There are places in America where the unthinkable is happening: Thousands of babies are dying.
Of the 23 richest countries, the United States has the highest rate of infant mortality, according to the CIA World Fact Book. And in Shelby County, Tenn., which encompasses Memphis, the state health department says a baby dies every 43 hours -- a rate higher than that of any other major city. The babies most at risk come from impoverished parts of town with largely black populations.
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This old Mississippi River town is now part of the "new South." More than a million people live in Memphis' city and suburbs. As in many other places, the city has been divided between those who can afford an upgraded lifestyle and those who remain in the older version of the city.
In the richer sections they've created their own parks, hospitals and schools -- and, of course, churches.
Twice a year the Rev. Eli Morris, a minister at Hope Presbyterian, leads volunteers from his suburban congregation to a mission downtown, where they tour what can seem like a foreign country.
"When we abandon the city, I really believe that we compromise our community's future," Morris said. "And Memphis continues to be the second-most-segregated city in the country."
Young Moms and Health Risks
Five years ago, Hope Presbyterian bought a house and established a permanent mission in one of the poorest zip codes in Memphis. They named it "The Oasis of Hope" and hired a full-time manager, Karen Durham.
"We are really in a critical state on infant mortality," Durham said. "We have children having children, and they need to know that somebody is there to walk beside them. And we never know what some of these children have been through themselves. You really just have no idea where they've been."
Terry Drumwright, who has lived in Memphis all her life, heard about the mission through her church and volunteered to be a mentor to a young woman who lives in Memphis with her grandmother, mother and younger brother.
"I talked to Karen Durham and she said, 'Hey, we've got a young lady that we've been working with for a long time, and she's pregnant, and I would love for you to work with her,'" Drumwright said.
Married with two grown daughters, Drumwright lives with her husband in a Memphis suburb. She began working with Andreah "Precious" Simpson, a high school graduate, who at the age of 17 became pregnant by a 19-year-old who lived in the neighborhood.
At the time, Simpson she said she wasn't ready to be a mom.
"I'm not stable enough to have a child," she said. "I'm still a child."
Simpson considered having an abortion, but Drumwright, her new mentor, helped her decide to have the baby. Because she's young and poor, Simpson is in that group most at risk of giving birth too soon -- and premature birth is the primary medical cause of infant mortality. Drumwright's first mission was to get Precious to a clinic to begin regular prenatal care.
"We send missionaries all over the world to help people in dire situations, and this is something right here in my hometown that's just on the other side of Memphis, and it's something I can do," Drumwright said.
"Whenever I call her, she'll come by to help me. She's great," Simpson said. With Drumwright's support, Simpson began seeing a doctor each month.
"Precious is very brave, because I was that strange white lady calling her and saying, 'I don't know you, but let's get together,' you know, 'Let's go out and let's talk,'" Drumwright said.
"You know, coming up with topics of conversation at first was a little bit awkward," Drumwright added. "But at the same time, she's a girl just like my daughters. And we talk about things. We talked about boys, we talked about friends, and that's the same regardless of what color somebody is."
At a local health clinic, Simpson was found to have Group B Strep, a common infection that's usually harmless in adults but can be life-threatening for newborns.
Simpson already knew something about the risks to her baby. Her sister-in-law lost a baby when the fetus got an infection in the womb.
"She wasn't going to the doctor as she was supposed to," Simpson said.
Simpson and her unborn daughter were treated with antibiotics to head off any problems. Regular trips to the clinic had eliminated at least one threat to having a healthy baby.
'I Was Angry; I'm Still Angry'
Simpson is not alone. So far this year, unwed mothers in Memphis had given birth to 5,188 babies -- most of them delivered at the Regional Medical Center at Memphis, a big public hospital. At "The Med," as it is called, classes are held for women and girls who have the interest and the means to visit before they're in labor.
The rate of infant mortality in Memphis would be even higher if it weren't for the work of The Med, where they save more than 1,000 babies a year who are born too early. Many of them are two, three or even four months premature.
"20/20" visited Dr. Ramasubbareddy Dhanireddy, who leads the The Med's Neonatal Intensive Care Unit, as he checked in on one baby that was born 12 weeks early and weighed only 932 grams at birth.
Dr. Sheldon Korones, founder of the neonatal unit, had a successful practice in 1968, when Dr. Martin Luther King Jr. was murdered in Memphis. The young pediatrician began campaigning for a state-of-the-art newborn center at the public hospital in the heart of Memphis' inner city to help black babies who were born poor.
"I was angry. I'm still angry," he said. "The situation hasn't changed much at all. Wherever there is a high concentration of Afro-Americans -- Washington, D.C., Memphis, Tennessee, New Orleans, you name it -- there is a higher infant mortality rate. So is it a racial issue? It seems to be preponderant among black babies, this proclivity to death."
