It Takes a Village (7 page)

The children in this group were given good nutrition, educational toys, and plenty of other stimulation, as well as the encouragement to explore their surroundings. A “home-school resource teacher” met with each family every other week to coach the parents on how to help their children with school-related lessons and activities.

By the time the children were three years old, those in the experimental group of children averaged 17 points higher on IQ tests than the other half of the original group, 101 versus 84. Even more significant than these impressive gains is their durability: the differences in IQ persisted a decade later, when the children were attending a variety of other schools. Dr. Ramey is continuing to follow the children to see what their further development brings.

Bear this research in mind when you listen to those who argue that our nation cannot afford to implement comprehensive early education programs for disadvantaged children and their families. If we as a village decide not to help families develop their children's brains, then at least let us admit that we are acting not on the evidence but according to a different agenda. And let us acknowledge that we are not using all the tools at our disposal to better the lives of our children.

 

A
NY DISCUSSION
of how the brain's processes affect cognitive intelligence tells only half the story about the first blossoming of intelligence. The other half is how we behave in our relations with other people—what is now being called our “emotional intelligence.”

One unusual aspect of living in the Arkansas governor's mansion was getting to know prison inmates who were assigned to work in the house and the yard. When we moved in, I was told that using prison labor at the governor's mansion was a longstanding tradition, which kept down costs, and I was assured that the inmates were carefully screened. I was also told that onetime murderers were by far the preferred security risks. The crimes of the convicted murderers who worked at the governor's mansion usually involved a disagreement with someone they knew, often another young man in their neighborhood, or they had been with companions who had killed someone in the course of committing another crime.

I had defended several clients in criminal cases, but visiting them in jail or sitting next to them in court was not the same as encountering a convicted murderer in the kitchen every morning. I was apprehensive, but I agreed to abide by tradition until I had a chance to see for myself how the inmates behaved around me and my family.

I saw and learned a lot as I got to know them better. We enforced rules strictly and sent back to prison any inmate who broke a rule. I discovered, as I had been told I would, that we had far fewer disciplinary problems with inmates who were in for murder than with those who had committed property crimes. In fact, over the years we lived there, we became friendly with a few of them, African-American men in their thirties who had already served twelve to eighteen years of their sentences.

I found myself wondering what kind of experiences and character traits had led them to participate in the violent and self-destructive acts that landed them in prison. The longer and better I came to know them, the more convinced I became that their crimes were not the result of inferior IQs or an inability to apply moral reasoning. Although they had not finished high school, they seemed to have active and inquisitive minds. Some had whimsy as well as street smarts. They showed sound judgment in solving problems in their work, and they plainly knew the difference between right and wrong. What, I wondered, had caused them to commit a crime that resulted in the loss of another's life?

Now that I have read Daniel Goleman's
Emotional Intelligence
, I am better able to understand what back then I could only wonder about.

Goleman brings to our attention new breakthroughs in psychology and neuroscience that shed light on how our “two minds”—the rational and the emotional—operate together to determine human behavior. Both forms of intelligence are essential to human interaction, and as any parent or teacher can tell you, both are constantly at work. If rational intelligence is unchecked by feeling for others, it can be used to orchestrate a holocaust, run a drug cartel, or carry out serial murders.

The power of emotion is equally dangerous if it is not harnessed to reason. People who cannot control their emotions are often prone to impulsive overreaction. They may be quick to perceive threats and slights even when none are intended, and to respond with violence. They are, in Goleman's phrase, “emotional illiterates.” Many of the gang members interviewed as part of a recent study released by Attorney General Janet Reno to investigate the extent of illegal use of firearms fit this profile. More than one in three said they believe it is acceptable to shoot someone who “disses” them—shows them disrespect.

As with cognitive intelligence, the development of emotional intelligence appears to hinge on the interplay between biology and early experience. Early experience—especially how infants are held, touched, fed, spoken to, and gazed at—seems to be key in laying down the brain's mechanisms that will govern feelings and behavior. Some experts speculate that the brains of emotional illiterates are hard-wired early on by stressful experiences that inhibit these mechanisms and leave people prey to emotional “hijacking” ever after.

