MARIA HINOJOSA: Up next, Rochester, New York, a city battling infant mortality.

SHERI HARRISON: It's horrible here in Rochester.

I'm not even going to sit here and lie to you.

HINOJOSA: With black and Latino families affected the most.

I put her to sleep and she never woke back up.

The hardest part of it was to hold him in my arms while he was taking his last breaths.

HINOJOSA: Why are so many babies of color dying before their first birthday?

Babies dying is real.

It doesn't get more real than that.

This is the New America: black, brown, Asian, LGBT, immigrants.

The country is going through a major demographic shift and the numbers show it.

The face of the U.S. has changed.

CHRISTINA IBANEZ: We're American.

We care about the same things, but yet, we also want to preserve our culture.

I just see it destroying what we had planned to happen here.

HINOJOSA: By 2043, we will be a majority non-white nation.

NORM GISSEL: We are making as we speak a new America.

And it's a marvelous moment in American history.

Everybody's voice is important to this debate.

HINOJOSA: America by the Numbers.

I'm Maria Hinojosa.

This program was made possible in part by: The Corporation for Public Broadcasting, and by contributions to your PBS station from: Behind every number, there's a story.

And today's numbers tell a dramatic one.

African-American babies are more than twice as likely to die before their first birthday as white babies.

Native Americans and Puerto Ricans also have significantly higher rates of infant mortality.

What's behind this racial disparity?

To find out, I traveled to Rochester, New York, which has one of the highest infant mortality rates in the country.

The city where Frederick Douglass fought to abolish slavery and Susan B. Anthony battled for women's rights still struggles with striking inequalities.

The largely white suburbs are home to those who work in Rochester's cutting-edge hospitals and businesses.

But the city itself, over 50% African American and Latino, is one of the poorest in the entire country.

In certain parts of the inner city, the poverty rate is as high as 70%.

This area is home to 27% of the city's residents, but 80% of the city's homicides.

There be, like, so much shooting and stuff.

I don't like it.

Shooting right around these corners?

Mm-hmm, mm-hmm.

They shoot every day.

Somebody just got shot the other day up the street, around the corner.

HINOJOSA: Sasha Fontanez is Puerto Rican.

She grew up here, one of nine children.

She didn't finish high school and at 18 had her first baby, Whallie, now a healthy two-year old.

Sasha's second daughter, Annie, was born the following year.

She was healthy, but Sasha had a hard time getting her to sleep.

And the only way she'll stay asleep was if I put her on her stomach.

If I lay her flat on her back, she wouldn't stay asleep.

She'll just be crying and crying.

And as soon as I flipped her over, she'll stop crying.

HINOJOSA: Then one night, tragedy struck.

I put her to sleep and she never woke back up.

How old was she?

Three months-- five days before she turned four months.

Tell me what happened.

She woke up crying, like, around 12:00-something.

So I took her back out the crib and I put her next to me.

And I was breastfeeding her.

Like, I laid her on the bed and I would just breastfeed her.

HINOJOSA: The next thing Sasha remembers is being awakened by the sound of her older daughter crying in the next room.

She told her boyfriend to get Whallie.

Then she reached for baby Annie who was lying next to her face down.

And when I touched her leg it felt hard, so I thought it was...

I was just...

I thought I was just, like, dreaming or something, because I just finished waking up.

But I wasn't.

When I flipped her over, she had, like, grey patches in her face and stuff.

And I tried to give her CPR but it wouldn't work.

And then I called 9-1-1, and they took forever to get there.

And then they told me that she was dead.

I already knew that, though, because she wasn't breathing.

Duh, that's what I kept telling them.

The police were in my house, like, taking pictures and all this stuff.

Then they tried to say I suffocated her, I laid on her and all this other stuff.

HINOJOSA: The cause of Annie's death was SIDS-- Sudden Infant Death Syndrome-- a catch-all for deaths that remain unexplained after an investigation.

For the 24,000 babies who die each year in the U.S. before reaching their first birthday, SIDS is the third leading cause, behind birth defects and preterm birth.

FONTANEZ: That's Annie Bannie's name.

