Study Shows Pesticides, Pollution, & Poverty Are Killing America's Babies

San Francisco Chronicle
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TOO YOUNG TO DIE

Erin McCormick, Reynolds Holding,
Chronicle Staff Writers
Sunday, October 3, 2004
<emccormick@sfchronicle.com>

California has one of the lowest rates of infant mortality in the nation,
but from San Francisco to Los Angeles there are pockets where babies are at
twice the risk of dying before their first birthday.

Babies born in the United States are twice as likely to die as those of
Sweden, Iceland, Japan, Spain or even the Czech Republic. And, within this
country, some babies -- depending on their race and where they live --
start out with heavy odds against them.

Almost 20 years after the United States set a goal of reducing infant
mortality, the rate of deaths among children in their first year of life is
still high.

Advances in medicine and technology have lowered the overall infant
mortality rate, from 10.6 deaths per thousand births in 1986 to 7 in 2002,
according to the Centers for Disease Control and Prevention, but failed to
raise the statistical survival chances of infants in the United States
beyond those of babies in many of the world's developing nations. The
latest infant mortality rankings from the World Health Organization show
the United States 36th among 196 nations.

A Chronicle study of infant deaths in California found that in
concentrating national efforts on medicine and technology, health care
leaders have ignored evidence that pollution and the stress of inner-city
life may be a threat to many newborn babies.

It also found that some of the medical marvels that can aid the survival of
the smallest and sickest babies -- infants born as many as 16 weeks early,
weighing as little as 1 pound 2 ounces -- fail to reach more than 1,000 of
the infants who die in California each year -- because of a breakdown in
the state's health care delivery system.

The Chronicle used state birth and death data to find the California
communities where infants stand the greatest chance of dying in the first
year of life.

Using a database that included information on each birth and death in
California, The Chronicle identified those ZIP codes where the infant
mortality rates -- the number of infant deaths per 1,000 births -- were the
greatest over a 10-year period.

In many cases, the disparities were startling.

San Francisco's Bayview-Hunters Point and several East Bay ZIP codes,
including Richmond's "Iron Triangle" and a north Oakland neighborhood that
surrounds the MacArthur BART Station, had strikingly high rates of infant
death.

The worst infant mortality rate in California was ZIP code 90008, covering
the Crenshaw neighborhood of South Central Los Angeles. Babies died there
from 1992 through 2001 at a rate of 13.8 for every 1,000 live births. The
state average was 6.1. Of the 66 babies who died, 56 were African American,
an all-too predictable statistic.

"You show me a poor, black neighborhood and I'll show you a place with a
high infant mortality rate," said Dr. Jeffrey Gould, a Stanford
pediatrician who studies infant mortality.

In the Central Valley, the hot spots for infant mortality were the Kern
County cities of Lamont and McFarland, and other rural areas populated
mostly by Hispanics, an ethnic group with a generally low rate of infant
death.

Although the United States pursued a campaign to reduce infant mortality
for almost two decades, it failed to keep pace with the rest of the
industrialized world. Last year, for the first time in decades, the
national infant-mortality rate increased -- an uptick that experts
attribute to a rise in premature births.

Black infants around the nation are still twice as likely as whites to die,
a statistic that applies across every level of education, income or social
class.

Hispanic infants, on the other hand, survive at a higher rate than whites,
despite their generally lower socioeconomic status. Hispanics who immigrate
to the United States have better infant-mortality rates than those who are
born here.

The Chronicle found ZIP codes in heavily agricultural Kern County with
Hispanic rates much higher than expected. Experts cannot explain the higher
rates, though new research is finding links between infant death and
pesticides, air particles, smog and other types of pollution.

The search for answers continues. Whatever the cause, the death of an
infant "is always a tragedy," Boston University medical school Professor
Paul Wise writes in a recent article on infant mortality. "But the death of
an infant from preventable causes is always unjust."

----------

BAY AREA

94124: San Francisco, SAN FRANCISCO COUNTY 11.8

94609: Oakland, ALAMEDA COUNTY 11.3

94801: Richmond, CONTRA COSTA COUNTY 10.9

94703: Berkeley, ALAMEDA COUNTY 10.8

94710: Berkeley, ALAMEDA COUNTY 10.3

State Average: 6.1.

SACRAMENTO VALLEY

ZIP code/ Infant mortality

city/county rate

95202: Stockton, SAN JOAQUIN COUNTY 13.1

95814: Sacramento, SACRAMENTO COUNTY 10.6

95605: West Sacramento, YOLO COUNTY 10.4

95815: Sacramento, SACRAMENTO COUNTY 10.1

95961: Olivehurst, YUBA COUNTY 10.0

State Average: 6.1.

CENTRAL VALLEY

ZIP code/ Infant mortality

city/county rate

93263: Shafter, KERN COUNTY 13.4

93301: Bakersfield, KERN COUNTY 12.8

93706: Fresno, FRESNO COUNTY 12.4

93250: McFarland, KERN COUNTY 12.1

93241: Lamont, KERN COUNTY 11.7

93721: Fresno, FRESNO COUNTY 11.6

93268: Taft, KERN COUNTY 10.9

93725: Fresno, FRESNO COUNTY 10.8

93307: Bakersfield, KERN COUNTY 10.1

93304: Bakersfield, KERN COUNTY 10.0

State Average: 6.1.

SOUTHERN CALIFORNIA

ZIP code/ Infant mortality

city/county rate

90008: Los Angeles, LOS ANGELES COUNTY 13.8

(Note: Highest rate in California)

92404: San Bernardino, SAN BERNARDINO COUNTY 12.7

92408: San Bernardino, SAN BERNARDINO COUNTY 12.3

93543: Littlerock, LOS ANGELES COUNTY 11.4

90746: Carson, LOS ANGELES COUNTY 11.3

90047: Los Angeles, LOS ANGELES COUNTY 10.8

92284: Yucca Valley, SAN BERNARDINO COUNTY 10.6

92313: Grand Terrace, SAN BERNARDINO COUNTY 10.4

92324: Colton, SAN BERNARDINO COUNTY 10.4

92410: San Bernardino, SAN BERNARDINO COUNTY 10.3

90222: Compton, LOS ANGELES COUNTY 10.1

90062: Los Angeles, LOS ANGELES COUNTY 10.0

93555: Ridgecrest, KERN COUNTY 10.0

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art
One: Life's Toll
<mailto:emccormick@sfchronicle.com>Erin McCormick and Reynolds Holding,
Chronicle Staff Writers
Sunday, October 3, 2004

In Bayview-Hunters Point, the stress created by environmental problems,
racism, poverty and crime may explain why so many babies die young. Infant
mortality is twice as high here as in the rest of San Francisco.

