Birth of a Notion

Authors of ‘What to Expect’ books use their clout to start charity that serves the needs of poor pregnant women

When Heidi E. Murkoff was asked to talk to pregnant inmates at Rikers Island about how to improve their chances of giving birth to a healthy baby, she had little idea what to expect.

As she conversed with the women, many of them emaciated from drug abuse — except for their swollen bellies — Ms. Murkoff passed out free copies of her best-selling book, What to Expect When You’re Expecting, and hoped that her words, both spoken and written, would inspire them to take better care of themselves and thus give their infants a better start in life.

Ms. Murkoff was inspired, too. She realized that the book, even though it contained much that interested the women, was not written in a way that made it immediately accessible and useful.

So two years ago, Ms. Murkoff decided to put her own entrepreneurial skills to work to create the What to Expect Foundation, a charity that is developing a series of easy-to-read pregnancy and child-rearing books, as well as videos, to be distributed free to expectant mothers and fathers living at or below the poverty level. The charity is also raising money for health and literacy programs across the country that work to improve the lives of poor families.

Joining Ms. Murkoff in founding and running the charity were her co-author and mother, Arlene Eisenberg, and Lisa Bernstein, former marketing director for the “What to Expect” series, which also includes What to Expect the First Year, What to Expect: The Toddler Years, and What to Eat When You’re Expecting. Since 1985, 19 million books in the series have been sold. A USA Today poll found that 93 percent of all pregnant women who buy a pregnancy book buy What to Expect When You’re Expecting, a comprehensive month-by-month guide that includes everything from information on myriad medical procedures to a selection of healthful recipes.

While Ms. Murkoff and her mother have contributed a total of more than $100,000 to the What to Expect Foundation and have pledged to make annual donations, the charity has a grassroots aspiration. It hopes to convert legions of loyal readers into donors who can help other parents by participating in fund-raising “strollerthons” and other events, and by volunteering at health-care and literacy charities.

And although it is still in its infancy, the charity has already been successful in attracting support from a handful of large corporations eager to be associated with the popular What to Expect name.

“It’s easier to open doors when you have the What to Expect name,” Ms. Murkoff says. “This is a great opportunity to use corporate money for good.”

In August, the charity received a $1.5-million grant from Nissan Motor Company to finance the development of its first book, tentatively titled Baby Basics: Pregnancy, which is due to be published by the end of the year. The automaker has also donated two minivans — one to Children’s National Medical Center, in Washington, and one to a childbirth center in Phoenix, to transport expectant mothers to and from the doctor’s office.

The relationship began in 1998 when Nissan asked the What to Expect authors to team up with the company for a publicity campaign on car-seat safety. Ms. Murkoff and Ms. Eisenberg wrote a booklet titled The What to Expect Guide to Car Seat Safety in exchange for a donation to the new charity. Nissan has distributed more than a million copies of the booklet to pediatricians’ and obstetrician and gynecologists’ offices across the country, and another million will be distributed by the end of the year.

Other corporations have since joined in. Target Corporation has donated $150,000 to the group, including $50,000 to develop a Spanish version of Baby Basics. The Prudential Insurance Company of America and Pfizer have each donated $25,000 toward researching and developing Baby Basics publications.

The need for such materials is great, says Benita Somerfield, executive director of the Barbara Bush Foundation for Family Literacy, which makes grants to programs that encourage families to improve their literacy skills.

“This is an area where there’s a tremendous need for written information that speaks to the experience of poor women, crossing whatever ethnic lines,” says Ms. Somerfield, who has advised Ms. Bernstein on getting the What to Expect Foundation off the ground. “These women don’t have access to the prenatal care they need, and even if they do, they’re often intimidated and they do not go. We need to put materials in their hands that enable them to take care of themselves and their babies. That does not exist at this time.”

Experts agree that the nation’s health-care system has made much progress in the past two decades in providing poor and uninsured women with prenatal care and in lowering the number of babies who die at birth or in infancy. In fact, the percentage of women who began prenatal care in the first trimester of pregnancy rose for the ninth consecutive year in 1998, to 83 percent. The infant-mortality rate was at an all-time low — 7.2 deaths per 1,000 babies born in 1997, the most recent year for which statistics are available.

However, many challenges remain, especially for minorities. The infant death rate among black babies is more than double what it is among white babies; among American Indian babies, the death rate is nearly one and a half times what it is among white babies.

“Getting people access to the health-care system is just the start of it,” says Stephanie Denning, director of marketing at Denver Health, the government agency that oversees health care in the Denver metropolitan region. “It’s also about helping them to understand how to use the health-care system in an appropriate way, not just for a birth but for the rest of their life and the rest of their baby’s life. And it’s about teaching them healthy lifestyles for their children.”

The goal of the What to Expect Foundation is to help provide that information to poor and minority women, says Claudia Morris, the charity’s program director.

“We’re taking a different approach to reaching a population that always felt tuned out because they didn’t think they were being talked to,” says Ms. Morris, former deputy executive director of Healthy Mothers, Healthy Babies, a national coalition of organizations that focus on the importance of prenatal care. “We’re trying to get at issues that are not discussed in mainstream books that these women may have questions about but don’t know where to go to get answers.”

