French system kicks in before birth

LYON, FRANCE -- The day Chantal Ribes learned she was pregnant, she filled out a government form at her doctor's office that kicked in a series of preventive health and financial benefits that would astound most Americans.

 To encourage proper prenatal care, Ribes would receive $130 a month if she went to her monthly doctor's visit.

 To make sure Ribes would be prepared for her new child, a nurse would visit her to monitor the pregnancy, make sure she had a crib and other baby furnishings and answer any questions.

 To ensure the baby is well cared for after birth, it receives free monthly exams and preventive care at Ribes' neighborhood health clinic.

 This is how life begins for millions of children in France.

 Even before children are born, mother and child become part of a comprehensive government network designed to increase the odds that children are born healthy and that their families are prepared to raise them.

 "If they hadn't been here, I don't know what we would have done," said Ribes, 25, the mother of Kevin, now 3, during a recent visit to her neighborhood clinic in the city of Lyon in southeastern France.

 "The people here gave me so much advice on raising my child," she said. "They see when there are problems, and try to help. They tell you where to go to find work. And if you have financial problems, they tell you where to go for help."

 Assuring healthy babies

 It's all part of a unique French creation called PMI (Maternal and Infant Protection), a program that has been studied by dozens of U.S. policy makers. Launched after World War II to care for children injured in war, PMI has been converted into a major weapon in France's battle against premature babies, abuse and neglect and high medical costs associated with high-risk pregnancies.

 About one-third of all French children are in the sweeping system that tracks the most at-risk families and makes sure they get adequate care. The system, which cost about $2.3 billion last year, targets young unmarried mothers, mothers with histories of miscarriages or health problems and parents with histories of abuse or chemical dependency. However, any French family can request services.

 U.S. families may be wary of such close government monitoring, but many children's advocates say the system holds lessons for the United States, where 7 percent of newborns consume 60 percent of newborn health dollars, according to research by Columbia University Prof. Sheila Kamerman. Likewise, 1 percent of U.S. births are premature, compared with 5 percent in France. 

It's not just French children who have an edge on U.S. kids. At least 16 other countries have a lower proportion of infants with low birth weights, and at least 20 others have lower infant mortality rates, Kamerman said.

 France, however, has become a leader in preventive medicine for kids. Dr. Aline Garat, the lead pediatrician at the bustling clinic in central Lyon where Ribes brings her son, explains the philosophy.

 Helping 'the whole family'

 "Our mission is to help the whole family," said Garat. "For a child to develop, he needs a solid family situation to help him. So we start at pregnancy. We have the names of all the pregnant women in this area.

 "A nurse goes to visit the family to prepare for the birth. She makes sure the woman is going to the doctor, makes sure the house is being arranged for the baby. And if there are other kids, she finds out who will take care of them when the mother is in the hospital. If no one can, they will prepare some possibilities."

 Garat works in a small office at the PMI center. On this Tuesday morning, she's lifted about eight infants onto the examination table, where she's measured heads, checked reflexes and peered into eyes, ears and throats. Outside in the waiting room, a nurse warmly greets the women as they enter the clinic, then weighs the children.

 Financial and social counselors sit in offices just outside the waiting room, available to help parents with nonmedical problems such as housing, day care, public assistance and job training.

 The counselors were a big help to Ribes, who wanted to get some job training. Her nurse recommended a secretary training program, which Ribes recently finished. She's already been hired at a Lyon hospital.

 Ribes' clinic is one of 145 in the department of Lyon, that track the well-being of 30,000 children under age 2, said Maryse Vocanson, regional director of the program. That's one-third of all children in that age group, she said. The clinics are scattered throughout the city's neighborhoods and in low-income high-rises outside the city. The key is to set up shop where people live, she said.

 "For example, in a high-rise, there might be a clinic next to an infant day-care center or a day-care drop-in center," Vocanson said. "You wouldn't build a special PMI building. You'd try to integrate."

 PMI staff make house calls

 In addition to checking children at the clinic, PMI staff visit preschools, stop by hospitals to visit newborns, and train and certify in-home day-care providers. Nurse midwives visit homes of people with high-risk pregnancies to give medical advice and counseling.

 On a recent Wednesday morning, for example, a midwife visited the home of two music teachers who were expecting their first child. The mother had been ordered to stay in bed, and the nurse midwife made a point to visit her every week.

 Walking past the grand piano and African folk instruments in the living room, the midwife made her way to the bed of Judith Paquet, who was looking tired and a little worried. The midwife sat down at her side, measured her stomach, asked about contractions. She took notes in a book Paquet kept at her bedside, which she'll eventually bring to the hospital.

 The young mother said she was grateful for the care.

 "It calms me down," said the 25-year-old. "Without it . . . I'd probably have to spend all this time in the hospital. Or I would have had the baby by now -- with all the problems involved with premature infants." 

© Copyright 1996 Star Tribune. All rights reserved.