----------
In a bungalow at the back of an alley between industrial warehouses in San
Francisco's Bayview-Hunters Point district, a young woman cried out in pain.

"Take me to the hospital," 22-year-old Tuli Hughes called to her husband,
Walter, on the evening of April 6, 2001.

The baby was coming.

It was barely the fifth month of Hughes' pregnancy -- way too early for the
infant girl she was carrying to have a chance at a healthy life.

The mother had been through this before. Three times she had lost babies to
miscarriages. A fourth infant -- baby Joseph -- was born early with a fatal
birth defect and died within minutes.

"I thought it was just me," Hughes recalled recently. "I thought I was
alone."

But she is not alone. The Bayview-Hunters Point ZIP code where Hughes has
lived her entire life has one of the highest infant mortality rates of any
ZIP code in California. It is a long-neglected neighborhood in the
southeast corner of San Francisco -- beset by poverty, joblessness, crime
and environmental issues. The area's infant mortality rate is one more
striking statistic that reflects the disparity between its residents and
those in the rest of San Francisco.

Bayview-Hunters Point has an infant mortality rate comparable to Bulgaria
or Jamaica, while San Francisco has been cited in studies as having the
best infant mortality rate among large U.S. cities, even with the death
rate of Bayview-Hunters Point included. Babies are 2.5 times more likely to
die in their first year there than those in other areas of San Francisco, a
Chronicle analysis of 10 years of state data shows.

How can a few miles make such a difference?

The answers are complicated, but the facts are clear.

Bayview-Hunters Point, like most areas with extremely high infant mortality
rates, is poor and has a large minority population. But statistically,
researchers say, the heightened risks associated with being poor and with
being a minority (particularly an African American) don't account for the
extra-high infant mortality rates in these areas.

Entire groups at risk

The answer, some experts believe, lies in the cumulative toll levied by
stress from neighborhood conditions -- ranging from violent crime, drugs,
slum housing, a dearth of grocery stores, a lack of political clout and
living in a dumping ground for industrial pollutants.

"Neighborhoods can put entire groups of people at risk,'' said Jennifer
Culhane, a researcher who has studied reproductive health at Thomas
Jefferson University in Philadelphia. "Neighborhood conditions may be so
onerous that they literally get under residents' skin."

Half a block from Tuli Hughes, around the concrete barriers set up to keep
drug dealers from hot-rodding down her street and past the police
checkpoint that guards the entrance to the Alice Griffith public housing
projects, neighbors Cheryl and Bakari Fields lost their twins after
premature births one year before.

Three doors from them, another mother went into early labor with her twins
10 months before that. One baby survived only two minutes; the other hung
on to life in the hospital for a month and a half before dying of
respiratory failure.

A year before that, just around the corner, in a public housing unit
overlooking the contaminated remains of the now-closed naval shipyard, a
3-month-old boy died of sudden infant death syndrome.

And, as Tuli Hughes rushed to the hospital to give birth to a daughter
weighing only 1 pound, another neighbor, Patrina Council, was just coming
home with her baby boy, Jyimeir. Born prematurely, he had spent his first
four months in a hospital neonatal intensive care nursery -- and he was not
yet out of danger.

All these families thought they were facing their crises alone. They didn't
realize that their children's stories were part of a grim statistic that
has confounded experts studying the problem of premature birth and infant
mortality on local, state and national levels.

The Chronicle analysis of California births and infant deaths between 1992
and 2001 identified infant mortality hot spots in isolated ZIP codes up and
down the state. In the Bay Area, babies living in Bayview-Hunters Point and
in troubled pockets of Richmond and Oakland were roughly twice as likely to
die in their first year as those in the rest of the state.

Throughout California and the nation, researchers say, stubborn islands of
elevated infant mortality like these are keeping the United States from
matching the infant survival rates of Canada, France, Japan and dozens of
other countries that spend much less on health care than we do.

In the late 1980s and early 1990s, the United States began a campaign to
reduce its infant mortality rate to a level similar to those of other
industrialized nations. The effort concentrated on medical care, ensuring
pregnant women access to prenatal care and redoubling efforts to save sick
babies through high-tech intensive care.

But the nation did little to address the day-to-day inequities that follow
residents of these neighborhoods from cradle to grave.

"We know that healthy babies come from healthy moms and healthy moms come
from healthy communities, so you can't just apply a quick fix." said Dr.
Michael Lu, a professor at UCLA, who studies disparities in infant health.

Bayview-Hunters Point, which accounts for 4 percent of San Francisco's
population but 15 percent of its infant deaths, is not a healthy community.

According to the 2000 U.S. Census, a third of children younger than 5 live
below the poverty line -- $17,603 for a family of four -- in one of the
most expensive cities in the nation. Half of these children have only one
parent in the home.

Much of the housing is rundown and infested with insects and mold,
particularly in city-owned public housing, where many units are boarded-up
and abandoned.

Crime and violence are common. Of the 130 homicides committed in San
Francisco last year and the first seven months of this year, 25 -- or 19
percent -- occurred in Bayview-Hunters Point. Last year, a stray bullet
killed a 7-week-old baby as he slept in his uncle's arms inside a house.

Jobs are scarce, and some residents say drug sales are the area's major
industry. According to the 2000 Census, the unemployment rate for the
Bayview is 9 percent, almost twice the 4.6 percent rate for the city.

In addition, this corner of San Francisco is home to almost all the city's
polluting industries, including the main power and sewage treatment plants
and the now-closed Hunters Point Naval Shipyard -- a Superfund cleanup site
where the military once experimented with radiation.