Most of us don't habitually react with impulsive violence, but all of us “blow our tops,” give in to irrational fears, or otherwise feel overwhelmed—hijacked—by our emotions from time to time. Why do we, as thoughtful human beings, allow emotional impulse to override rational thinking?

As Goleman explains, the temporary “hijackings” are ordered by the amygdala, a structure in the oldest, most primitive part of the brain, which is thought to be the physical seat of our emotions. This brain structure acts like a “home security system,” scanning incoming signals from the senses for any hint of experience that the primitive mind might perceive as frightening or hurtful.

Whenever the amygdala picks up such stimuli, it reacts instantaneously, sending out an emergency alarm to every major part of the brain. This alarm triggers a chain of self-protective reactions. The body begins to secrete hormones that signal an urgent need for “fight or flight” and put a person's senses on highest alert. The cardiovascular system, the muscles, and the gut go into overdrive. Heart rate and blood pressure jump dramatically, breathing slows. Even the memory system switches into a faster gear as it scans its archives for any knowledge relevant to the emergency at hand.

The amygdala acts as a storehouse of emotional memories. And the memories it stores are especially vivid because they arrive in the amygdala with the neurochemical and hormonal imprint that accompanies stress, anxiety, or other intense excitement. “This means that, in effect, the brain has two memory systems, one for ordinary facts and one for emotionally charged ones,” Goleman notes. And he adds, “A special system for emotional memories makes excellent sense in evolution, of course, ensuring that animals would have particularly vivid memories of what threatens or pleases them. But emotional memories can be faulty guides to the present.”

Problems arise because the amygdala often sends a false alarm, when the sense of panic it triggers is related to memories of experiences that are no longer relevant to our circumstances. For example, traumatic episodes from as far back as infancy, when reason and language were barely developed, can continue to trigger extreme emotional responses well into adulthood.

The neocortex—the thoughtful, analytical part of the brain that evolved from the primitive brain—acts as a “damper switch for the amygdala's surges.” Most of the time the neocortex is in control of our emotional responses. But it takes the neocortex longer to process information. This gives the instantaneous, extreme responses triggered by the amygdala a chance to kick in before the neocortex is even aware of what has happened. When this occurs, the brain's built-in regulatory process can be short-circuited.

Most people learn how to avoid emotional hijackings from the time they are infants. If they have supportive and caring adults around them, they pick up the social cues that enable them to develop self-discipline and empathy. According to Dr. Geraldine Dawson of the University of Washington, the prime period for emotional development appears to be between eight and eighteen months, when babies are forming their first strong attachments. As with cognitive development, the window of change extends to adolescence and beyond, although it narrows over time. But children who have stockpiled painful experiences, through abuse, neglect, or exposure to violence, may have difficulty enlisting the rational brain to override the pressure to display destructive and antisocial reactions later in life.

The answer to Goleman's essential question—“How can we bring intelligence to our emotions—and civility to our streets and caring to our communal life?”—appears to be that, difficult as it may be, it is never too late to teach the elements of emotional intelligence. The structure imposed by the responsibilities of work and the enlightened assistance of concerned people in the prison system and at the governor's mansion helped those onetime murderers I knew in Arkansas to achieve a greater understanding of and control over their feelings and behavior.

A number of schools around the country are incorporating the teaching of empathy and self-discipline—what social theorist Amitai Etzioni calls “character education”—into their curricula. In New Haven, Connecticut, a social development approach is integrated into every public school child's daily routine. Children learn techniques for developing and enhancing social skills, identifying and managing emotions like anger, and solving problems creatively. The program appears to raise achievement scores and grades as well as to improve behavior.

 

W
E ARE
beginning to act—albeit slowly—on the evidence biology and psychology provide to us. But practice lags far behind research findings. As Dr. Craig Ramey notes, “If we had a comparable level of knowledge with respect to a particular form of cancer or hypertension or some other illness that affected adults, you can be sure we would be acting with great vigor.”

