In addition to food, shelter and medical care, access to a phone is one of life’s bare necessities — at least according to the American federal government.

The story is all too familiar.

A property developer buys a large swath of land with grand plans to build high-end homes and sell them for a substantial profit. But the housing bubble bursts. The lots don’t move. The property sits empty, and eventually, the developer can’t repay the bank loan used to purchase the land. It falls into foreclosure and becomes an artifact of the U.S. real estate market crash.

What was once a construction scene characterized by luxury, mountainside housing and second-home developments has a newcomer at the table. The latest construction project in Macon County are not mini-mansions in the highlands but a low-income apartment complex in town.

Haywood County’s old hospital is set to get a new life after commissioners agreed last week to sell the building for use as low-income housing for the county’s senior citizens.

Following discussions in closed session at their Nov. 15 meeting, Commissioner Mark Swanger made a motion to sell the building to Fitch Development company for $1.275 million.

The sale, however, is contingent on the development company reaching several different benchmarks before the deed is handed over.

“There’s a lot of things that have to happen,” explained interim county manager Marty Stamey, one of which is garnering a historic property designation and listing on the National Register of Historic Places.

The company would have to apply for tax credits from the N.C. Housing Finance Agency. If the buyers can jump through those hoops, the county has agreed to front them a 20-year, $159,000 loan at 2 percent interest to get the project off the ground, and increase its competitiveness for the tax credits. Under current plans for the building, that would amount to $3,000 per unit.

Those figures might change, as the final number of units to be housed in the former hospital hasn’t been determined.

This offer is contingent on the fact that all these things come into play,” said Stamey, “but [on the current timescale] the developers would start environmental remediation and construction in April 2012.”

The building is currently home to the county’s Department of Social Services and the Board of Education. While DSS has found a new home in Clyde’s former Wal-Mart building, the Board of Education will now have to find a new space before construction gets under way.

The current plan for the building calls for 53 units. As construction draws closer, an analysis will be done to assess the current needs of the county. The results of that study may change the type and number of units.

The offer from Fitch was one of two bids presented to commissioners and offered the highest purchase price for the property.

Stamey said he sees this as a win-win for the county, who will not only get a good price for the building and pull in more tax revenue, but a valuable piece of Haywood County history will be preserved and maintained. And, elderly residents will find the housing they need.

“There’s a serious lack of elderly housing that’s affordable for seniors in our area,” said Stamey. “A lot of counties and municipalities are doing this across the state, and one of the worst things you’d want to see is for the hospital to sit up there and be a dinosaur and just deteriorate away. It has so much historic value to so many people.”

Built in 1927, the massive brick building was the first county hospital in North Carolina. It was renovated in 1955, but a full-scale renovation would, today, cost about $6 million, more than the county could afford on its own. The sale would not include the site’s excess parking or the building that now houses the Smoky Mountain Center.

It’s Thursday afternoon, and Amy Grimes has her head in a freezer digging around for a few things to add to the cardboard boxes at her feet that are already filled with food of various descriptions. A few yards away, volunteers scurry back and forth, bringing food to guests at the many table scattered throughout what was once a living room. With its cozy setting, plethora of set tables, and the inviting smell of chili wafting from the kitchen of this old house, it would be easy to mistake the scene for a mom-and-pop restaurant gearing up for the dinner rush.

But it isn’t. This is Sylva’s Community Table, where those in need can stop by four evenings a week to enjoy a hot meal, friendly company and — if they need it — some extra food to get them through. And most of all, says Grimes, handing one of the now-full boxes to a customer, they can do it with dignity.

While the Community Table has long been a busy spot in Jackson County, Grimes says her customers have changed over the last few years. As the recession has deepened,  for many the long-promised light at the end of the tunnel has not come.

As recently as last year, the Community Table hosted up 40 dinner guests each night; now they’re serving around 100 people per night on a regular basis.

“For the entire year of 2009, we served 10,335 meals,” says Grimes. “This year, through October, we’ve served over 18,000. We’re going to more than double [by the end of the year].”

The requests to the food pantry have increased as well. Grimes said she received about one request a month for take-home food two years ago, if that. Now she gets up to 80 requests for boxes every month.