Studies show that residents of the area face elevated rates of asthma,
diabetes and cervical and breast cancer.

"It's chaos out here," said Espanola Jackson, a Bayview community activist.
"We have been San Francisco's dumping ground for decades.''

A family home

Like many parents in the neighborhood, Walter and Tuli Hughes don't
consider Bayview-Hunters Point an uncomfortable place to call home.

Along with others in the area, they complain about the smell of sewage
wafting up from the streets when water levels are high and the strange
odors that ooze up from the ground in the evenings. And they sometimes
worry about the gunshots they hear at night and the drug dealers and users
who congregate around the liquor stores.

One night Walter Hughes heard gunfire and learned later that a neighbor's
18-year-old son had been shot while working on a car in the garage. The
baby shot while cuddled in his uncle's arms in the back bedroom of his
family's home lived four blocks away.

But Tuli Hughes was born in this neighborhood and has lived in the same
house with her big, extended Samoan family since she was 12. Walter, an
African American, was raised in Bernal Heights. He's been around the
Bayview pretty much all the time since he fell in love with Tuli on their
first date, on the night before her 18th birthday. They were married the
next year, in what they now fondly describe as an act of defiance against
Tuli's protective parents.

"Her parents were really strict, and I was always kidnapping her," Walter
said. "They would say, 'What's going on here? You guys aren't married.' So
one day we said, 'Oh yeah?' " They had sneaked off to City Hall and tied
the knot.

Beyond race

The neighborhood has been a hub for San Francisco's black community since
the 1940s, when thousands of families migrated from the South to take
advantage of jobs at the then-thriving naval shipyard. While the jobs
lasted, it was a vibrant community, with a neighborly spirit. Family
businesses sprouted up along Third Street. Churches were packed on Sundays,
according to Jackson, who moved to the area in 1948.

In recent years, high housing costs and a lack of jobs have driven many
blacks out of the area and out of San Francisco altogether. According to
the 2000 Census, blacks are no longer a majority in the Bayview-Hunters
Point ZIP code, 94124. In place of those who left, many Asian/Pacific
Islanders and Hispanics moved in.

In Bayview-Hunters Point, each of these groups -- blacks, Asian/Pacific
Islanders and Hispanics -- face infant mortality rates above what is
expected for their races in California. Not enough white babies were born
in Hunters Point over a 10-year period to accurately calculate their
mortality rate.

The infant mortality problem in Bayview-Hunters Point goes beyond the
bounds of race.

This is consistent with the findings of dozens of researchers who have
studied how stressful neighborhoods affect health.

Philadelphia researcher Culhane discovered that the difference between
birth outcomes for black women and white women was almost one-third less
when the women lived in the same neighborhoods.

"I believe the solution is deeply rooted in social inequities,'' Culhane
said. "We're going to have to look at interventions that are not within the
medical domain. They're about neighborhood quality, housing quality,
political clout, participation in the labor force and, ultimately,
addressing racial and ethnic discrimination."

Researchers such as Culhane said it's difficult to say that any individual
baby died because of neighborhood stress, but when one looks at the known
factors -- age of mother, drug or alcohol abuse and smoking, for instance
-- they don't add up to enough of a discrepancy to account for the amount
of infant death that is occurring.

The breadth of these issues leads some infant mortality experts to discount
the stress theory as interesting but impractical.

"There's something there, but can you fix it?" said Karla Damus, a
professor at Albert Einstein College of Medicine in New York. "Who wants to
wait that long?"

One approach is just to plow ahead, said Dr. Rajiv Bhatia of the San
Francisco Health Department. He runs a program designed, in part, to reduce
stress in Hunters Point by improving the neighborhood. He concentrates on
creating affordable homes and keeping people from being evicted.

"On one level, it's very simple," he said. "Poverty kills. But researchers
want to know why poverty kills, and stress gives them a handle on that.
Where I am is, poverty kills, so I want to work on poverty."

Premature birth

When Tuli and Walter Hughes arrived at Saint Luke's Hospital on the evening
of April 6, 2001, doctors confirmed that their baby's tiny head was already
on its way out of the mother's cervix.

Doctors had Tuli put her legs in the air in hopes that it might slow things
down.

While the number of preterm births in the United States has risen
dramatically in recent years, doctors have been unable to find a way to
prevent premature labor or stop it once it begins.

A full-term baby spends 40 weeks in the womb. Doctors told Tuli and Walter
Hughes that, at only 22 weeks of gestation, their baby had no viable chance
of survival. In studies done during the mid-1990s, researchers found that
all babies born this early died before 6 months of age.

So, even though the baby might be born alive, most hospitals will not use
interventions, such as inserting breathing tubes, to try to save an infant
this premature. Hospitals typically recommend taking no action to save a
baby born at less than 500 grams -- about 1 pound 2 ounces -- or less than
24 weeks gestation. Many refuse to intervene before this point.

Tuli's labor could not be stopped.

The baby girl was born at 10:35 a.m. the next day. She was little bigger
than a kitten. She had tiny hands, tiny toes and tiny facial features, all
beautifully formed but impossibly small. A doctor placed her in Walter's
arms so he and Tuli could hold her and talk to her as they said goodbye.

"I knew it was coming, but I couldn't believe it," Walter Hughes said. "She
was trying to breathe; she was gasping. I said, 'Put her in an incubator or
something.' "

Then, together, the parents held the daughter they had named Angel as she
struggled for life and finally died.

Stress hormones

In all, 66 babies less than a year old died in Hunters Point between 1992
and 2001, a mortality rate of 11.8 per 1,000 births. Of those infants, 43
-- or 65 percent -- were African American.

Prematurity and sudden infant death syndrome were the major causes. Babies
with low birth weight were 17 times more likely to die than those weighing
at least 51/2 pounds.

In Bayview-Hunters Point and throughout the nation, the number of infants
being born early is on the rise.

The rate of prematurity in the United States jumped 13 percent between 1992
and 2002, with a record high of 480,812 babies born prematurely in 2002, or
12.1 percent of all live births, according to the National Center for
Health Statistics.