If, in scientific terms, the twentieth century has been the century of physics, then the twenty-first will surely be the century of biology. Not only are scientists mapping our genetic makeup, but new technologies are letting them peer into living organisms and view our brains in action. The question we must all think about is whether we will put to good use this accumulating knowledge. Can we find ways to communicate it to all parents, so that it can help them to raise their children and to seek out coaching if they need it? Will we give working mothers and fathers enough time to spend feeding their babies' brains? Will we have the foresight and the political will to provide more and better early education programs for preschoolers, especially those from homes without adequate “brain food”? Will we challenge elementary school students with foreign languages, math, and music to reinforce brain connections early in a child's life? Given the increasing level of violence and family breakdown we see around us, why wouldn't we?

 

I
N THE
next few chapters I will explore what happens in families during the first few years of children's lives—the period that we now know is so vital in giving them a solid start. Researchers may differ over how particular experiences influence a child's development, but no research study I have ever read has disputed that the quality of life within the family constellation strongly affects how well infants and young children will adapt to the circumstances that confront them throughout their lives. On the contrary, the research underscores the critical importance of constructive stimulation during a child's earliest years.

But if family life is chaotic, if parents are depressed and unexpressive, or if caregivers change constantly, so that children can rely on no one, their ability to perform the essential tasks of early childhood will be impaired. The next time you hear someone using the word “investment” to describe what we need to do for our younger, more vulnerable family members, think about the investments the village has the power to make in children's first few weeks, months, and years. They will reap us all extraordinary dividends as children travel through the crucial stages of cognitive and emotional development to come.

T
here I was, lying in my hospital bed, trying desperately to figure out how to breast-feed. I had been trained to study everything forward, backward, and upside down before reaching a conclusion. It seemed to me I ought to be able to figure this out. As I looked on in horror, Chelsea started to foam at the nose. I thought she was strangling or having convulsions. Frantically, I pushed every buzzer there was to push.

A nurse appeared promptly. She assessed the situation calmly, then, suppressing a smile, said, “It would help if you held her head up a bit, like this.” Chelsea was taking in my milk, but because of the awkward way I held her, she was breathing it out of her nose!

Like many women, I had read books when I was pregnant—wonderful books filled with dos and don'ts about what babies need in the first months and years to ensure the proper development of their bodies, brains, and characters. But as every parent soon discovers, grasping concepts in the abstract and knowing what to do with the baby in your hands are two radically different things. Babies don't come with handy sets of instructions.

How well I remember Chelsea crying her heart out one night soon after Bill and I brought her home from the hospital. Nothing we could do would quiet her wailing—and we tried everything. Finally, as I held her in my arms, I looked down into her little bunched-up face. “Chelsea,” I said, “this is new for both of us. I've never been a mother before, and you've never been a baby. We're just going to have to help each other do the best we can.”

In her classic book
Coming of Age in Samoa,
Margaret Mead observed that a Samoan mother was expected to give birth in her mother's village, even if she had moved to her husband's village upon marriage. The father's mother or sister had to attend the birth as well, to care for the newborn while the mother was being cared for by her relatives. With their collective experience as parents, they helped ease the transition into parenthood by showing how it was done.

In our own American experience, families used to live closer together, making it easier for relatives to pitch in during pregnancy and the first months of a newborn's life. Women worked primarily in the home and were more available to lend a hand to new mothers and to help them get accustomed to motherhood. Families were larger, and older children were expected to aid in caring for younger siblings, a role that prepared them for their own future parenting roles.

These days, there is no shortage of advice, equipment, and professional expertise available to those who can pay for it. If breast-feeding is a problem, for example, there are lactation specialists, state-of-the-art breast pumps, and more books on the subject than you can count. But nothing replaces simple hands-on instruction, as I can attest. People and programs to help fledgling parents are few and far between, even though such help costs surprisingly little. We are not giving enough attention to what ought to be our highest priority: educating and empowering people to be the best parents possible.