Funeral Costs and Post-traumatic Stress
The first city health department report warning that Memphis has a problem with infant mortality was issued in 1935. Today, every Tuesday and Thursday, as the bodies accumulate, the Health Department takes over for the families who can't afford a funeral.
"The county offers this service and most people gonna take it, because they do not have money to go to a private cemetery," said Robert Savage, a gravedigger in Memphis. "We do as better job as we can because we giving those bodies back to God."
The County Cemetery used to be called "Potter's Field." Now some people in the poor parts of town call it "Babyland."
"This is a great cemetery, and I have seen it over the years just explode, just explode with burying people," Savage said.
For now, Simpson is praying that her baby will live.
"It's so risky. I don't care about curly hair or blue eyes, green eyes, as long as she's healthy, that's all my main concern is, a healthy baby, 'cause you see so much nowadays, yep, so much," she said.
At the "Oasis of Hope," Durham tries to create what she calls a "safe house," where young people can escape, if only for awhile, some of the dangers that define their everyday lives. At the house, there's always running water, electricity, snacks and something to do.
Mothers-to-be like Simpson are told to avoid the physical and emotional strain that can damage an unborn child: Studies show that people living in crime-ridden inner cities actually suffer from post-traumatic stress disorder similar to veterans of war.
"The inner city is like the most stressful place, I think. The crime rate is too high. You see too much things goes on in the neighborhood," said Simpson. "Stress plays a major role in pregnancy. If you're stressed out a lot, you can easily have a miscarriage. I know several people who have lost their child due to a miscarriage. My friend Tonya, she lost her child, like a couple of weeks ago she lost her child."
Tonya Conley, who lives with her grandmother and babysits her brother's children, was 17 when she got pregnant. She went into labor four months early.
"When he came out he was already ... dead," said Conley. "They gave me, like, two pictures of my baby and stuff, and they let me hold my baby. I really wanted my baby."
"Words can't explain, I guess," said Simpson. "It's something that you live with forever, the loss of your unborn child."
Living Without Resources, or Entitlement
Drumwright said that since Memphis' infant mortality rate had been publicized, many churches around the city have said the problem would have been avoided if only these young women had chosen abstinence.
"And yes, that's important," Drumwright said. "But still we have the pregnancies, we have the babies, so we need to take care of them, we need to talk to them. And we need to educate the young moms about taking care of their child, and also about birth control and about abstinence."
Wendi Thomas, a local reporter who grew up in Memphis, often asks in her weekly column why poor people don't get more attention from elected officials.
"I think that there are a lot of assumptions that you make, we make about people who are poor -- and unless you have spent time and interacted with people who are poor, you have no idea what their lives are like," Thomas said.
"People who are poor in my experience don't have that same feeling of entitlement to quality housing, to buses that run near where they live, to a grocery store that even has produce that you would want to eat," she added. "And all these things compound upon each other to create a cycle and a system of poverty that seems, it can seem inescapable."
Buying birth control and visiting health care clinics isn't easy when you're without insurance, and you don't own a car. And many of these young mothers are raising babies alone. Nearly 65 percent of black children nationwide grow up with only one parent according to the 2006 U.S. Census American Community Survey.
Simpson hasn't spoken to her father since the day she told him she was pregnant.
"I try not to let it get to me so much, but it's not a day go by that I don't think about where he's at and why would he walk out on me now. You know, this is a big time when you need your father the most to help support you," Simpson said.
"The young women are so hungry for attention," Drumwright said, "and if that's the way they can get it, then that's the way they can get it. Because I do believe a lot of the relationships are very casual, first date, second date.
"It's not a little couple that's been going together necessarily a long time, you know, having a long-term relationship," she added. "It could be something that they just meet up and have sex. And I think that goes back to there not being any men in a lot of the children's lives."
'Every Baby Deserves a First Birthday'
In 2006, Tennessee Gov. Phil Bredeson gathered community groups and government agencies for an infant mortality summit meeting in Memphis.
The governor brought his state health commissioner at the time, Dr. Kenneth Robinson, who's also pastor of a Memphis church.
"Every baby deserves a first birthday," Robinson said at the conference. "I want this day to be the day when the people of Memphis and the people of the state of Tennessee stood up together and said: 'We're not going to be silent, we're not going to stand aside as one more child dies in vain.'"
In 2006, 202 babies died. That was far more than the number of homicides in Memphis -- 122 that same year. Even so, it wasn't the babies' deaths that usually made headlines.