"It's the No. 1 cause of newborn deaths, and we don't know why preterm
births happen," said Dani Montague, director of the Northern California
chapter of the March of Dimes.

Studies have shown that personal factors such as smoking, being older than
35, drug use, domestic violence, infections and diabetes can put a mother
at increased risk of going into labor early.

But researchers have found that such factors fail to explain as much as
half of preterm births. For many women who go into preterm labor, the cause
is a complete mystery.

Researchers are trying to measure how a combination of neighborhood and
lifetime stressors can result in hormonal changes in pregnant women.
Culhane and UCLA professor Lu, among others, believe these hormones may
cause early births, and their presence can explain the high number of
premature babies in neighborhoods like Bayview-Hunters Point.

"When you talk to these women, they don't necessarily say they're
stressed," Lu said. "This is how they grew up. They may accept (their
living conditions) as part of their daily lives. But they may walk around
with high levels of stress hormones."

In a study published in 1999, Calvin Hobel, a doctor at Cedars-Sinai
Medical Center in Los Angeles, took blood samples from 524 pregnant women
and measured them for corticotropin-releasing hormone. He found that women
who had preterm births also had significantly elevated levels of the
hormone, which is believed to be released by the brain during stress.
Corticotropin is believed to be associated with the onset of labor.

Research being conducted by Culhane is looking at whether stress affects
the way pregnant women's bodies fight infections. Culhane collected blood
samples from pregnant women in Philadelphia and looked at how their blood
cells responded to bacterial invasions that might typically cause an
infection.

Though the study has not been published, preliminary results suggest that
pregnant women with elevated stress hormones react differently to bacteria
in a way that might put them at increased risk for preterm labor.

Generations of stress

Lu and other researchers have taken a particular interest in the racial gap
between blacks and whites. They focus on the grinding stress -- from
factors like segregation and racism -- that blacks may face over a lifetime.

"For about 20 years we thought, if we could just get women to prenatal
care, that would address all these issues that women are facing on a daily
basis," Lu said. "What we're seeing now is that you really need to start
before the women get pregnant. We believe a long time before."

In a paper published last year, Lu suggested that research should look at
the stress a mother experiences during her whole "life-course," beginning
with her own development in the womb, or even stretching back to encompass
the intergenerational effects of the stress her grandmother may have
experienced.

He cited studies showing that mothers who were themselves born at low birth
weights are much more likely to give birth to low-birth-weight babies. He
pointed to other research conducted in Scotland in the 1950s, which showed
that lower-class women who married into a higher social class experienced a
greater chance of infant mortality than those who had been in that higher
class all their lives.

"They suggest that it may take more than one generation to equalize
socioeconomic disparities in birth outcomes," said the 2003 article,
co-written by Dr. Neal Halfon of the UCLA School of Medicine and Public
Health.

Eight babies lost

Within yards of each other, around the barracks-like Alice Griffith Housing
Projects -- also known as Double Rock -- five families have lost a total of
eight babies.

On weekday afternoons, crowds of jobless young men congregate around cars
parked in the streets, while children play in the long grass of vacant
fields that old-timers say are landfills made of garbage. The abandoned
cranes of the Hunters Point Naval Shipyard loom on the horizon.

A year before Angel Hughes was born and died, a similar tragedy befell
Cheryl Fields, a neighbor who lived in Alice Griffith public housing maybe
200 steps from the Hughes' house just outside the project. She was 32 with
three children entering their teens at the time.

Fields didn't go into premature labor. She faced another common cause of
premature birth, a maternal illness called preeclampsia. Basically, her
pregnancy suddenly made her so sick near the end of her sixth month that
the only way doctors could save her life was to deliver her twin babies
immediately by cesarean section, even though they were too tiny to survive.

After the C-section, Fields was so ill that doctors wouldn't let her hold
the babies. They died in their older brother's arms.

While she said the pain has lessened over the years, Fields will never
forget her two lost "angels." A photo of them, their bony faces nestled
together in a white blanket, decorates her front parlor. She and her
husband, Bakari, wear tattoos with the baby's names on their arms.

"My son (Armani) lived two hours. My daughter (Amari) lived an hour,''
Cheryl Fields said. "The thing that upset me the most was I didn't even get
a chance to hold them."

What Patrina Council went through may have been even harder. Five months
before Tuli Hughes went into labor with Angel, Council's baby, Jyimeir, was
born 51/2 months into her pregnancy, weighing 1 pound 12 ounces. Doctors
consider that to be the edge of viability.

He began his first days of life on a ventilator in a hospital neonatal
intensive-care ward. It took him more than four months to grow enough and
become stable enough to leave the hospital.

The 21-year-old Council brought him home to the four-bedroom public housing
unit she shared with her four sisters and three children.

Council, who had her first child at age 13 and her second at 19, said baby
Jyimeir came home with six different medications and was so fragile that
she was afraid to take him outside.

He lived a little more than a month.

"He was asleep upstairs one day and he just stopped breathing,'' Council
said. "I came downstairs, and when I went up to check on him, he was
already blue.''

An autopsy showed that he died of respiratory arrest from having been born
prematurely.

The data collected on infant deaths in California does not include any
indication of whether maternal drug use was a factor in those deaths. But
in at least one of the eight deaths in this neighborhood, there seemed a
possibility that drugs had played a rule. One 3-month-old boy died of
sudden infant death syndrome after having been born to a mother who was
addicted to crack cocaine.

There is constant talk in the neighborhood about the young men being killed
by gunfire in Bayview-Hunters Point. But few people discuss infant deaths,
said Marie Harrison, an environmental activist and longtime resident of the
area.

"There's a taboo on conversations about people who lose their little
babies," she said. "The mother is usually made to feel she's done something
wrong, so she won't talk to her neighbors. There's no support."

A living Angel

Tuli and Walter Hughes' long struggle with early births and infant deaths
has a happy ending. Her name is Alyanna Angel Hughes, and she is now a
healthy 1-year-old.

Cheryl and Bakari Fields are happy parents as well. Their daughter Aneiyah
-- 7 pounds 2 ounces -- was born July 6, and though Cheryl endured
complications from a C-section, she and Aneiyah are now doing fine.