Lisa James, director of Haywood Christian Ministries, echoes those sentiments. Her staff and volunteers busily pack food boxes in the basement of their Waynesville building, working to keep up with the 60-to-80-box-a-day demand they’re currently seeing.

“Last month we had 315 families in October alone,” James says.  “I don’t remember a month that we’ve had that many people.”

That change in volume has also been accompanied by a change in clientele. Historically, organizations like the Community Table and Haywood Christian Ministries have served the traditionally disenfranchised — the elderly living on fixed incomes, those with physical or mental disabilities, the long-term homeless. Now, however, working families are beginning to represent a greater portion of the needy in Western North Carolina.

It’s a fact that is reflected across the region in the percentage of kids who receive free and reduced lunch at school.

Free lunches: a barometer of the times

In Haywood, Jackson, Macon and Swain counties, more than half of public school students are getting their school meals free or at a reduced price. Jackson and Macon have been above 50 percent for the last few years: Jackson had right at 50 percent in the program in 2009, and it’s now climbed to just over 55 percent, while Macon is holding steady with 59 percent of its students getting free or cheaper food, up from 56 percent at the end of the 2008-2009 school year. Haywood County saw that statistic climb above the 50 percent for the first time this fall. The system now has 52 percent of its student body enrolled in the federal program, a 10 percent increase from just six years ago.

Free and reduced lunch numbers are often used as an indicator of how many children are living in poverty, but what, exactly, do they mean?

To get free lunch through the federal government’s National School Lunch Program, a family must be living at or below 130 percent of the national poverty level. For a family of four, that’s $28,665 this year. To get a reduced-price lunch, which amounts to 40 cents instead of the undiscounted price of $2, total family income has to be between 130 and 185 percent of the poverty level. This year, that’s anywhere between $28,666 and $40,793 for a family of four.

Lynn Harvey, Child Nutrition Director for the North Carolina Department of Public Instruction, says that these numbers aren’t isolated in the western part of the state. Children across the state have been hard hit by the slouching economy and depend on the food they get at school.

“Since late 2008, we’ve seen about at 10 percent increase in the number of students who qualify for free and reduced price meals,” says Harvey. “North Carolina now ranks second in the number of children and adults who are food insecure. That essentially means that these are children who literally do not know where their next meal will come from. That makes [school meals] a real lifeline for them.”

According to the U.S. Department of Agriculture, around 15 percent of the nation — 17.5 million people — are struggling to put food on the table, which translates into scores of children depending on outside sources of food to stave off their hunger.

Ginger Moore, the cafeteria supervisor at Jonathan Valley Elementary School near Maggie Valley, has seen this truth firsthand. She and her fellow cafeteria workers have noticed that, especially after long holiday weekends, many students come back desperately hungry.

“When a 6-year-old can eat four bowls of cereal, you know they’re pretty hungry,” she says. That, in part, is why the school has teamed up with Asheville’s Manna Food Bank to offer what they call Manna Packs. It’s a simple pack of kid-friendly food, like instant macaroni, that can feed a child through a weekend where they might not otherwise find a hot meal in front of them.

Back in Jackson County, they’re doing the same. Kids that teachers, counselors, cafeteria or social workers notice may need some food at home are getting sent away each Friday with a few things to sustain them through the weekend.

Poverty strikes children hardest

While the number of children slipping into poverty and hunger may be on the rise, the disproportionate effect of poverty on kids is nothing new. Dr. Lydia Aydlett is a psychologist specializing in children who has been working with kids and families since the 1970s. According to Aydlett, when the poverty rate increases, kids are the most at-risk.

“Children are going to be poorer than the population as a whole,” says Aydlett, and this is particularly true for Western North Carolina. Haywood County, for example, has a relatively low poverty rate of 14.5 percent, which includes everybody, from the nursery to the nursing home. But for the county’s kids — everyone under 18 — just over 23 percent of them live in poverty.

Macon County is much the same. They have a pretty low overall poverty rate — about 13 percent, the lowest among Haywood, Jackson, Macon and Swain counties — but nearly 24 percent of children there are in poverty, the highest among those four. This means that, while everybody suffers when a recession drags on, unemployment remains lackluster, and the available balance in nearly everyone’s bank account is dwindling, the consequences for the youngest are exponentially more dire.

