Mayor Marian Barry said yesterday that his two-year-old, comprehensive plan to lower infant mortality in the District of Columbia had been stalled by "bureaucratic inertia" and they city's continuing financial crunch.
Nine days after he became mayor on Jan. 2, 1979, Barry declared infant mortality the city's "Number One health problem" and appointed a blue ribbon panel to study it. The panel, along with the Department of Human Services, subsequently recommended a 49-point program to lower the city's infant mortality rate, one of the highest in the nation.
Nevertheless, on Tuesday, city officials conceded that the rate for infant deaths rose 10 percent between 1979 and 1980, and they disclosed that only eight of the recommended programs were in operation. Twenty-five were supposed to be in place by this month.
James A. Buford, director of the D.C. Department of Human Services, cited several examples yesterday of those progrmas whose implementation has been stalled by the city's bureaucratic and fiscal problems:
The District has yet ot find $75,000 to purchase a mobile nursing clinic to provide medical care for women in distant neighborhoods and those who do not regularly use centrally located facilities.
Prenatal clinics around the city are still waiting for the delivery of patient passbooks designed to provide a readily available medical history of every woman treated. Researchers had found that one of the factors contributing to infant deaths was the fact that complete records were stored in neighborhood clinics and were not on hand at the hospital when the child was delivered.
The city was supposed to increase the number of home visits by public health nurses, but it has no money to hire them. Three such additional nurses would cost $90,000.
Arlene Fregulia, a DHS employe in charge of monitoring implementation of the 49-point program, said city officials were also told more than a year ago that Metro farecards would be better incentives than free bus tokens to encourage women to return for follow-up appointments at city clinics. No one has adopted that suggestion, she said, and bus tokens are still given out.
"Some recommendations were not implemented because the staff was dragging their feet," Buford said.These included a public education project hampered by staff vacancies, adoption of city-wide standards for hospital units that specialize in treatment for very ill babies born prematurely and a supplemental food program for infants and nursing mothers, he said.
"The action plan is not on target as it should be," Barry told reporters yesterday at his regularly scheduled monthly press conference. He said there are adequate for facilities for "each and every pregnant mother in the city," but city health workers have been unable to get women to use those facilities.
Barry announced yesterday that he was establishing another panel, this one composed of 23 persons, to follow up on the work of the initial blue ribbon committee. The mayor said that the new group, to be headed by Dr. Arthur Hoyte of Georgetown University Medical Center, would help implement the 49 recommendations.
Hoyte is a former special assistant to the mayor for health affairs and was a member of the blue ribbon committee. City officials said the new board will prepare a final plan of action, set priorities and coordinate activities between the public and private sectors.
Dr. Frederick C. Green, associate director of Children's Hospital and chairman of the initial committee, said many workers in the Department of Human Services did not place the same emphasis on the infant mortality problems as did the mayor.
Dr. Leroy A. Jackson, an obstetrician in Southeast Washington and a member of the new advisory group, said many of the women for whom the program is intended are not motivated to use the available services.Jackson said he could not explain that apparent lack of motivation.
In 1980, there were 24.6 deaths for every 1,000 live births in Washington compared to 22.2 in 1979 and 25.8 in 1978. In 1979, there were 9,403 children born in Washington, 207 of whom died in the first year of life. Last Ear, 9,257 were born and 228 died.
Although statistics show that the rate at which newborns die in Washington has generally declined over the past decade, it continues to be one of the highest in the country. City health officials say major contributing factors to the problem include:
Pregnant women not getting early or adequate prenatal care, and therefore are more likely to have babies who suffer the effects of poor nutrition, drug abuse, untreated infections and undetected complications.
The high percentage here of pregnancies among teen-aged girls, who often have poor health habits and whose bodies may not be mature enough to support a healthy fetus. Last year's statistics suggest that the number of teen-agers' pregnancies here has decreased somewhat.
The lack of a fully implemented plan for transporting seriously ill infants to intensive-care units.
No effective system for follow-up care for high-risk babies to make sure they receive adequate nutrition and medical care during the first year of life. t