Smiling mother Tasha Henderson and her baby gently touch foreheads, a tender moment that almost didn't have a chance to happen. Six-month-old Trenton is a symbol of Memphis' success in fighting infant mortality.
A decade ago, babies born in the city and surrounding Shelby County were statistically more likely to die in the first year of their lives than any other populous county in the U.S. Nearly 15 of every 1,000 infants were dying before the age of 1 — a worse rate than some developing countries.
The Shelby County health department made saving babies its goal, enlisting help from national and community organizations, social workers, faith-based groups, businesses and hospitals. They sought to improve what experts call the "social determinants" of health, including education, income and living conditions. Other keys were good nutrition and stress management for expecting mothers.
With the efforts in place, Shelby County's infant mortality rate dropped by nearly a third en route to its lowest recorded level in 2011. The improvement equates to 74 more babies surviving to their first birthday. While the national infant mortality rate also fell over that period, it was a much more gradual drop.
One key to the Memphis-area efforts has been pinpointing at-risk mothers such as Henderson and giving them intense attention, education and counseling during and after pregnancy.
Henderson, a smoker with three older daughters, faced significant obstacles. She had lost her job and was evicted from her apartment. The baby's father was gone.
High blood pressure, breathing trouble and other issues led her to a high-risk pregnancy clinic. She was suicidal and considering an abortion.
Enter the Shelby County Health Department, which assigned a counselor to guide Henderson through a stressful pregnancy. The counselor visited Henderson's apartment each month and urged her to eat healthy foods, attend her doctors' appointments and take her medications. She gave Henderson her cell phone number and urged her to call any time.
"I was very, very stressed out and going through depression," said the 39-year-old Henderson, who quit smoking during her pregnancy.
Her counselor zeroed in on that. "That was her main focus, that I wasn't trying to commit suicide or trying to harm anybody else ... I could talk to her about any issues that I was having and she tried to calm me down and help me be happy with my pregnancy."
Henderson's mental state improved, and Trenton was born with club feet but otherwise healthy.
The counselor visits were provided by the county and partly funded by grants from the federal Healthy Start initiative, which also helps cover prenatal care costs.
It's one of several home visitation programs available in the county. Le Bonheur Children's Hospital has three home visitation programs, including one that meets with low-income teenage mothers. Another of the hospital's programs is targeting families in low-income apartment complexes with high dropout, crime and pregnancy rates.
The increase in such outreach efforts in Shelby County was aimed at paring an infant mortality rate that stood at 14.9 deaths per 1,000 live births in 2003. That rate was higher than French Guiana, Kuwait, Lithuania and other developing nations.
Shelby County, which includes Memphis, ranked worst in infant mortality in 2003, according to an Associated Press analysis of Centers for Disease Control and Prevention data for large U.S. counties with more than 12,000 births that year. Ranking just below were the counties that include Detroit, Philadelphia and Milwaukee, along with Prince George's County, Md., in suburban Washington.
Now, Shelby County health department figures show that the 2011 infant mortality rate had dropped to 9.6 per 1,000 births — the lowest on record. The other communities have taken similar approaches to Shelby County, and their infant mortality rates have also improved. Statistics for 2011 weren't available for all counties.
"To see it finally move consistently in the right direction and hit a low that this community has never before seen, is really a testament of what can happen when a community really develops public will to make something happen," said Yvonne Madlock, director of the Shelby County Health Department.
Work remains, though. Memphis still is above the national infant mortality rate, which was 6.05 for every 1,000 live births in 2011, according to the CDC. The national rate was 6.84 in 2003.
In Shelby County, the death rate among black babies in their first year was 13 per 1,000 births in 2011. That is down from 21 per 1,000 births eight years earlier, but there still is room for improvement, Madlock says.
Entrenched social problems of poverty and unequal access to care remain woven into the problem, both in Memphis and nationally, said Kathleen Buckley, director of the National Fetal and Infant Mortality Review Program.
"These are not easy issues to solve. They are part of a larger problem," Buckley said.
Public health officials around the country have been looking beyond medical care to a broad list of factors that can improve infant mortality — including social influences, said Diane Rowley, professor at the Gillings School of Global Public Health at the University of North Carolina-Chapel Hill. The result is a broad, multi-dimensional approach in many cities.
Most programs offered by Shelby County and Tennessee come at no cost to the pregnant woman. They are funded by grants, tax dollars and private donations.
Under a state program called TENNderCARE, employees call about 40,000 mothers throughout the state each year to talk with them about nutrition, breastfeeding and regular doctor's visits. A separate campaign targets preventable, sleep-related deaths.
Madlock applauds her county's Centering Pregnancy program, which creates a support group of pregnant women based on their delivery dates. The women attend pre-natal doctor's visits together and build relationships that lead to honest discussions about their pregnancies.
"That becomes a support system," Madlock said. "It normalizes some of the experiences they may be having."
Le Bonheur uses fetal MRIs and other technology to diagnose and treat babies still in the uterus to reduce premature births and low birth weights, said hospital president Meri Armour.
The hospital also has expanded its neo-natal intensive care unit from about six beds to 60 beds. Armour says the hospital has a 70 percent survival rate for premature babies born at 25 weeks.
Madlock said in the future her department plans to use social media to increase awareness and help mothers secure suitable housing, education and jobs.
In her Memphis apartment, Tasha Henderson praises Verkisserous Richey, the social worker who helped her.
Henderson has a new job as a telephone customer service representative and wants to go back to college. She's also busy taking care of her three daughters and Trenton, who sits quietly in her lap, holding up tiny hands balled into little fists.
Henderson says Richey's counseling and the visitation program saved her baby's life.
She then looked at Trenton and said: "He wouldn't be here right now, and I probably wouldn't be here as well. I needed someone to show that they care."