Tuli Hughes, now 25, was able to carry Alyanna through a full-term
pregnancy, with the help of doctors at California Pacific Medical Center,
who discovered that some of her problems were caused by a weak cervix that
was causing her to lose babies early. Such a condition is often the cause
of miscarriages, but it is usually detected and treated before causing
multiple infant deaths in women with access to good health care. There was
no explanation for the defect that killed her baby Joseph just after birth.

As the Hugheses recounted the stories of their lost infants in a living
room packed with framed photos of nieces and nephews and cousins and
uncles, they paused occasionally to nuzzle the baby's soft cheek or tickle
her belly.

"She's going to be pretty spoiled,'' beamed Walter Hughes, 28, who said
he's not sure they're brave enough to try for another. "One out of 6 --
those are pretty rough odds."

E-mail Erin McCormick at
<mailto:emccormick@sfchronicle.com>emccormick@sfchronicle.com.

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TOO
YOUNG TO DIE
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PART
TWO: TOXIC LEGACY
- Reynolds Holding, Erin McCormick, Chronicle Staff Writers
Monday, October 4, 2004

Babies born in neighborhoods afflicted by pollution -- from smog to
pesticides -- are more likely to die before their first birthday.

----------
That warm April midnight, Leslie Guttierez lay in silence at Kern County
Medical Center, hugging her newborn twins. She had named them Marie and
Mariah, but she called them her two little angels, because they were no
longer of this world.

Guttierez was young and healthy. She did not smoke or drink or take drugs.
She had received the care of a doctor and nurse since early in her
pregnancy. She was Hispanic, an ethnic group with a very low rate of infant
mortality. No one had a clue why Guttierez's infants died.

"It was," she said, "almost like something was in the air that took my
babies."

Or in the water or the ground.

Guttierez lives in rural Kern County, by several measures one of the most
polluted counties in the nation. Dense smog, agricultural waste and unknown
doses of dangerous chemicals create an environment that ranks third worst
among U.S. metropolitan areas for ozone and daily particle pollution,
according to the American Lung Association.

Kern County also contains four of the 10 California ZIP codes with the
highest rates of infant death from 1992 through 2001, according to a
Chronicle analysis. Guttierez's hometown of Shafter, ZIP code 93263, ranked
No. 2.

Although dirty air and water cannot explain any one death, new research
suggests that the risk of infant mortality -- death before the age of 1 --
is dramatically higher for women who live amid heavy pollution. Studies
published in the past few years link pesticides, carbon monoxide and tiny
airborne particles with birth defects, prematurity, low birth weight and
respiratory ailments that can lead to an infant's demise.

"It means," said UC Berkeley Professor Kenneth Chay, co-author of a 2003
study on air pollution and infant death, "that there are a huge set of
health benefits from cleaner air that have been ignored."

Almost two decades since the United States began a campaign against infant
mortality, the cost of ignoring those benefits is beginning to emerge.

Public health officials tried to reduce the infant death rate by stressing
better medical care rather than a cleaner environment or healthier urban
neighborhoods. Today, the overall rate is down, from 10.6 deaths per 1, 000
births in 1986 to 7 in 2002. But under the World Health Organization's 2002
rankings, the latest available, the United States was 36th among 196
countries. Although national figures show that Hispanic babies typically
have even better survival rates than whites, infants in the rural Kern
County ZIP codes that include Shafter, Lamont and McFarland are an
exception. Over the 10- year period examined by The Chronicle, the Hispanic
infant-mortality rate was twice as high for those Central Valley ZIP codes
as it was for California.

"It's shocking that it's that high,'' said Dr. Elena Fuentes-Afflick, a
UCSF professor who has studied infant mortality rates among Hispanic women.

Kern health officials say they run countywide programs to prevent infant
deaths, but they were unaware of the high death rates among Hispanics in
the county's rural ZIP codes until notified by The Chronicle. While
researchers have connected pollution and infant mortality elsewhere, no one
has studied these ZIP codes.

"This problem wasn't known before,'' Chay said. "It raises real questions
about what the causes are. As a public policy matter, trying to find some
answers may be important, not just to these towns, but to other areas as
well."

Effects of air pollution

The first suggestions of a link between pollution and newborn deaths came
from London, where the number of infant deaths doubled during a weeklong
weather inversion that trapped noxious smog in December 1952.

It was not until the 1990s, though, that researchers developed scientific
evidence that bad air could kill babies. In 1995 and 1997, two studies from
China found close associations between air pollution and premature and low-
weight births. A 1999 study of the Czech Republic connected high levels of
air particles with infant deaths from respiratory problems. The same year,
a study from Mexico City showed the number of infant deaths rising several
days after sharp increases in air particles, ozone and nitrogen dioxide.

In the United States, substantially lower levels of pollution obscured the
connection between air quality and infant death. Still, such a link "made a
lot of sense," said Dr. Beate Ritz, professor of epidemiology at UCLA
School of Public Health, "because we already knew that air pollution
increased adult mortality, especially among the elderly and people with
cardiovascular problems."

Ritz and other researchers have established that polluted air increases
infant mortality in the United States as well as abroad. But the potential
dangers from other sources of pollution -- contaminated wells, toxic dumps,
dairy farms -- remain a mystery.

From the cab of his Chevy pickup, Tom Frantz, a high school teacher,
environmental activist and son of a Kern County almond farmer, points out
one pollution problem after another.

Driving down a county road lined with cotton fields and almond orchards,
Frantz gestures to the crescent of barren mountains surrounding Kern to the
east, south and west. The rounded peaks are barely visible through the smog.

"We're in a bowl here, there are mountains all around us, so the air
pollution all gets trapped,'' he said. "Smog all the way from Sacramento
blows down and just stays here."

With trapped vehicle emissions and agricultural pollutants ranging from
dust to pesticides, Kern and the rest of the San Joaquin Valley threaten to
overtake Los Angeles as the smog capital of the nation, Frantz explained.