I got the day she was born and the day she passed.

I got a picture of her here that's when she was, like, probably, like, three weeks.

HINOJOSA: Yeah.

Ay, dios mio.

That's my peanut, that's her up there.

HINOJOSA: That's her?

FONTANEZ: Yeah, all these pictures is her.

HINOJOSA: Baby Annie had several risk factors for SIDS.

Sasha was under 20 when she had her and occasionally smoked cigarettes.

Annie slept on her stomach and sometimes slept in her parents' bed.

But SIDS is by definition unexplained, so the actual cause of Annie's death remains uncertain.

FONTANEZ: That's, like, a week or so before she passed.

They told me there was nothing wrong with her.

She just passed away in her sleep.

HINOJOSA: To look more deeply into the death of Annie and the tens of thousands of babies who die in the U.S. each year, I visited Dr. Jeff Kaczorowski, a pediatrician at the University of Rochester Medical Center, known as Dr. K. For his first seven years here, Dr. K. worked in the emergency room, treating sick and injured children, many of them from Sasha's neighborhood.

He shared with me some of his darkest moments in the ER.

DR. K.: I remember an evening working the night shift a young child maybe about a month and a half old who had been an ex-premature baby came into the hospital by ambulance.

We did everything we could to try and resuscitate the baby and he died.

And the memories I have of the emergency department are many, but some of the most vivid memories are about babies dying.

HINOJOSA: Experiences like this inspired Dr. K. to shift his focus from the ER to the surrounding neighborhoods.

He founded The Children's Agenda, an advocacy group for at-risk kids, and now works on reducing the impact of poverty on infant mortality.

We're now in the southwest neighborhoods.

You see lots of boarded-up houses, lots of kids out on the street, nowhere to play.

Climbing on a porch with a boarded-up house.

HINOJOSA: In parts of this city, over 50% of adults haven't graduated high school.

Unemployment is over 40% and the crime rate is nearly three times the national average.

People think about health as, you go to the doctor's office and you get it.

That's not the case.

Health is more than medical care, it's much more than medical care.

It's about the community that we live in, it's about the opportunities that people have.

HINOJOSA: Young mothers here are under tremendous stress to keep their children safe and provide shelter and food.

90% of Rochester's children are poor enough to qualify for free school lunches.

Dr. K.: What country do we live in?

The wealthiest country in the history of the world and we have 90% of kids in Rochester who have to struggle to get enough food to eat?

HINOJOSA: Dr. K. believes that these cumulative stresses on mothers and their children are a major factor in infant mortality.

Even though the U.S. spends more on health care than any other country-- over $3 trillion a year-- we rank 56th in the world when it comes to infant mortality.

And if Rochester were a country, it would be even further down the list, in 95th place.

The numbers have not gotten better in Rochester in a decade.

Twice as many babies get lost in the City of Rochester, some years three times as many babies in the City of Rochester than in the outside community, and it's because of this environment.

This is real.

I mean, babies dying is real.

It doesn't get more real than that.

CEMRE KORMAN: Last week we talked about stress, how we cope with our stress, what are some of the healthy ways we use, what are some not so healthy ways.

HINOJOSA: In counseling sessions with pregnant women here, the stress level is high.

HINOJOSA: What do you worry about?

SHERI HARRISON: There's no jobs here.

There's no, like, community centers where, for kids... youth centers where they can be comfortable and go.

You have little gangs out here, kids carrying guns, so it's... it's a lot.

I'm going through a lot of stuff, like, it's just me, really, by myself.

My grandmother is the only real support, like, with my other son that I have.

I don't know if it just be me, just, all that just be compounding together sometimes, but majority of the time, it will wake me up out of my sleep and my heart will just be racing really fast.

SHERI HARRISON: In my neighborhood where I live at, it's just... it's horrible.

I turn on the news, breaking news, right the street next over, a girl... they are shooting out there.

Women are shooting at each other.

It's horrible here in Rochester.

I'm not even going to sit here and lie to you, it really is.

It's sad.

HINOJOSA: Experts have long connected infant mortality to poverty and the problems that go with it, including violence and poor nutrition.