“Living in poverty has some pretty grave consequences for kids,” says Aydlett. “In general, they’re likely to have poor education, they’re likely to have greater health problems, they’re likely to have lower cognitive skills, and that’s children across the board living in poverty. For little kids, the youngest kids, they’re the most vulnerable because their brains are still forming. As their brains are forming, they’re dependent on a good environment and good nurturing for them to reach their potential. And when kids are in poverty, there are huge family stressors.”

Being food insecure, then, isn’t just bad for the body, it’s bad for the whole child, says Aydlett, because parents are more likely to succumb to those ‘family stressors,’ to be more concerned with keeping children fed and clothed than tracking or nurturing their development. When a family is working just to survive, there is no time or energy left on which to thrive.

“Child development goes way down the list of important things when parents are worried about where the next meal’s coming from or how they’re going to pay the heating bill,” says Aydlett. She says research has borne out the theory that parents who are more financially secure are able to devote more time to their child’s development.

“There are all kinds of studies about language differences of parents who are in poverty and parents who are not,” explains Aydlett. “Parents who live in poverty tend to give children orders or directions, where middle-class families, they’re more likely to say, ‘well what did you do at school today, let’s talk about this.’ There is more conversation, more elaboration, more attention.”

Study reveals upside of economic security

A 2003 Duke University study done in Cherokee after following the casino opening found much the same result. Researchers discovered that, because of the small stipend provided by casino returns, parents were spending more time keeping up with their kids. The kids, in turn, acted out less and had fewer behavior problems, both at home and at school. Even if it didn’t have any effect at all on the parents’ lifestyle — workplace hours didn’t decrease, wages didn’t go up — that small extra measure of financial safety led to great changes for their kids.

“Exploratory analysis suggested that the quality of parental supervision was linked to parents’ sense of time pressure,” researchers reported in a university newsletter at the study’s release. “Although the casino income did not lead parents to cut down on their working hours, it did seem to help them feel less ‘pressured,’ which may have helped them to devote more attention to what their teenagers were doing. Moving out of poverty was associated with a decrease in frequency of psychiatric symptoms over the ensuing four years.”

However, Aydlett notes, being poor doesn’t, by default, deprive children of the nurturing they need to develop into healthy adults.

“It’s parent involvement. What really seemed to happen [in the Duke study] is that the money allowed the parents to be more involved, to monitor more, so you’re going to have bad outcomes, you’re going to have kids who are in trouble even in very wealthy families if they don’t have input and don’t have those relationships.

“If you’re poor but have a tight-knit family in a healthy community, even though you’re poor you’re likely to be OK,” she said.

That combination is what many programs in the community — like Head Start and even the free and reduced lunch program — aim to provide to low-income families.

Life on the edge of poverty

Charles and Karen Tucker say their family is benefiting from such programs. The Tuckers are regulars at Sylva’s Community Table, and they say it’s been a lifeline for them in raising their five children.

They’ve lived for years on the edge of sustenance, always working but never with much extra. But when the recession hit, Karen’s hours were cut at Roses, where she’s worked for 10 years, and the help they’d always occasionally taken from the Community Table became vital.

“We pretty much just live paycheck to paycheck,” she says. She is at the Community Table tonight, having dinner with her husband, still in her ‘Roses’ uniform polo and khaki skirt. Finishing her last few bites of cole slaw, she praises the efforts of organizations like the Community Table that have helped her family get by.

“If it wasn’t for them, we couldn’t make it at all,” says Tucker. She says that she and her husband, with help from their church and other community organizations, have raised their children without a poverty mindset. Although scraping by was tough, and continues to be, she has high hopes for her kids’ success. Her eldest son is in the military in Oklahoma, her oldest daughter is happily married and living in Georgia with three children of her own, and their 17-year-old daughter is currently investigating colleges.

“I’m really pushing my girls to go to college, because I don’t want them to end up like I have,” Tucker says. “It ain’t easy, I can tell you that. I mean, we’ve managed all these years, but it’s just a big struggle.”

Part of the challenge for groups trying to help families like the Tuckers is overcoming the stigma associated with asking for help, and Lynn Hunter with the state’s child nutrition program says that’s one of their greatest goals: getting food to kids who need it without exposing them to shame or ridicule.