The smell of manure fills the air as Frantz drives his truck along a
sprawling dairy farm where thousands of Holstein cows huddle in huge, muddy
enclosures. Along one side is a small mountain of feed covered in plastic
held down with old tires. The gases from cattle urine and manure produced
by these farms mix with the air to worsen the smog problems, Frantz said.
Until this year, dairies were not subject to clean air regulations.

"The pollution from these dairies is worst in the winter," he said,
"because tons of ammonia evaporate into the air and mix with fog to become
dangerous particles of ammonium nitrate" that can lodge in people's lungs.

Frantz points out the cotton, grape and almond fields that dot the area.
Here, the pesticides change with the seasons. In April, farmers spray
herbicides to clear their fields for planting. In May, hormones are applied
to make the grapevines bloom. In June, agricultural crews use a chemical
fungicide to prevent fruit from rotting. In August, they add sulfur to get
rid of mildew.

Though many Kern residents share Frantz's concerns, a substantial portion
of them believe agriculture gets a bad rap.

Loron Hodge, 65-year-old executive director of the Kern County Farm Bureau,
remembers growing up in Tulare County and helping his father in the alfalfa
fields.

"I never had any adverse reactions," he said. "Now, why would I have such a
good life? I don't think you can explain it. There are people who adapt to
this valley and people who do not."

Hodge said he finds it "difficult to grasp" that infant deaths would be
connected to agriculture. "My opinion is that we are seeing more pollution
in the valley because we have more people coming, bringing their
automobiles," he said. "The frustration we (farmers) have is that we get
this broad brushstroke that says agriculture is doing bad things, when all
we want to do is provide food and fiber to the people we serve."

A family tragedy

Off the truck-choked lanes of Route 99, down the Elmo Highway through hazy
acres of cotton and grapes, left at the tire shop, Carlos Hernandez lives
with his wife, Manuela, and their daughter, Mireya.

They live in McFarland, "cancer town," site of a childhood-cancer cluster
from 1975 through 1995 and, now, the ZIP code with the eighth-highest
infant mortality rate in California.

State investigators found no environmental cause for the cancers, but the
infant deaths are harder to dismiss. They approach a rate seen in Tonga,
Fiji and other developing nations. Hernandez makes light of the pollution
around him -- "I figure, whatever you're going to die of" -- but cannot
account for what happened to his son.

Carlos Jr. arrived in March 2003. He was a bruiser, at three weeks "so big
and long that I couldn't lay him on my arm no more," said Hernandez, short
but strong himself.

Everyone loved Carlos Jr. He was his grandfather's "Little Buddy" and his
father's dream fulfilled.

One day after Father's Day last year, at his grandfather's home nearby,
Carlos Jr., 3 months old, began to fall asleep as aunts and uncles and
sisters passed him from lap to lap. Hernandez carried him to the bedroom.

"I kept going back, three or four times," to check him, Hernandez recalls.
The last time, "my brother went in and my brother said he didn't see him
there. I went in and said he's right there."

There, but no longer breathing.

"I just dropped to the ground. I didn't know what to do, so I took him to
the hospital, but ..." Hernandez's hand goes to his brow and jars the bill
of his 49ers cap. He begins to sob. Manuela Hernandez sits next to him,
lips quivering, her words locked inside because she cannot speak English.

The doctors at the hospital could not offer any answers. They told them it
was just something that happens.

But researchers are finding that it sometimes happens because the air
contains too much microscopic dust, called particulate matter 10 microns
wide or less, or PM10.

In 1997, federal environmental experts published a study showing that air
rich in particles increased the death rate from sudden infant death
syndrome - - 26 percent for babies of Carlos Jr.'s age and birth weight.
The amount of particles in the areas studied ranged from 11.9 to 68.8
micrograms per cubic meter. The findings squared with research on infants
in Taiwan, Korea and the Czech Republic and with studies linking adult
mortality to high particle levels.

Measurements are unavailable for particles in McFarland, but nearby
Bakersfield ranks No. 3 nationally in particle pollution, just behind
Visalia (Tulare County) and Los Angeles, according to the American Lung
Association. According to the California Air Resources Board, the average
amount of particles in Bakersfield over the past three years was about 60
micrograms per cubic meter.

Whatever took his son does not much matter to Hernandez now. He still
grieves hard, visiting the grave once a week in Delano (Kern County) and
keeping Carlos Jr.'s room just the way it was.

He draws strength from his family and, most of all, from 6-year-old Mireya.

On a particularly difficult night, they sat together remembering.

"She said, 'Don't cry, Daddy. My little brother is with God, and he's
already a little star, watching over us. We can sit at night and look at
the sky and see him,' " Hernandez said.

'Something's wrong'

Thirty miles southwest of McFarland in Kern County is Buttonwillow,
population 1,266. Its skies routinely fill with the dust of tilled earth
and air-dropped pesticides, but its environmental notoriety stems from the
deaths 12 years ago of two babies born without brains within eight months
of each other. The occurrence of two cases in one year creates a rate 25
times higher than expected for Kern County, according to the California
Birth Defects Monitoring Program.

Mary Helen Mendez and other residents suspected the nearby hazardous waste
dump. They tried to force the dump's closure by marching through town, but
their efforts failed after investigators found nothing to explain the
deaths.

Still, with her son and husband sickened by asthma and other ailments, she
knew something was wrong with this place. In 2001, they moved northeast
across Interstate 5 to Shafter, and it was there that her problems grew
worse.

Mendez, 29, was pregnant. She said she was happy at first, living in a
one-bedroom apartment and working at a computer in a pistachio warehouse.
She quit when the season ended during her fifth month of pregnancy.

"I was healthy," she recalls, "but it was confusing because I was so big."

Much to her surprise, Mendez was pregnant with twins.

On the evening of Oct. 2, she began to feel queasy. By 9 p.m., she was in
pain. Her husband hustled her to the hospital, and at midnight she
delivered two boys.

"All the scariness and sadness and pain," she said, "went away."

But both sons, Jesus and Jorge, were three months early and weighed less
than 2 pounds. They had to stay behind when Mendez left the hospital on
Oct. 3.

"That night, I got a phone call from the hospital," she said, furiously
wiping her sudden tears, "telling us to come down."