"It's a very sad reality that infant deaths don't seem to get the priority, often, that some of the other high profile, newsworthy, six and 10 o'clock news stories do get," said Robinson. "When you really think about it, that infant deaths in this nation account for more deaths than all of the other causes of death combined for children up to the age of 18, we should be marching. We should be absolutely indignant about those numbers."
Officials at the meeting announced state grants to fund more studies and more pilot programs and a billboard advertising campaign.
Dr. Korones remains frustrated.
"I've been going to meetings about this with just chest-beating and programs and so on," Korones said. "But what we need to realize, and I think that we finally do, you're looking at infant mortality as a manifestation of the accumulated social inadequacies that we have tolerated historically. And we happen to be tackling infant mortality.
"There is so much else in that picture, ranging all the way from the proper lifestyle and diet, to the proper education and life itself," he added. "If you're on welfare, and you don't know where your next meal is coming from, and you have to walk wherever it is because you can't buy the gas or whatever those things are, your chances of having a healthy baby are diminished. In this community, when a premature baby is born, society has failed."
One Life Ends as Another Begins
By the time she checked into The Med and family members gathered, Simpson had carried her baby to full-term. With the help of her mentor, Drumwright, Simpson was one pregnant teenager who had done all the right things to take care of herself and her daughter, who was born at 7 pounds, 6 ounces.
It was a difficult delivery, but the baby was healthy. Precious gave her the name Bryson Lewis, the baby's father, wanted: Bryanna. But although he fathered the child, Lewis wasn't prepared to be a dad.
"The only time I met the baby's father was at the hospital the night that Bryanna was born," Drumwright said. "And he would talk so ugly to her. When she, early on in her pregnancy, she would tell me some of the things that he'd say -- I mean, it was pretty, a rough relationship."
Simpson said she's better off without Lewis, calling him a "typical thug" who has a lot of girlfriends.
"He don't care about nothing but his car, rims, money," she said. "But you know, I ain't going to hold no grudge against him. If he ever feel like he want to straighten up and be there for the baby, he can. But you know, there's nothing more between me and him. There can never be anymore us. But if he ever feel like he wants to come see the baby, I'll let him see her."
Durham said she sees past Simpson's bravado.
"I think she very much wants him to be a father, but she ain't going to say that, because that makes her weak," said Durham. "That makes her something that she doesn't want to be. That's just women. Women are very strong around here. They are very strong or at least give you the appearance of it.
"In a lot of cases they're survivors," Durham added. "So, they will raise that child with or without that man. But I don't think the thought process is any different as to everybody wants her child to have a mom and a dad, and grandparents, and all those things. I don't care who you are."
Any hopes Simpson may have had that Lewis might become part of her family ended before Bryanna was two months old. Lewis was shot dead on the street three blocks from the home of his new daughter.
Now, Simpson is forced to think about how she'll eventually tell her daughter about him.
"I ain't going to leave nothing out," she said. "I'm going to tell her the good stuff about him and the bad stuff. I think everybody should know, you know, about their parents."
The Job Search
While coping with the loss of her baby's father, Simpson had to focus on finding a job to support herself and her new daughter. She left Bryanna with a girlfriend to go look for work, but all she could find was a part-time job five miles from home -- a summer job at a city pool that paid minimum wage. It required two buses to get there.
Unemployment is rising in Memphis, and so is the teen birth rate.
It's often said that the best social program is a good job: Studies show that teenagers with jobs are happier and less likely to allow themselves to become pregnant.
When the city offered a summer work program, it got six times as many applications as it had jobs. So it held a lottery.
Even more worrisome, the Memphis and Shelby County Health Department faces more funding cuts this year, which could hurt programs that fight infant mortality. As a result, more and more programs are funded entirely by non-profit organizations.
Erma Simpson, a counselor at the Exchange Club Family Center, a non-profit group in Memphis, found that raising private money to help mothers and babies at risk is not easy.
"I sent out an APB [all points bulletin] across the city: 'Please help me, we need maternity clothes,' she said. "I had one donation of maternity clothes. I had trouble getting Pampers, so imagine trying to get $60,000, $70,000, a $100,000 grant."
But Simpson said people care less about Memphis' inner-city children because the babies at risk are black.
Dr. Linda Moses at The Med said both race and finances affects the quid-pro-quo.
"I think the bottom line, more so than race, is finances," she said. "What am I going to get back if I put all this money into this inner-city indigent program? Are they going to come out and vote for me? Are they going to do the things that's going to make me get to where I want to be? It's the human race, and basically it's a selfish race."
Despite the efforts of so many people of good will, work goes on as usual for the government workers. And as the gap in income and health between rich and poor continues to grow, so does the number of babies buried across the country in places like Babyland.