“For any human being, when their self-esteem is compromised because they’re participating in a food assistance program, that’s a very painful thing,” she says. To combat that, Hunter and her team are pushing a breakfast-in-the-classroom program in schools statewide. If offers a low-cost breakfast to kids who don’t qualify for free or reduced price, and a discounted or free breakfast to those who do. But, Hunter says, it does much more to promote togetherness and health among all students, while quietly giving the hungry just what they need.

“It helps to remove some of the stigma associated with being the only child who arrives early to have breakfast at school,” says Hunter. “We’re trying to create an environment where all children participate, all children can enjoy.”

Schools are already halfway to this goal, no longer publicizing children who receive free or reduced lunch and offering whole-family applications for assistance, so older, more independent students don’t have to ask for themselves.

Amy Grimes of the Community Table is aiming for the same goal, trying to give help that isn’t a package deal, with shame and exclusion thrown in for free.

“It’s hard to come and ask for help anyway, so we want this to be the most welcoming, dignified environment,” says Grimes.

Many of her newer clients, she says, have never had to ask for help before and feel uncomfortable coming in. They are still working but aren’t making a living wage, and it’s those people who feel most heavily the stigma of taking help.

“They apologize for needing help, but everybody needs it sometimes,” says Grimes.

In Haywood County, Lisa James sees the same thing.

“We have seen an increase in the people who are unemployed who, in the past, have been giving to us,” says James. “Now they’re coming back and having to ask for help themselves.

“We’re seeing people who are working at $7 an hour, who were making 10 and 12. Minimum wage just doesn’t cut it.”

So as the economy continues to prove sluggish, organizations like the Community Table and Haywood Christian Ministries are striving to navigate these new waters, this paradigm shift from generational poverty to situational poverty that’s creeping steadily across greater parts of the community.

Aydlett firmly believes, even if there is no economic turnaround in sight, that the community can still help even the poorest children succeed if they are vigilant.

“Children show resilience if somebody — it doesn’t have to be parents — but if somebody really loves them, really thinks they’re the best thing since sliced bread,” she says. “We need to make sure kids have connections to grandparents, aunts or uncles, neighbors, somebody that can help provide love and support for those kids. Everybody needs that kind of person.”

How you can help

In Haywood County:

Haywood Christian Ministries

150 Branner Avenue

Waynesville, NC 28786

828.456.4838

Donations taken: food, clothing, financial gifts

Volunteers needed? Yes

In Jackson County:

The Community Table

127 Bartlett Street

Sylva, NC 28779

828.586.6782

Donations taken: food and financial gifts

Volunteers needed? Yes

In Swain County:

Bryson City Food Pantry

c/o Bryson City Presbyterian Church

311 Everett Street

Bryson City, NC 28713

828.488.8433/828.488.2480

In Macon County:

CareNet

130 Bidwell Street

Franklin, NC 28734

828.369.2642

Donations taken: food, clothing, financial gifts

Volunteers needed? Yes

Thousands of poor and low-income children across Western North Carolina rely on schools to get least at one square meal a day, but with classes now out for summer, there’s no easy solution for keeping kids fed.

“This question has been asked many times, and we’re trying to come up with a solution for the problem,” said Beth Stahl, MANNA Food Bank youth programs coordinator. “It’s scary to know they don’t have nutrition on a regular basis. We’re trying to fill in the gaps, but it’s a slow process.”

Throughout North Carolina, about 700,000 children qualify for free or reduced meals during the school year, but only 53,000 or about 8 percent get free meals during the summer, said Cynthia Ervin, North Carolina summer food service programs coordinator.

“We have a lot of work to do,” Ervin said. “I believe we can do better than 8 percent.”

The United States Department of Agriculture reimburses approved programs $1.85 per breakfast, $3.25 per lunch and 76 cents per snack.

But nonprofits, schools or other programs have to be in charge of preparing the food and keeping up with the paperwork required for reimbursement.

“It’s definitely one of the most needed federal programs,” Ervin said. “But it is the most underutilized program.”

In Macon County, 66.6 percent of the 4,239 students enrolled in public schools are eligible for free or reduced lunch. But no programs are in place to ensure those 2,825 children get good nutrition during the summer.

“It’s because we don’t have organizations that are interested or aware of the program,” Ervin said. “They just haven’t stepped up to the plate.”