When she arrived, the doctors "were explaining a bunch of medical terms,
and I looked into his (Jesus') bed and he wasn't there," Mendez said. "I
told my husband, 'Something's wrong, he's not in the incubator,' and he
said, 'Yes he is,' and I said, 'No, it's covered,' and that's when they
told me my son was dead."

In 2000, three years after the federal study connecting SIDS with air
particles, UCLA Professor Ritz and three colleagues published research
showing that a pregnant woman's exposure to high doses of particulate
matter, as well as carbon monoxide, could cause premature birth. In 2002,
they published a second study linking ozone and carbon monoxide with heart
defects in newborns.

The researchers studied babies born from 1987 to 1993 in Los Angeles,
Orange, Riverside and San Bernardino counties, and Ritz cautions that it is
unclear whether the effects were caused by the substances themselves or by
undetected toxins that accompany those substances in the air.

In 2001, Shafter exceeded national ozone standards for 30 days, longer than
most communities measured in neighboring Los Angeles County. Ozone is not
measured in Buttonwillow, and carbon monoxide and air particles are not
measured in either Buttonwillow or Shafter.

But the ozone and daily levels of air particulate pollution in the
Bakersfield metropolitan area are ranked third worst in the nation in a
2004 study by the American Lung Association.

No one knows whether pollution contributed to Jesus' death, but Ritz's
research suggests a connection between bad air and his brother Jorge's
problems.

Several days after his birth, Jorge was rushed to UCLA for an operation to
close a hole in his heart. Later, he spent three weeks at a Fresno hospital
with lung problems that developed into pneumonia. It would be the first of
three bouts with the virus.

Now 2, Jorge has chronic lung disease and frequent ear infections. He is
deaf in his left ear and very rarely talks.

"Jorge, he just studies people. That's how Jorge is," Mendez said as she
chased her little boy pedaling through the parking lot of the apartment
complex. "He went through a lot, and at the moment, I don't want any more
babies."

Poisoned wells

Tom Frantz swings his truck back toward Shafter and pulls into a dirt road
running between a cluster of plywood shacks, each about the size of a one-
car garage. Children play by the alley, and laundry hangs above bare
patches of soil. The area, known as Myrick's Corner, started as a migrant
worker camp during the 1930s "Okie exodus" described in John Steinbeck's
"The Grapes of Wrath."

The one-room houses have been rebuilt on the foundations of the old tent
cities, Frantz said. Now they are occupied exclusively by Hispanic migrant
workers.

"People rent these for something like $400 a month. Sometimes there are as
many as 15 to a house," he said.

Until the mid-1990s, Myrick's Corner and a similar immigrant community on
the southwest edge of town, Smith's Corner, got all their water from
shallow wells polluted by agricultural chemicals.

City officials sent letters to residents warning them not to drink the
water because it was contaminated with nitrates. A component of fertilizer,
nitrates cause "blue baby syndrome,'' a potentially fatal condition that
limits the body's ability to distribute oxygen.

Residents successfully lobbied to get their homes connected to the cleaner
water system that serves Shafter proper. Still, they fear their health has
been damaged by the polluted water and the pesticides sprayed in nearby
cotton fields and almond orchards.

"Whenever they spray, we can smell it. We try to run inside, but it causes
headaches,'' said Sonya Garza, a Smith's Corner resident whose teenage
brother suffers from leukemia and whose 44-year-old mother suffers from
cirrhosis of the liver, though she has never used alcohol or drugs.

"We don't know what these chemicals do to us," she said.

Stench of chemicals

Leslie Guttierez grew up just north of Shafter, in Wasco, in a labor camp
beside the dog-food plant and the four ribbed silos storing charcoal.

"It would stink," said Guttierez, 18. "There was a lot of pollution that
would make us sick all the time."

When Guttierez turned 12, her father, a garlic picker, moved the family to
a subsidized house he had built near the center of Shafter. It took awhile
for Guttierez to warm to her new neighborhood, but then she met Alonzo.

He was five years her senior, dark and sweet and still two years away from
the farm accident that would take his right hand. They dated a year before
Guttierez found out that she was pregnant in November 2001.

She was only 16, and the news did not sit well with her father. He
"wouldn't talk to me for like three weeks," she said. "He was just crying."

But when an ultrasound revealed that Guttierez was having twins, a grandson
and a granddaughter, her father hugged her "and said he would always be
there to help me."

Guttierez received lots of help, from her relatives and her doctor and a
nurse who visited her home. But all the help in town could not prevent the
pains that, in her fourth month, gripped her back. She took to her bed for
a few weeks, and the pains went away, only to return about one month later.

The doctor said the pains were normal, but they got worse. And in the dead
of night, while she and Alonzo were staying at her sister's house, she felt
she could suffer no longer.

"I went into the bathroom," Guttierez said, "and I hit my knees because my
mom had told me to do that for the pain. Then I felt the baby's head, and
all of a sudden the little girl came out. I picked her up, and she was
alive, and we called an ambulance. Then I passed out."

Since Guttierez lost her twins two years ago, the evidence linking
pollution and infant death has grown stronger. In April 2003, UC Berkeley
Professor Chay and his colleague published their study of substantial air
pollution reductions that resulted from a decline in manufacturing during
the recession of 1981 and 1982. They found that the decreased pollution may
have prevented as many as 2,500 infant deaths nationally.

In October, UCLA Professor Janet Currie and a colleague published research
showing that air particles, carbon monoxide and, to a lesser extent,
nitrogen dioxide from vehicle exhaust contributed to infant mortality
throughout California in the 1990s. But the researchers also estimated that
an additional 1,366 infants survived because the air actually grew cleaner
over that decade.

Guttierez and Alonzo were married three weeks after their twins died. They
buried the twins in the Shafter Cemetery, in a quiet grove with other
infants.

They visited the cemetery on a recent afternoon, during the funeral of
their friends' 2-year-old, who had been hit by a car.

They turned from their twins' grave and walked toward the tent that
sheltered the small white casket of their friends' son. Alonzo joined the
gathered crowd, but Guttierez, 10 weeks pregnant, stood at a distance.

