BOSTON'S MATERNAL HEALTH COMMISSION was created in 1990 following a Boston Globe series on infant mortality in Boston. It was convened by former Mayor Ray Flynn, chaired by Anna Faith Jones of the Boston Foundation, and staffed or advised by an impressive roster of local health care experts. The commission's three-year charge was to answer this question: Why were black infants dying at three times the rate of white infants, and what would it take to keep them alive?
In its latest -- and final -- report, the commission offers a host of safe, predictable, offend-nobody answers, most of which can be boiled down to one word:
Leaf through the report's 25 pages, and you'll read about the St. Mary's Women and Infants Center, about the Boston Healthy Start Initiative, about WIC subsidies, about support services for addicted women.
You'll read that the state's "free-care pool, the last resort of uninsured women, is underfunded." That "transportation services are spotty and uncoordinated." That "private teaching hospitals are not keeping up with their pledge to provide $8 million to $12 million" to combat infant mortality. That not issuing welfare checks early in pregnancy "will deny poor pregnant women the money they need for housing, food and other essentials."
You'll read Anna Faith Jones' summary on the first page: "The scourge we must attack is poverty."
What you will not read, not anywhere in the entire report, is the word "father." Or "husband." Or "marriage."
As in its earlier reports, the Maternal Health Commission refuses to acknowledge the overwhelming evidence that illegitimacy is deadly to infants. The correlation is profound. Data from the Centers for Disease Control show that regardless of a mother's race or age, babies born out of wedlock are more likely to die than babies born to a married couple.
Nor is infant mortality a function of a mother's education. The National Center for Health Statistics reports that the death rate of infants born to unmarried women with a college education -- a Murphy Brown, so to speak -- is higher than for infants born to married high school dropouts -- an Edith Bunker.
And for all the commission's emphasis on money ("the scourge we must attack is poverty"), it is simply not true that poverty causes infant mortality. The states with the highest rates of infant mortality, for example, tend to have higher per-capita incomes than the states with the lowest.
Another example: Blacks in the United States are more affluent than blacks in Puerto Rico. Yet black infant mortality is lower in Puerto Rico (based on 1988 data) than on the mainland.
In a 1992 study, Nicholas Eberstadt of Harvard's Center for Population and Development Studies noted: "Asians and Pacific Islanders have a higher poverty rate than US whites, yet their infant mortality rate . . . is substantially lower. By the same token, infant mortality rates for Hispanic Americans and non-Hispanic whites are reportedly just about the same, even though the poverty rate for Hispanic children is more than twice as high."
The point is worth repeating. Poverty is not a good predictor or explanation of infant mortality. Neither is race. Neither is education. Neither is location.
Fatherlessness is. Black infants in Boston are born into homes without fathers at two to three times the rate of white infants; that is why we lose black babies so much more frequently than white babies.
But the Maternal Health Commission lacked the honesty or the courage to say so. More than three years' worth of meetings, surveys, and reports, and not once did the commission say: What babies need to thrive is mothers and fathers living together. Preoccupied with demanding more money and programs from the state, the city, the hospitals, it never got around to demanding of young women: "Don't have a baby if you don't have a husband. Don't get pregnant if you aren't ready to support a child."
Babies born to unmarried mothers are deeply disadvantaged. Not only are they likelier to die in infancy, but they are likelier to have emotional and behavioral problems if they survive. They are likelier to be sick. Likelier -- six times likelier -- to be poor. Likelier to end up on welfare. Twice as likely to drop out of school. Likelier to end up in prison. Likelier to get pregnant as teenagers.
Fathers are vital to children's well-being. Intact two-parent families are vital to society's well-being. The best social science research says so. Bill Clinton and Dan Quayle say so. Barbara Dafoe Whitehead (in The Atlantic Monthly) and Charles Murray (in The Wall Street Journal) say so. Donna Shalala, the liberal US secretary of health and human services, says so. Her conservative predecessor, Dr. Louis Sullivan, does, too.
Everybody says so, it seems. Except the Maternal Health Commission. What a pity. What a disgrace.
(Jeff Jacoby is a columnist for The Boston Globe.)