But they're just beginning to understand that there could be a biological link.

Dr. Wanda Barfield heads the Division of Reproductive Health at the Centers for Disease Control in Atlanta.

BARFIELD: What we understand now in terms of the research is that there are circumstances labeled as toxic stress, where there is prolonged stress either due to an adverse home environment-- substance abuse, or violence by a caregiver-- other circumstances that are relentless.

And the stress response areas in a pregnant woman occur both in her own system as well as the baby, as well as the placenta, which also has an ability to respond to stress with cortisol.

HINOJOSA: In chronically stressed women, stress hormones continually circulate from the brain to the placenta and back to the brain in a feedback loop that amplifies the body's stress response and can trigger early labor.

Dr. K. believes that toxic stress goes a long way toward explaining the high rate of infant mortality in Rochester's inner city.

Define this term that you use, "toxic stress."

Because everybody in this country is stressed.

You're talking about a kind of stress that is toxic and that can lead to infant mortality.

That's right.

There is stress that gets overwhelming.

And beyond that, there is stress that becomes toxic.

When you feel like you don't have any help, when you feel like no one cares, when you feel like, no one is there for me.

Toxic stress can increase the risk of pre-term delivery, the main driver of the infant mortality rate in the United States.

All of these things that are associated with poverty, that are wrapped up together, sometimes those things result in babies dying.

Neuroscientists, cognitive scientists, pediatricians, researchers have looked at this issue and it is absolutely the case.

HINOJOSA: Laquitta Hall lives with her partner Eszabia Johnson.

In 2010, she was pregnant and under tremendous stress from a violent ex-boyfriend.

Her baby, Nathan, was born prematurely after only 23 weeks in the womb and weighed less than two pounds.

I never carried a baby that small before.

I don't know, he was a tiny, tiny baby.

Can you show me in your hands?

Like, if I hold him, he's from here to here.

I'm used to holding a baby in my arms like this, not like this.

Like, he was in my hand like this.

And... but, he was the beautifulest thing, though.

Beautifulest thing.

HINOJOSA: Pre-term birth is far more frequent among African-Americans than other groups and is the main reason for their higher rate of infant mortality.

He was fully developed except for his lungs.

So he needed help.

I think he had about three machines.

They all were at the max with air.

And he held on as long as he could.

HINOJOSA: Baby Nathan spent two weeks on life support in the neonatal intensive care unit.

HALL: I remember that morning he wasn't doing so well because his oxygen levels were getting low.

I just went in a they had him on the bed trying to resuscitate him.

And they took the breathing tube out to let me hold him.

And he's just staring me in my eyes.

And he just...

I can't do anything.

Just hold him and look at him.

I mean, the hardest part of it was to hold him in my arms while he was taking his last breaths.

HINOJOSA: As part of an effort to support grieving mothers like Laquitta, the University of Rochester Medical Center gives them memory boxes.

It has all of his little things.

This is his picture.

Oh, my goodness.

HALL: He looks big.

He looks big, but he was really tiny.

And I accept that we live and we die.

And he was just an angel that was called back.

HINOJOSA: Experts like Dr. K. and Dr. Barfield say that even full-term babies can be impaired by their mother's stress levels during pregnancy.

that even fullToxic stress babies cancan affect babies in the mother's womb and it can affect babies who are born, as well-- hurt their long-term outcomes, carrying that forward in terms of their health trajectory.

HINOJOSA: So I went back t Sasha Fontanez to find out more about what was going on in her life when she had Annie, the baby she lost to SIDS.

FONTANEZ: A lot of stress.

A lot of stress?

Yeah.

HINOJOSA: What kind of stress?

FONTANEZ: Like, not having a job, not being able to just get her whatever she needed at the time and place.

I was doing everything I had to.

was filling out applications, going on interviews and everything, and nobody would hire me.

Just because I didn't have a GED or high school diploma.

I would be without eating.

I would go down to my mama's house and eat, but then I'd make sure they'd have, like, their milk, their diapers, their wipes, and everything they needed before I even had to eat.