Education and empowerment start with giving parents the means and the encouragement to plan pregnancy itself, so that they have the physical, financial, and emotional resources to support their children. Some of the best models for doing this come from abroad. I'm reminded in particular of a clinic I visited in a rural part of Indonesia.

Every month, tables are set up under the trees in a clearing, and doctors and nurses hold the clinic there. Women come to have their babies examined, to get medical advice, and to exchange information. A large poster-board chart notes the method of birth control each family is using, so that the women can compare problems and results.

This clinic and thousands like it around that country provide guidance that has led mothers to devote more time and energy to the children they already have before having more. The fathers, I was told, have also been affected by the presence of the clinic. They are more likely to judge their paternal role by the quality of life they can provide to each child than by the number of children they father.

This community clinic program, which is funded by the government and supported by the country's women's organizations and by Muslim leaders, is a wonderful example of how the village—both the immediate community and the larger society—can use basic resources to help families. The honest, open, matter-of-fact manner of dealing with family planning issues that I observed in Indonesia provided me with a point of comparison to the approaches I have observed in many other places.

The openness about sexuality and availability of contraception in most Western European countries are credited with lowering rates of unintended pregnancy and abortion among adolescent and adult women. By contrast, more than one hundred million women around the world still cannot obtain or are not using family planning services because they are poor or uneducated, or lack access to care. Twenty million women seek unsafe abortions each year.

In October 1995, I saw a striking example of the consequences when I visited the Tsyilla Balbina Maternity Hospital in Salvador da Bahia, Brazil. I learned that half the admissions there were women giving birth, while the other half were women suffering from the effects of self-induced abortions. I met with the governor and the minister of health for the state, who have launched a campaign to make family planning available to poor women. As the minister pointed out to me, rich women have always had access to such services.

We may think that our country is far from this end of the spectrum, but the statistics tell a different story. Two in five American teenage girls become pregnant by the age of twenty, and one and a half million abortions are performed in America each year. It is a national shame that many Americans are more thoughtful about planning their weekend entertainment than they are about planning their families. And it is tragic that our country does not do more to promote research into family planning and wider access to contraceptive methods because of the highly charged politics of abortion. The irony is that sensible family planning here and around the world would decrease the demand for legal and illegal abortions, saving maternal and infant lives.

As usual, the children pay. When too-young parents have children, or when families expand without the means to support their growth, children are affected by the burdens and anxieties of parents who cannot meet their obligations. Family planning, more than just limiting the number of children parents have, protects the welfare of existing and future children.

The Cairo Document, drafted at the International Conference on Population and Development in 1994, reaffirms that “in no case should abortion be promoted as a method of family planning.” And it recognizes “the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so.” Women and men should have the right to make this most intimate of all decisions free of discrimination or coercion.

Once a pregnancy occurs, however, we all have a stake in working to ensure that it turns out well.

 

T
HERE IS
no experience more moving than to walk through a neonatal intensive care unit crowded with babies born too early—the whir of the ventilating machines, the rushing about, the smell of newborns mixed with the smells of hospital halls, the tangle of tubes inserted into wrinkled little bodies. I have walked through many such units in my lifetime, in Washington, Chicago, Little Rock, Boston, Oakland, Miami. The scenes are all the same—babies no bigger than my hand fighting for a life they've barely tasted.

In a 1992 study by the World Health Organization, the United States ranked twenty-fourth among nations in infant mortality. That means twenty-three countries, led by Japan, do a better job than we do of ensuring that their babies live until their first birthday. Seventeen countries, led by Italy, have better maternal health than we do. We shouldn't be surprised at these results, since nearly one quarter of all pregnant women in America, many of whom are teenagers, receive little or no prenatal care.

We know that women who receive prenatal care, especially in the first trimester, are more likely to deliver healthy, full-term, normal-weight babies, while women who do not receive adequate prenatal care are more than twice as likely to give birth to babies weighing less than five and a half pounds, the definition of “low birth weight.” And women who do not receive complete prenatal advice on alcohol and drug use, smoking, and proper nutrition are also more likely to give birth to low-birth-weight babies. In 1991, such babies represented only 7 percent of all births but about 60 percent of all infant deaths, for they were twenty-one times as likely to die before their first birthday as babies born weighing more. Inadequate prenatal care also results in higher rates of preventable problems, including congenital anomalies, early respiratory tract infections, and learning difficulties.

