Chicago is learning lessons in preventing infant mortality from Cuba

CHICAGO – Over the past few months, medical professionals on Chicago's South Side have been trying a new tactic to bring down the area's infant mortality rate. They're finding women of childbearing age and asking them about everything. Really, everything.

"In the last 12 months, have you had any problems with any bug infestations, rodents or mold?" Dr. Kathy Tossas-Milligan, an epidemiologist, asked Yolanda Flowers during a recent visit to her home in Chicago's Englewood neighborhood. "Have you ever had teeth removed or crowned?"

Though they seem to have little to do with motherhood, these questions are borrowed from the playbook of the Chicagoans' new mentors — doctors from the Cuban Ministry of Public Health. As Tossas-Milligan administered her survey, two Cuban doctors sat nearby, observing.

Cuba, a poor country, may seem an unlikely role model for American health care. But its infant mortality rate, at 4.3 per 1,000, is lower than the United States' 5.7 per 1,000. And Cuba's rate is much better than the infant mortality rates in some of the poorest parts of the U.S. In the Englewood neighborhood, 14.5 babies per 1,000 do not reach their 1st birthday. That's a rate comparable to war-torn Syria.

"Cuba is not a rich country," said Dr. Jose Armando Arronte Villamarin, one of the Cubans. "[So] we have to develop the human resources at the primary health care level."

Now University of Illinois, Chicago health workers are bringing Cuban-style surveys and home visits to Englewood.

"Sometimes the answers are in the most unexpected places," Tossas-Milligan said.

In exchange for a $50 stipend, the women answered dozens of questions ranging from the state of their home to their emotional well-being.

The project is funded by a $1 million grant from the W.K. Kellogg Foundation.

In Chicago, researchers plan to use the data they gather to classify women into four risk groups. Those deemed at higher risk will be recommended for additional home visits. The idea, Tossas-Milligan said, is to address these women's medical issues at an early stage and at home.

One question the team has been asking women is when they last saw a dentist. Gum disease, while unlikely to come up during an expectant mother's hospital visit, has been linked to premature birth.

Flowers said that she hadn't been to a dentist "since 1999 or 2000." At 47, Flowers has had a difficult history: three miscarriages and one premature birth. Her baby did not survive.

Experts who have studied the Cuban health system say that is an idea worth exploring, but it would require much more than just home visits.

"When a doctor or team [in Cuba] finds there are problems in the home … and they think it has any bearing on her pregnancy, she gets help," said Dr. Mary Anne Mercer, a senior lecturer emeritus at the University of Washington.

Mercer noted that Cuba, despite being poor, guarantees resources for at-risk women. By contrast, the Chicago effort may identify women who need food or different housing, but they would have to find a way to fill those needs on their own.

"Thinking about a very poor, low-income, disadvantaged setting in the U.S., I don't think we've got those resources," Mercer said. "So it's nice to say, 'Yeah, we could do it, if we were willing to expend those resources,' but I am not convinced we could."