Jackson, Swain and Haywood counties all have free meal centers and programs to reach kids who need food. But the number of kids fed during the summer through these programs still falls well below the number eligible for free or reduced meals during the school year.

In all three counties, any child up to 18-years-old can simply go during the right time to an open meal site and get a free meal. Proof of lower-income status isn’t required in counties where more than 50 percent of the student population is eligible for free or reduced lunches during the school year.

In Jackson County, 52 percent or about 1,500 to 1,800 students are eligible for free or reduced lunch during the school year, said Jim Hill, director of child nutrition. But in summers past, free lunch and breakfast programs have served only about 250 meals a day.

This year, Hill anticipates that number will double, he said.

“There is a major effort in North Carolina to get the feeding numbers up, and we want to be a part of that,” Hill said. “It’s going to take a lot of effort to get a lot of people involved.”

Led by Jeffery Vickery, senior pastor at Cullowhee Baptist Church, volunteers are delivering lunch to children at four free meal sites in the Tuckasegee, Cullowhee and Canada communities every weekday this summer to expand the reach of the program to more remote areas.

“These kids are spread out in little pockets everywhere,” Hill said. “You want to take it right to their neighborhood, and that’s the tough part.”

Vickery met with school officials to determine which areas had the poorest children and estimated the number of meals to prepare based on how many kids get off at nearby school bus stops.

“This is filling a gap that no one else has,” Vickery said. “The children needed the food. We are just a conduit willing to do it.”

Staff at Smoky Mountain High School prepares lunches that meet strict government nutrition guidelines, and Vickery and his crew deliver them.

Last week — the first week the four satellite sites were open — Cullowhee Baptist Church distributed 151 meals, Vickery said. He anticipates the number will increase as more children learn about the sites, he said. On Fridays, the students also get bags of food to take home for the weekend.

“We said going in that if there were four or five kids who didn’t go hungry this summer, it would be a success,” Vickery said.

Even with the new meal sites, about two-thirds of students who are eligible for free or reduced lunch during the school year aren’t taking advantage of summer feedings.

“The big challenge is that there’s other children we can’t get to,” Vickery said. “The difficulty is knowing we could feed twice as many if we had other people willing to host a site.”

Although Jackson County has seen a great improvement in the number of children getting lunch during the summer, Swain and Haywood counties only have one location where meals are served to the general student population.

In Swain County, 1,230 of 1,880 or 64 percent of enrolled students are eligible for free or reduced price meals during the school year, said Diane Shuler, Swain County school food service director.

Swain County Schools will offer breakfast and lunch at the Swain Middle School cafeteria seven weeks during the summer, starting next week.

Last year, between 140 and 150 kids came to the middle school each day to get food. Most of those children attend summer camps. Few come in off the street, Shuler said.

Although Haywood County has several meal sites, only one — the Pigeon Community Center — is open to the general public. The rest serve students in specific summer day camps.

The Pigeon Community Center also offers a summer camp for eight or nine weeks each summer and usually enrolls between 37 and 47 children, program coordinator Lin Forney said.

Forney said the day camp focuses on children whose families can’t afford other summer camps. For the entire summer, the camp costs $200. But any child up to 18 years old can come in for breakfast or lunch, Forney said.

Besides a handful of children just down the street from the center, relatively few children come in for the meals, Forney said. She said she never sees children from other parts of the county like Canton, Clyde or Maggie Valley.

“The major issue is transportation,” Forney said. “Awareness is another factor.”

During the school year, 42 percent of enrolled students in Haywood County Schools are eligible for free lunch and another 9 percent can receive reduce priced lunch. Allison Francis, Haywood County director of child nutrition, said she is sure some children fall through the cracks, and other organizations are stepping up to try to fill the gaps.

In addition to meal sites this year, MANNA Food Bank is supplying food to Haywood Christian Ministries, which in turn will distribute it every Friday to eligible kids through a program called Summer Sacks.

The kids will receive between four and a half and five pounds of food, which may include pasta meals like Hamburger Helper, dried beans, rice, fruits, vegetables and a smaller bag of kids’ snacks, Stahl said.

“With what the family is already receiving from the food bank, I would say it would last about a week,” Stahl said.

Summer Sacks is a spin-off of a similar effort in Haywood County during the school year. School counselors identify students in need of extra food on weekends, and teachers stuff it in the kids’ backpacks on Fridays to get them through until Monday, Stahl said.