Indeed, the What to Expect Foundation is designing its materials to appeal to women from a variety of ethnic and racial backgrounds, and will include in those materials information specifically of use to poor families, such as what government programs and benefits are available.

In developing Baby Basics, the What to Expect Foundation sought help from pregnant women and community health outreach workers — people who work closely with residents in poor neighborhoods, usually visiting them in their homes. Often those workers — many of whom are employed by or volunteer for non-profit health-care organizations — are themselves from the same neighborhoods and share the same cultural and economic background as those they seek to help.

The charity asked focus groups composed of health-care workers in the New York and Los Angeles areas to read What to Expect When You’re Expecting and to make suggestions on how the book could be changed to make it more accessible.

“They told us the book has too much information and not enough information at the same time,” says Ms. Bernstein, the former What to Expect publicist who left her job as an associate publisher to become executive director of the charity. “There was not enough about the reality of some of these women’s lives.”

Based on the feedback, the charity decided that Baby Basics should include quotes and stories from women and men with whom its readers would identify. They also decided to begin each chapter with an eight-page summary that includes all of the pertinent information from the chapter in its simplest form.

Once the Baby Basics draft is completed, the focus groups will read and review it and offer additional recommendations. The book will also be examined by an advisory committee composed of medical and health-care professionals and grassroots health-care workers.

Creating the Baby Basics books is just the beginning, Ms. Bernstein says. The charity has also been working to figure out how to get as many books as possible into the hands of those who need them — 200,000 by the end of this year. And, it eventually hopes to produce and distribute MTV-style videos on pregnancy and child-rearing, featuring celebrities who will appeal especially to young mothers.

With help from organizations such as the March of Dimes; Healthy Mothers, Healthy Babies; and the National Coalition of Hispanic Health and Human Services Organizations, the group is putting together lists of health clinics and charities that serve pregnant women, where books and videos can be donated.

And it has organized a handful of fund-raising events to finance the printing and distribution of the first round of books.

The first is a two-day event in Minneapolis, scheduled to start April 7. Sponsored by Target, it will feature a $25-a-plate dinner with Ms. Murkoff and Stephen R. Covey, author of The 7 Habits of Highly Successful Families, as speakers, and a baby fair the following day with vendors, speakers, and information on child rearing, education, and other topics.

The price of the dinner was deliberately kept low, Ms. Bernstein says, to encourage middle-income parents to attend.

“In some way what we’re trying to do is create a popular movement,” she says. “When it comes to issues of poverty, it’s hard to get people to take time out of their lives to do something about it. But when they become parents, that’s the time in their life when they relate more than ever to others.”

The money raised will be used to distribute Baby Basics in the Minneapolis area, Ms. Bernstein says.

Ann Aronson, director of community relations at Target, says the company was enthusiastic when it was approached two years ago by the What to Expect Foundation, even though the charity was so new that it had no track record.

“The What to Expect books had such high credibility,” she says. “And after meeting with Heidi and Lisa, we felt very confident in what they would be able to do.”

Three additional fund-raising events are planned for the fall, two in New York and one in Los Angeles. For one New York event, Ms. Bernstein is relying on her former colleagues in the publishing world. The evening will feature writers reading from their works and talking about the importance of reading to children.

The two other events are maternity fashion shows, for which designers are being asked to donate their services to create one-of-a-kind outfits for mothers-to-be, as well as for new fathers and babies.

But what the charity hopes will become its signature event isn’t scheduled to happen until 18 months from now. In fall 2001, the What to Expect Foundation plans to hold its first national “strollerthon,” in which parents in cities and towns across the country will be encouraged to plop their babies in buggies and stroll to raise money for literacy programs and charities that rely on community health outreach workers.

“These are the workers who go into expecting mothers’ and fathers’ homes and open the fridge and say, ‘You don’t have milk. Let’s go to the supermarket and I’ll show you what to buy.’ Or, ‘I’ll show you some games to play with your baby,’” Ms. Bernstein says.

She adds, “We want to become an organization that helps these programs grow.”

Health experts say many programs that send trained health-care workers into neighborhoods are chronically underfinanced, even with support from large grant makers such as the W. K. Kellogg Foundation. In 1998, Kellogg began a five-year program to distribute $55-million to 13 areas across the country that are relying on neighborhood health-care workers to help the poor.

“What we’re realizing is that with the diversity of the population, you need to have people who know the community, people who speak the language, who can go in and talk to residents and give them the help that they need,” says Halcyon Liew, a spokeswoman at the Kellogg Foundation.

For its part, the What to Expect Foundation plans to continue to capitalize on those now-famous three words to run its charitable programs. HarperCollins Publishers, which this spring will begin publishing a series of What to Expect books written by Ms. Murkoff for kids, has pledged to donate a yet-undisclosed percentage of the books’ profits to the charity.

And Bliss Spa, a popular day spa in New York, recently presented the group with $25,000 after it chose the What to Expect Foundation as the first beneficiary of its new philanthropic venture — a T-shirt company in which all profits go to charity.

Ms. Bernstein is confident that the enduring popularity of the “What to Expect” series will continue to fuel the charity: As of this week, What to Expect When You’re Expecting, which has made numerous appearances on the New York Times bestseller list over the last 15 years, had popped back on.

“What we bring to the table,” Ms. Bernstein says, “is really the fact that What to Expect is a great name that will raise money.”