Lessons learned: the unintended consequences of policy decisions affecting maternity services for Pittsburgh's African Americans.

In the Pittsburgh region, as elsewhere, the Black infant mortality rate, reflecting overall health disparities, is higher than the rate for White babies. This study suggests that the answer to the infant mortality racial disparity question may lie partially in the characteristics and availability of prenatal care as well as broader changes in the social and economic environment. Numerous known risk factors associated with infant mortality have been present for as long as statistics have been recorded. Only wide ranging comprehensive programs will combat such factors as low income, education, teenage motherhood, unemployment, and inadequate housing. The other more specific factors of low birth weight and inadequate prenatal care, however, can be addressed by providing adequate prenatal care in a setting that is accessible and designed specifically with the cultural awareness and concerns of the African American community in mind. The strategies of fifty years ago offer some insights that are worth noting as policy planners begin to design and implement new programs to combat the continuing tragedy of African American infant mortality.