The last week of school, these same students got notes put in their backpacks to let their parents know they can pick up extra food bags at the Haywood Christian Ministries this summer.

Nobody knows how many kids will come for the summer backpacks, however, Stahl said.

The Summer Sack program started with a food drive led by Bonnie Williams with the Waynesville office of Keller Williams Realty. The company does regular service projects, and Williams raised the question in a planning meeting for their spring project.

“I said, ‘Does anybody know where these kids get their food in the summer?’” Williams said. “Over the summer there would be two months where they wouldn’t get food. So we decided to take it on.”

The realtors gathered food at four locations in Waynesville and collected more than 1,500 pounds of food on a single day in May. There was so much food, they couldn’t fit it into their cars to take to MANNA. Instead MANNA had to send a truck, Williams said.

“We didn’t know how much food it would take so we worked our butts off,” Williams said.

Summer meal sites for school kids

Jackson County

• Tuckasegee Baptist Church

• River Park Trailer Park (Cullowhee)

• Jackson County Recreation Complex

• Canada Community

Lunch 12:30 – 1:30 p.m.

Haywood County

• Pigeon Community Center

Breakfast 8:30 – 9:30 a.m.

Lunch 12:30 – 1:30 p.m.

Swain County

• Swain Middle School

Breakfast 7:30 – 8:30 a.m.

Lunch 11:15 a.m. – 12:30 p.m.

Macon County

• None

Wanting to help?

Organizations interested in sponsoring meal sites should contact Cynthia Ervin, North Carolina summer food service programs coordinator, at This email address is being protected from spambots. You need JavaScript enabled to view it..

Ervin begins recruiting new sponsors in the fall and visits potential organizations. Organizations must apply and be approved before they can get reimbursement, and volunteers must go through training.

There’s no minimum requirement for how many days or weeks an eligible organization serves meals during the summer or how many kids get fed through the site, Ervin said.

“We want them to do whatever they are capable of doing,” Ervin said.

A pivotal moment arrives every time a pregnancy test turns positive at public health departments across the state.

The new mother could walk out the doors, overwhelmed and underprepared, never to return again. She could receive little or no prenatal care before delivery. She could possibly die.

Or, she could pay absolutely nothing for prenatal care, delivery and 60 days of postpartum care. Not to mention, childbirth and parenting classes, one year of Medicaid for her newborn child, family planning services, and even emotional support and advice throughout the pregnancy.

It’s a moment that nurses at Haywood and Jackson County health departments don’t take lightly.

“That’s where we grab them,” said Vicki James, maternal care coordinator for Haywood for the past 11 years.

“We really have the nurse literally come knock on my door as they get their positive pregnancy test,” said Courtney McLaughlin, Jackson’s maternity care coordinator. “As soon as we get them, we connect them to all these services.”

North Carolina has come a long way in providing support to low-income women, bringing them closer to the reality of an uncomplicated pregnancy and a healthy baby.

Moreover, Medicaid for Pregnant Woman extends generous financial aid to women who don’t usually qualify for regular Medicaid.

Yet a study released this month by Amnesty International, a human rights group, shows a major gap still exists in care given to pregnant women across the state.

The report states 15.7 percent of women in North Carolina still receive delayed or no prenatal care, equivalent to about one in six women. That number jumps to nearly one in four among women of color.

Amnesty International claims that women who do not get prenatal care are three to four times more likely to die than women who do.

With 11.4 mothers dying per 100,000 live births, North Carolina ranks 37th in the nation for maternal mortality. In comparison, Maine, the top-ranked state, has 1.2 mothers dying for every 100,000 live births.

The reasons for the disparity are manifold, but major culprits include lack of health insurance, lack of access, and lack of education and awareness.

Nevertheless, lawmakers in Raleigh have already made significant cuts to the Baby Love program, which provides nursing and social work to low-income women. They are considering doing away with the program altogether — an idea that causes deep worry for health officials across the state.

“We’re not sure where these clients will go if that program ceases to exist,” said Debbie Sprouse, adult health supervisor in Haywood County.