So, are you saying that there were some times... Where I didn't eat to feed myids, yes.

do nothing for my kids.

t Like, I was bringing kids in the world and I wasn't going to be able to take care of them.

Like, that was hard.

HINOJOSA: There's no scientific measurement yet for toxic stress, and we may never know what caused the death of baby Annie, but I was struck by how much Sasha's description matched the ones given by Dr. Barfield and Dr. K. It was just so much building up, and I used to get angry and used to sit down and cry for hours.

So, that was hard.

That's, like, blankets and pants and her onesies.

HINOJOSA: Sasha is still traumatized by the death of baby Annie.

I still got her blankets.

I got everything.

I didn't throw nothing away, I got everything.

FONTANEZ: I wanted to keep everything that was hers.

I kept everything.

FONTANEZ: The way the baby passed away, that, like, messed my head up.

Can you tell me about that?

Like, I rarely sleep.

I watch everybody, make sure everybody's breathing and stuff.

It's because I be scared.

I be watching them sleep and stuff, and I be feeling like I make myself, like, paranoid.

Like, what if I go to sleep and I wake up and my daughter's passed away, too?

HINOJOSA: Health care professionals here are focusing more and more on ways to reduce toxic stress in young mothers at risk.

Arms go up, deep inhale.

And then exhale, draw in.

HINOJOSA: This inner city medical practice offers counseling and yoga as part of their prenatal care.

Coming here just really separates you from whatever's going on at home, and we try our best to distress you from... De-stress.

De-stress?

De-stress, not distress.

De-stress!

(all laughing) Eso mismo, eso mismo.

HINOJOSA: Baby Love, a community-based program of the University of Rochester Medical Center, features home visits by health professionals to pregnant women and new mothers at risk.

What time that appointment?

11:00.

11:00?

Okay, you going to need transportation for that?

Yes.

TRELAWNEY MCCOY: Okay.

HINOJOSA: And Healthy Moms, formerly known as Healthy Start, takes a comprehensive approach.

ALISE GINTNER: We provide a lot of intensive case management services that focus on providing basic needs-- food, clothing, shelter.

And then we also have a job training program for our moms that are parenting where we teach them the job skills that they need so that they can gain paid employment or go back to school for a degree-- maybe finishing their high school diploma or getting a college degree.

And then, it gives them a path out of poverty so that they can have a better life for themselves and their children.

YOLANDA SAYRES: My name is Yolanda.

My name and number is on the bottom.

If you know someone that doesn't have medical insurance, we can help them get either free or low-cost medical insurance.

HINOJOSA: Yolanda Sayres is the outreach coordinator for the Perinatal Network of Monroe County, a nonprofit that helps at-risk women get access to prenatal care.

Hi, how are you?

Can I give you a flyer?

I actually call myself a foot soldier, where I am out in the community, walking the streets in targeted neighborhoods where I know there is a high infant mortality rate talking to anyone that will talk to me to let them know about different programs that the City of Rochester offers to try to help reduce infant mortality so that Mom can have the best, healthiest pregnancy that she can have.

SAYRES: A healthy baby begins with you, so if you have any questions about anything...

Remember what I said about the prenatal vitamins, making sure that you're taking those.

So, don't hesitate to give me a call.

And I have my card and everything.

All right, no problem, thank you.

HINOJOSA: So, your sense is that, on the ground...

Yes.

Women want the help.

They want the help.

What are the barriers?

There's so many barriers.

They don't know how to communicate with their doctor, transportation to get to a doctor's appointment, or they're intimidated by the doctors alone.

On the other hand, I can help out with car seats, parenting classes for you and for Dad, baby clothes.

And maybe having a rough month, baby formula and diapers, as well.

So having that conversation with them right here, on the street, finding out what their need is, I can assess as to best possible referral service that I can do.

HINOJOSA: Yolanda is one of only two foot soldiers in the neighborhood.

Together, they help connect over 500 women a year with support services.

But outreach is only half the battle.

The other half is resources.

The Healthy Moms program can serve only a small fraction of the roughly 3,000 women from Rochester's inner city who give birth every year.

We've got a bigger need for services than we're able to meet.

