Taking an obvious, but largely overlooked, approach to problems of infant mortality, the Baltimore Healthy Start program has been working with fathers since 1991. The shift upset social workers, and recipients, but is involving a growing number of men in constructive activity. This is the second of three articles on new approaches to reduce teen pregnancy in Oakland, Baltimore and Denver. PNS associate editor Joan Walsh, a Bay Area based journalist, authored a recent report for the Rockefeller Foundation entitled "Stories of Renewal: Community Building and the Future of Urban America."

BALTIMORE -- Daisy Morris was a "traditional health administrator" working in maternal and child programs until her moment of truth.

"You'd have thought I believed in immaculate conception," Morris recalls, "because with all the programs I did for mothers and babies, I had nothing to do with fathers."

That all changed in 1991, when Morris became director of Baltimore's innovative Healthy Start initiative, a federal program intended to reduce infant mortality in U.S. inner cities, where babies die at rates higher than in many Third World countries.

It has helped. Working in close collaboration with other agencies and groups, they have brought violent crime and infant mortality down an estimated 20 percent, raised school attendance and helped find jobs for 800 residents -- a healthy number in a neighborhood of 10,000.

Early in the planning, Morris recalls, a staff member challenged her. "He said 'You're not relating to the dads.' That hurt me, but I realized he was right."

"So we began to change the way we do business. We can't raise children with mothers only. We have to be about forging relationships between father and child -- and father and mother, where that's possible."

Morris's change of heart reflects a larger shift in the world of anti-poverty programs, away from service provision and toward fostering relationships through which poor people can help each other and themselves. The new "community building" thrust recognizes that many poor neighborhoods once were richer in social relationships -- extended families, church networks, neighborhood associations -- that provided ladders of opportunity into the mainstream, and cared for the people who fell from those ladders. Antipoverty programs, community builders argue, should aim to strengthen social bonds that have been eroded by isolation and poverty.

Baltimore Healthy Start pursued that goal by hiring low-income community residents, not social workers, to reach out to their pregnant neighbors and link them to prenatal care and other support. Then it began a slow process of outreach to the fathers of children expected by women in the program.

"It really started with me doing home visits to the women. I'd run into the boyfriends, who'd be suspicious, " recalls Joe Jones, who now directs male services. "When I convinced them I was there to help, they'd say, 'Hey man, can you get me a job?"'

Jones then sponsored focus groups with men in the community, "and the first thing we realized is, these guys need to talk. We'd plan meetings for an hour and a half and they'd want to stay three or four hours." So they began support groups and developed a curriculum on manhood and fatherhood.

Then the program added a jobs component. Men who regularly attended groups and classes were eligible for construction jobs starting at $8 an hour. Soon it will begin a "coparenting" program, teaching couples who may not stay together how to cooperate to raise their children -- difficult for low-income couples, where a history of unemployment, drug abuse or prison may have left the father with no relationship to his family.

Today Baltimore Healthy Start serves 160 men with eight outreach workers and two administrators. The shift required Morris and Jones to challenge the mind-set of programs for inner-city women. "We were so much for the moms, sometimes we were perceived as being against the dads -- as trying to get the woman away from the man, out of a bad relationship," Morris explains. "Now, safety for women is still critical. We don't want them in violent situations. But we also have to be about strengthening relationships. They may not stay partners with the dad, but they should have some relationship that at least lets them coparent their children."

Was the shift controversial? "Oh, it divided our staff," Morris says. "Some of the women we serve were opposed, too. It was like, 'You're gonna provide all these services for those low-down dirty dogs?' And I had to ask them, 'Do we want these men to change -- or do we just want them to suffer?"'

It's not all hearts and flowers. "We have two or three moms sharing the same dad in our program right now," Morris sighs. "We deal with all of it." Jones acknowledges some women remain unhappy with the services for men. "In some cases the relationship has ended and the dad's got a job, and the mom doesn't, and they don't get along, and the women feel like, "Why are you helping him?' But I have the attitude that even if the relationship doesn't work out, it's better to have that man employed than selling drugs and hurting the community. And down the road he might develop a relationship with the mother and child."