Logical disconnects

Julie Guffey, a 28-year-old Waynesville resident, says she can’t fathom why those who need prenatal care aren’t receiving it. Guffey qualified for Medicaid for Pregnant Women when she gave birth to twin girls almost a decade ago and easily obtained it again after learning she was pregnant late last year.

Medicaid for Pregnant Women covers all pregnancy-related costs, even those that result from complications. It also provides one year of Medicaid coverage for the newborn child automatically.

Guffey says the entire application process is very simple, and the care she’s received has been excellent. Nurses have sent her home with thick educational packets to prepare her again for pregnancy, and she’s taken advantage of free birthing classes at Haywood Regional Medical Center in the past.

“If the services are available, and if you qualify for Medicaid, I don’t see why they don’t use it,” said Guffey. “Anyone who’s not getting prenatal care, it’s their own fault.”

It is relatively easy for low-income women to receive Medicaid for Pregnant Women, commonly called “Pink” Medicaid because its ID card had been pink at one point.

Income requirements are significantly more relaxed than those that exist for regular Medicaid.

For example, a family of four must make no more than $594 each month to qualify for Medicaid for families, while they can qualify for Pink Medicaid if they make up to $3,400 each month. Unborn children are included in the family count.

But even such a generous eligibility requirement can leave those who need financial aid floundering. Pregnancies in Western North Carolina can run up bills from $4,000 to $8,000. Ultrasounds cost $500 and up, and most women need at least two per pregnancy.

Having health insurance doesn’t necessarily shelter expecting mothers from the burden of financial worries. It’s not uncommon for policies to exclude prenatal care and to consider pregnancy a pre-existing condition.

Katie Martin, a 35-year-old Waynesville mother of two, said she paid nearly $2,500 in pregnancy-related costs, despite having state health insurance.

Martin says she’s not sure many of her friends could meet the Medicaid cutoff requirement even though they’d struggle to pay for prenatal care.

Because her own pregnancy was completely normal and she didn’t take any drugs during delivery, Martin was shocked when she set her eyes on such steep bills.

“I can’t even imagine if we had issues, how expensive the delivery would be,” Martin said.

Some of her bills had to be paid upfront, but Martin was able to set up a payment plan for the rest.

“Her birth is paid for now,” said Martin of her 1-year-old daughter, laughing. Of course, countless other expenses have piled up since then.

“From conception on, they cost a whole lot more than you would think,” Martin said.

Countless barriers to care

Charlene Carswell, prenatal clinic coordinator, understands that no matter how much she and her co-workers preach, some women will always insist that they don’t need prenatal care.

They’ll say “My sister didn’t have a low birth weight baby, and she smoked a pack a day,” said Carswell.

Others adamantly argue that no one received prenatal care a hundred years ago, so there’s no need for it now.

But late or no prenatal care can be detrimental to both the mother and the baby. It can lead to preterm births, dangerously low birth weights, gestational diabetes, and babies that haven’t fully developed.

Many of the women who don’t receive prenatal care do not have health insurance. Even those who have Medicaid may have trouble tracking down doctors who accept it.

Women who can’t afford medical care often put off early prenatal care to save up for the costs that’ll greet them in the third trimester. They pick and choose which tests they’ll get done and which they’ll skip. Even though it’s recommended that pregnant women get a check-up at least once a month, they’ll pass on those as well.

“They say ‘If I’m going to have to pay for the delivery, I’ll save for the delivery, not monthly visits to doctors,’” said Tania Connaughton-Espino, Latina program manager for the North Carolina Healthy Start Foundation, a nonprofit devoted to reducing infant death and illness.

Since Pink Medicaid applications can take up to 45 days to be approved, some patients who qualify for the aid skip out on appointments until it is formally approved.

Other barriers include lack of access to treatment, whether it’s not owning a car to drive to the health department or not being able to take off from work to make an appointment. Mothers might also not be able to line up childcare for their other kids while they are visiting the doctor.

And sometimes, it can be hard to even get an appointment with the recession sending waves of newly uninsured people to local health departments.

According to Connaughton-Espino’s experience, some women just might not see why prenatal care is necessary. They wonder why they’ve given up several hours of work time to wait for a 15 minute appointment with a nurse who measures their belly and takes their temperature.

“We just need to makes sure that moms understand that they can make that appointment important for them and ask questions,” said Connaughton-Espino.