We spend billions of dollars on high-tech medical care to save and treat tiny babies. In 1988, a child born at low birth weight cost $15,000 more in the first year of life than a child born at normal birth weight. It is a modern miracle that we are able to save thousands of babies who would have died if they had been born a few years ago and that we can help thousands more to develop normally. In many cases, however, good prenatal care and emergency obstetric services could have averted the need for medical heroics altogether.

 

F
OR
many pregnant women in America, prenatal care is not accessible or affordable. They live in isolated rural areas or in urban centers. Their employers do not offer insurance, and their families do not make enough money to buy it on their own. Even families who have insurance sometimes find that health care is out of their reach. A couple I met told me their story: Having limited resources, they decided to insure their children and the breadwinning father, but not the homemaker mother. When the mother unexpectedly became pregnant, they saved their money to pay the hospital bills and decided to forgo the expense of prenatal care and anesthesia during delivery. This purely economic decision put both mother and baby at risk.

Many pregnant women are not even aware that they should be seeking prenatal care. They may be teenagers in denial about their pregnancy or trying desperately to hide their situation from their families. They may be women who do not have husbands, family, friends, or others concerned and informed enough to encourage them to seek medical attention or, at the very least, to stop smoking, drinking, or taking drugs during the pregnancy. In general, women whose already chaotic lives have been further complicated by pregnancy tend to be reluctant to seek services until the last possible moment, leaving their babies vulnerable to much greater health risks.

Ultimately, we women must take responsibility for ourselves and our health, but many of us will need assistance and support from the village. Peer pressure can work. We all know instances where family and friends have consistently and firmly reminded an expectant mother to forgo an alcoholic drink or a cigarette. But such informal means of monitoring care are no substitutes for formal systems that have as their primary mission good health for all women and babies.

Examples of the village at work can be found in countries where national health care systems ensure access to pre- and postnatal care for mothers and babies. Some European countries, such as Austria and France, tie a mother's eligibility for monetary benefits to her obtaining regular medical checkups.

While it is doubtful that our country will anytime soon develop a formal means of offering or monitoring prenatal care, there are things we can do now that will lower medical costs for all of us and prepare children for a lifetime of good health, starting before birth.

Some states, health care plans, community groups, and businesses have created their own systems of incentives to encourage women to obtain prenatal care. In Arkansas, we enlisted the services of local merchants to create a book of coupons that could be distributed to pregnant women. This “Happy Birthday Baby Book” contains coupons for each of the nine months of pregnancy and the first six months of a child's life. After every month's pre- or postnatal exam, the attending health care provider validates a coupon, which can be redeemed for free or reduced-priced goods such as milk or diapers.

The Arkansas Department of Health, which has run television and radio ads with a toll-free number to obtain the book, estimates that nearly seven out of every ten pregnant women in the state have received the coupon book. Preliminary reports indicate that women who have participated in the coupon program have had fewer low-birth-weight babies.

Businesses have also begun to recognize that preventive care saves health care costs in the long run. Many have begun to provide incentives to encourage their employees to seek prenatal care. Haggar Apparel Company in Dallas, Texas, for example, offers to pay 100 percent of employees' medical expenses during pregnancy if they seek prenatal care during the first trimester of pregnancy. Levi Strauss in San Francisco offers pregnant employees a $100 cash incentive to call a toll-free “health line,” which provides information and advice to callers and screens them to identify those at risk for early delivery.

Insurance companies, particularly those offering managed care plans, are underwriting classes on healthy lifestyles for pregnant women and providing incentives like car seats and diaper services to encourage women to participate in baby-care training. Other insurance companies are offering one-on-one help, making nurse midwives or nurse practitioners available to pregnant women by phone around the clock.