken the NMPP from an annual $800,000 budget to one 10 times that size, and delivered impressive results. The partnership took a single Zip Code—a four-block area of central Harlem—and coordinated pre- and perinatal services for the women and babies living there. In 1990, central Harlem's infant mortality rate was 27.7 deaths per 1,000 live births. Fifteen years later, that number had plummeted to 7.4 deaths per 1,000 live births.

Organize and Mobilize

The main tactic the NMPP has employed under Drummonds is to organize and mobilize existing services, bringing in outside agencies to fill any gaps, he says. There are multiple state and federal in-home visiting programs, and they "don't communicate with each other on a neighborhood or regional level," Drummonds says. "You have representatives from Healthy Families, Healthy Start, and Head Start, all possibly talking to the same moms. That is a waste of a lot of human capital when you don't coordinate. That would never happen in our four-block zone. We deploy people so there won't be an overlap."

One of NMPP's recent campaigns aims to address the mental health needs of pregnant women and new mothers. The partnership's Harlem Maternal Mental Health Training Institute, funded by a grant from the New York City Department of Health, has trained approximately 500 clinicians, psychologists, psychiatrists, and social workers "to understand the epidemiology behind maternal depression," Drummonds says. "They were used to dealing with regular depression, not perinatal depression."

Specialist clinicians at area medical schools provided the training, teaching "obstetricians, midwives, and pediatricians to ask mothers how they are doing—not just how the baby is doing—after birth," Drummonds says. The institute then hired several of those clinicians to go out to community-based organizations and treat moms before, during, or after birth.

"We're striving to put the 'mother' back in maternal child health," Drummonds explains. "We're asking, 'When are you going back to school? Are you building a meaningful relationship? How can you extend the interpregnancy interval—which should be 18 months or more—and how can we manage hypertension, diabetes, obesity?'"

Room for Improvement

While the lecture was Drummonds's first visit to Alabama, he sees parallels between health care gaps in the state and in the heart of Harlem. Max Michael, M.D., dean of the UAB School of Public Health, agrees—and that's part of the reason he invited Drummonds to present the lecture.

"For a section of Harlem to have a strategy that in 10 to 12 years reduced infant mortality rates below the mortality rates of white infants in Alabama is remarkable," Michael says. "But it's one thing to reduce infant mortality in an urban housing community and another to do something comparable in Alabama. So much of the effort here has been getting people into prenatal visits. What they did in Harlem was way beyond that, starting care in the first trimester, rather than the second or third. It also went beyond the medical aspect—they're doing things like kicking smokers out of the house or kicking out boyfriends who use drugs, for example."

Some help for addressing this issue in Alabama is on the way: In March 2013, the Centers for Medicare and Medicaid Services announced that UAB's Department of Obstetrics and Gynecology, along with 26 other organizations across the country, will begin participating in its Strong Start for Mothers and Newborns initiative. UAB will receive $730,000 over the next four years to find new ways to prevent significant, long-term health problems for high-risk pregnant women and newborns enrolled in Medicaid or the Children's Health Insurance Program. Learn more in this article.

Call to Action

In his McMillan lecture, Drummonds emphasized the need for strong leadership to advocate for women and children. Leaders in the community, academia, and business "need to converge and create a sense of urgency," Drummonds said. "They must create a new mood in town that says, 'This is unacceptable—here are some of the things we're going to do from a policy and program perspective to turn the tide,' and then hold themselves accountable to find results."

After a day of meeting with UAB faculty, clinicians, and others, Drummonds said that attitude seems to be present in Birmingham: "The dial has been turned up around the need to do something different about both disparities and infant mortality in the state of Alabama."