And it's not just my program, I think it's all of our perinatal partners in Rochester.

That there's more moms out there than we have the ability to reach.

HINOJOSA: For young mothers able to take advantage of Rochester's prenatal programs, the results are often dramatic.

Nayda Bones didn't realize she was pregnant until the fourth month, and until then she'd been drinking socially.

No, I wasn't aware of it because I was having a period.

HINOJOSA: Nayda got a referral to the hospital where Dr. K. works.

Once I found out, I was right in the hospital.

Every week, every other?

Every week, every week.

Finding out if he was okay, since I was drinking for the first four months of being pregnant.

Like, I just didn't know whether he was going to have mental issues or be deformed.

And I was really scared.

I didn't know what to do.

But then, Planned Parenthood did direct me to the hospital where they helped me.

And I did find out he was going to be okay.

What were the things that you learned when you were seeing your doctor?

They told us what to eat.

They gave us medicine to take care of the baby.

They told us a lot.

Like, you know, don't lift, don't... Just be careful.

Because I worked through the nine months of my pregnancy.

HINOJOSA: Infant mortality in the U.S. has dropped 12% since 2005, with the biggest improvement among African Americans.

Rochester's rate, by contrast, hasn't shown significant improvement in over a decade.

But for these moms and children, the outlook is brighter.

BONES: He's my dude.

(laughing) He's my friend, I love him.

I would never change that.

And I'm glad I took that decision to have my son.

I want to keep him focused.

And I want education.

I want him to go further than what I did.

The streets is not an option, at all.

HINOJOSA: After the loss of Nathan, their premature baby, Laquitta and Eszabia conceived again.

This time, they got comprehensive pre-natal care from the University of Rochester's Baby Love program.

They made her stay in the hospital because they felt as if that was the best thing for her to do to have a baby long-term.

And honestly, I think that's what saved our baby.

After 23 weeks I was amazed, because that was my last stop for my last pregnancy.

Every week after 23 weeks were like getting a million dollars.

(laughs) HINOJOSA: Laquitta carried her baby a full nine months before going into labor.

Oh, my God, it was... it was so exciting.

So exciting.

HALL: I was just standing there like, "Is this my baby?"

Like, "I can't believe that he's here!"

And I put my finger in his hand and he... As soon as I do it, he just squeezed like this and it was just so beautiful.

HINOJOSA: Their new baby, named Jordan, weighed seven pounds, four ounces.

HINOJOSA: What will you tell little Jordan about Nathan?

That his brother tried to come into the world and it just wasn't his time.

And I just could show him the little pictures and his things and let him know that some of his blankets are his, and that we love him as much as we loved him, too.

HINOJOSA: Sasha's luck finally turned and she landed a job as a cashier at a discount store.

FONTANEZ: And I got hired.

I start working tomorrow from 1:00 to 5:00.

HINOJOSA: Yay, Sasha!

HINOJOSA: It turns out, the manager had recently lost her grandchild to SIDS and wanted to help Sasha.

Her son's baby's mom, the baby just passed away.

What?!

The same thing, yeah.

In the bed.

And then she was like, "Well, you know, I know how it feels, it's hard."

And then, so I got the job.

I was like"Oh, my God, you're going to make me scream, you're going to make me cry."

She's like, "No, no, no, don't cry, don't cry, just be happy."

HINOJOSA: And Dr. K. continues to fight for the resources to help more Rochester mothers and their babies.

DR. K.: We could put our arms around the children here and carry them to something better and carry their famies to something better.

If we could cut infant mortality rates in the United States down to where they are in other developed countries, from where we are in the world down to first or second, why wouldn't we want to do that?

HINOJOSA: Next time, the new Mad Men.

In the last ten years, the purchasing power of people of color doubled to $3 trillion.

The face of the U.S. has changed.

And who we market to has shifted.

HINOJOSA: To learn more about this and other episodes of America by the Numbers with Maria Hinojosa, please visit pbs.org.

America by the Numbers with Maria Hinojosa is available on DVD.

To order, visit shopPBS.org or call 1-800-PLAY-PBS.

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