According to Connaughton-Espino, the best route to a solution is through education. Some expecting mothers just don’t know when they’re supposed to take a prenatal vitamin or how often they should visit the doctor.

A whole other category of women who are not receiving prenatal care are undocumented workers. Because citizenship is a requirement for Pink Medicaid, illegal immigrants who are expecting often are left behind.

They do have the option of applying for presumptive eligibility Medicaid, which provides care until an application is formally approved or denied. However, this kind of Medicaid promises only a maximum of two months of care. It allows only minimal contact with a doctor and does not cover the cost of delivery.

At most public health departments, undocumented workers pay on a sliding scale based on their income. Even though the cost of care might be within reach, undocumented immigrants are afraid to even show up on the health department’s doorstep.

“They fear that they’re going to be arrested or shipped back to Mexico,” said Adrienne Maurin, a licensed therapist at Jackson County’s health department.

“Some of them come in later for care, some decline testing doctors recommend,” said McLaughlin, who tries to schedule ultrasounds and any other major tests within the few weeks that undocumented workers gets Medicaid coverage.

Children of undocumented workers who are born in the U.S. automatically get American citizenship, but they might still receive inadequate care because of their mother’s illegal status.

Carswell doesn’t think that that’s fair.

“It’s not the baby’s fault, whoever is pregnant,” said Carswell. “You just have to have good prenatal care.”

For many low-income women, pregnancy can lead to more stress than excitement. Most of the expecting mothers who visit local health departments are facing unplanned pregnancies.

Maternal care coordinators across the state have experienced firsthand all possible emotions along with the patients they support.

“I have a box of Kleenex in my office that I just leave here,” said Courtney McLaughlin, maternal care coordinator for Jackson County.

As part of the Baby Love program, maternal care coordinators contact patients once a month to check in throughout the pregnancy and up to two months after the mom delivers.

“Nine times out of 10, you’re their support system,” said Vicki James, maternal care coordinator for Haywood County. “You talk to them just like you do your own kid.”

Often times the father of the baby isn’t involved or the parents have turned their back on their pregnant daughter. So James picks up the slack and provides advice like a mother would.

She advises women on where to buy cribs, tells them how often they should see their doctor, and answers questions about what is or isn’t normal during a pregnancy.

James has made a lot of friends through her work, but the job comes with many ups and downs.

“It’s very rewarding, it’s very frustrating,” said James.

Jackson County, one of the few counties in the area to have a high-risk prenatal clinic, routinely sees extreme social work cases. Some expecting mothers are dealing with weighty issues, like sexual and physical abuse.

“You don’t know until you make a home visit what this pregnant girl is going through,” said Charlene Carswell, prenatal clinic coordinator for Haywood County.

Adrienne Maurin, a licensed therapist at Jackson’s health department, said she’s recently treated a pregnant woman who was just recovering from a substance abuse problem while simultaneously battling a mental illness.

Others have no psychological issues but come to Maurin just to vent their frustrations.

“They say, ‘I’m pregnant, and I don’t have a job, and I can’t get a job because I’m pregnant,’” said Maurin. “That causes a lot of stress for most of the ladies.

Of course, not all women who visit the health department have unhappy endings to their stories.

Carswell recalled a teenager who was petrified about her mother discovering that she was pregnant.

“Several of us cried with her,” said Carswell. “She was in a state.”

But when her mother found out, she was supportive, and to top it off, the baby’s father re-entered the picture.

James remembered one Hispanic woman who prepared a generous meal for her when she paid a visit, even though the woman had little to feed her own family.

“We had already ate, but we ate again,” said James, who was touched by the kind gesture.

James has seen women from all backgrounds, education and income levels and says there’s no stereotype for the kind of woman who takes advantage of the health department’s services, especially since the economic downturn.

Many who come in are finding it difficult to purchase basic baby supplies, like diapers, carseats and cribs — none of which is covered by Medicaid for Pregnant Women. Maternal care coordinators help provide some of those supplies, though their resources are quickly drying up.

“I’ve seen moms who have slept a baby in a laundry basket or a drawer,” said McLaughlin. Others share a bed with their baby, sometimes leading to cases of suffocation.

Maurin said she worries about her patients quite a bit, especially about the risks of post-partem depression.

“They are more prone to it because of the level of poverty,” said Maurin.