"I can just imagine," she whispered, "how that mom feels."

Incident at Weedpatch

No one saw the plume of noxious gas that drifted over the apartments and
shacks of the Lamont farming community known as Weedpatch on the evening of
Oct. 4, 2003. But its effect on residents was immediate.

Children playing on the grass around their apartments ran inside with their
eyes burning. Babies vomited. Parents, with tearing eyes and burning
throats, scrambled to shut windows as a pungent, sweet chemical odor,
similar to that of flypaper, exploded into their nostrils.

"I called 911 and said, 'What's happening to us? What's going on?' '' said
Flora Bautista, a mother of five, who was in her apartment in Weedpatch
that evening. Within minutes, she said, her elementary-school-age children
were vomiting, eyes stinging, so violently ill that they were rolling on
the ground in pain.

After hundreds of people were evacuated from the community, residents
learned what had happened.

A pesticide application company, hired by the owner of a nearby onion farm,
had injected a highly concentrated fumigant into the soil in an attempt to
sterilize it. The chemical, which leaked into the air and drifted into the
homes of Weedpatch, was a 100 percent solution of chloropicrin, the active
ingredient in tear gas.

Gabriela Cornejo, 19, was visiting her mother in Weedpatch that evening.
She was one of more than 130 people who complained about being sickened by
the fumes.

"Suddenly, I couldn't breathe right,'' she said. "I started feeling dizzy.
I'm like, 'What's happening to me?' "

Two days before the pesticide drift incident, Cornejo realized she might be
pregnant with her second child. Two days after, still feeling a little sick
from the exposure, she went to the doctor to confirm the pregnancy and
asked how the chemical might affect her baby. The medical staff couldn't
answer her question.

Four months later, "out of nowhere," she said she suddenly started to
bleed. She called her doctor, who told her to go to the hospital
immediately.

Her baby didn't survive long enough to be considered a live birth. It was
miscarried in its fourth month of gestation.

Cornejo, a lifelong resident of the Lamont area, said she'd never been
exposed to agricultural chemicals before this. She is one of more than a
hundred victims of the Oct. 4 drift who have joined a lawsuit against the
pesticide spraying company and the farm owner. Western Farm Service, the
pesticide company, agreed to pay $60,000 to settle state and county
allegations that it violated pesticide-handling rules.

Dale Dorfmeier, an attorney representing Western Farm, said that, "to the
best of our present knowledge," all precautions and legal permits required
to apply the pesticide safely "were followed on this job." He said the
drift was caused "by changed atmospheric conditions" rather than by the
company's actions.

After the company was told about the drift, he said, its employees "did all
they could" to solve the problem.

In Kern County, pesticide drifts happen with some regularity. There were
120 reported pesticide drifts -- resulting in 418 reports of illness -- in
the 10 years between 1992 and 2001, according to the California Department
of Pesticide Regulation. In these cases, chemicals from an agricultural
site drifted off to sicken people in adjacent areas. There were another 353
reports of pesticide exposure incidents in which 417 workers complained of
being sickened by pesticides at their work site.

Yet almost nothing is known about the long-term health effects of most
pesticides on adults, much less how they affect pregnant women and babies.

Materials-handling advisories describe chloropicrin as "highly toxic" and a
"powerful irritant," which can attack the liver, heart, kidneys, lungs and
stomach, and can cause death in high enough doses. Studies have shown that
exposure to it increases mortality in rats, but there are few studies on
its long-term effect on humans.

In March, in one of the few studies that have looked at how pesticides
affect unborn children, Columbia University researchers found that pregnant
women in New York exposed to high levels of two pesticides had
significantly smaller babies than their neighbors.

After the pesticides were restricted, baby size increased in the
neighborhood. Both pesticides -- chlorpyrifos and diazinon -- are often
used on fields in Kern County.

Cornejo's attorney, Jeff Ponting of the nonprofit group California Rural
Legal Assistance, said he cannot know for certain what caused Cornejo's
miscarriage.

"But to be exposed to something like this, and to become violently ill as a
result of that exposure, seems likely to have a negative effect on a
pregnancy,'' he said.

Cornejo said the incident has left her fearful.

"Where we live, it's all farmland," Cornejo said. "Now, this makes me
wonder, 'What if this happens again?' "

'Kind of scared'

Early this year, Carlos and Manuela Hernandez thought they might get a
second son.

Manuela was pregnant, and for two months she endured the nausea that she
assumed was part of the experience. In her ninth week, though, her doctor
measured her girth and concluded that the fetus had not grown.

Two weeks later, Manuela went with her husband to get measured again.

When they returned from the doctor's office, it was clear that the news was
not good. Manuela was silent. Carlos Hernandez took a seat on the couch and
started toying furiously with a small Cat in the Hat doll.

The fetus had stopped growing, he said. The doctor called that afternoon to
tell them that it had to be removed.

"We got to try again," Hernandez said, "at least so my daughter can stop
thinking about her little brother."

In late February, Mary Helen Mendez, who had lost her son Jesus, found out
that she was also pregnant. She was unsure how another child might fit with
a household already strained financially and emotionally.

"I'm kind of scared," she said.

And on April 24, Leslie Guttierez gave birth to 7-pound 2-ounce, flush-
with-health Clarissa.

Guttierez marveled at how easy the delivery was. A little back pain around
midnight, a nudge to Alonzo that it was time, a drive to the hospital and,
within about an hour, a new baby girl.

"It was," Guttierez said, "the happiest day of my life."

----------

THE SERIES

SUNDAY: High-stress neighborhoods can doom infants.

TODAY: Pollution linked to infant deaths.

TUESDAY: Going door-to-door to save young lives.

WEDNESDAY: Flawed health care system costs babies' lives.

THURSDAY: A hospital where miracles occur daily.

This series is available online at SFGate.com. To obtain infant death
statistics for neighborhoods by ZIP code and track the infant death rate by
county over the past decade, go to sfgate.com/infantmortality/.

E-mail Erin McCormick at
<mailto:emccormick@sfchronicle.com>emccormick@sfchronicle.com.

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