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The rural Alabama pregnancy and infant health program.


 Infant mortality in the state of Alabama is among the highest in the nation and its breakdown among subgroups shows that the rate for nonwhite infants is more than 60% higher than for white infants. In an attempt to improve perinatal outcomes, the Rural Alabama Pregnancy and Infant Health (RAPIH) Program was founded in 1983 to reach out to high-risk, black childbearing women in 3 of Alabama's poorest counties: Greene, Hale and Sumter. The RAPIH Program is part of the larger Child Survival/Fair Start initiative funded by the Ford Foundation and is administered by the federally funded West Alabama Health Services, Inc. (WAHS). About 70% of the population in the service area is black, of whom more than 50% live below the poverty level. The Program is a home-visit program that relies on lay community workers to provide outreach, education, and social support to low-income families. A model visitation program begins at the 20th week of gestation and continues to the child's 2nd birthday. The home-visit services are provided by a group of black laywomen who are mothers recruited from the counties they serve. Prior to assuming their caseload, they participate in a 2 week training program sponsored by WAHS. Role-modeling activities provide active practice in establishing relationships with clients, presenting lessons, and dealing with problems. Prenatal and postnatal visits are conducted in the client's home; during each visit; the home visitor addresses a particular aspect of prenatal care or child health and development. Starting as a teacher, the home visitor eventually develops a partnership with the client in her understanding of and finding solutions for her problems including the use of community resources therefore. In an attempt to increase accessibility to both health and social services in the area, WAHS has purchased several vans to provide transportation to eligible residents. Records indicate that the home-visit group received an average of 5.3 home visits during the prenatal period and an additional 10.4 visits during the child's 1st year of life. As the program gets older, visit frequencies are expected to increase.
