Child Neglect

Doctors know many of the questions to ask pregnant women to improve their chances of having healthy babies. But doctors cannot ask those questions unless they see the women at some point during pregnancy. In America today, too many poor women do not receive this prenatal care. As a result, too many babies die or are born with diminished prospects.

Between now and 1990, 16,500 babies will die primarily because they are born too small to survive, according to the Children’s Defense Fund. At least one in nine of those deaths could be prevented through sound prenatal care.

It is a national problem, a state problem, a local problem. In California in 1984, 32,000 babies were born to mothers who received late prenatal care or none at all. In South-Central Los Angeles, Martin Luther King Jr. Hospital handled almost 8,000 deliveries last year. About 20% of those maternity patients had no prenatal care. More than 40% of the stillbirths and deaths of infants less than 1 month old come from that group of women.

Numbers, but what do they mean to the mother and to the child? And ultimately to society?

Women who receive medical care during pregnancy can give doctors information that they can use to anticipate trouble or treat it when it occurs. Dr. Jeffrey Pomerance of Cedars-Sinai Medical Center says that simply knowing when a woman became pregnant helps in knowing when her baby might be long overdue and at greater risk.

Prenatal visits can help doctors spot high-risk pregnancies. That can reduce the chances that babies will be born weighing too little to survive at all or without some impairment. A premature infant may lose weight faster than calories can be replaced. Its lungs may be immature. It may have heart problems because a key vessel hasn’t closed as it does with infants carried to term. It may suffer from infections more easily.

Poor women are not the only ones who have premature babies. Expert care doesn’t guarantee lack of problems. But only with some medical attention can come the care that could reduce some of these problems. Dr. Ezra C. Davidson Jr., who heads King Hospital’s obstetrical department, says that half the women who delivered their babies there but had no prenatal care had neither money nor insurance for that care.

Advocates like the Children’s Defense Fund blame the White House for failing to respond to these human tragedies. On top of past cuts, President Reagan’s 1987 budget would freeze maternal and child-health grants at their present $478-million level, despite increasing need. The Gramm-Rudman arbitrary deficit-cutting plan would cut $21 million from those grants alone. If these cuts are made, California must provide the money to maintain existing services. The state could also help by implementing AB 3021, a new program sponsored by Assemblyman Burt M. Margolin (D-North Hollywood) that seeks to improve prenatal care for the one out of every four mothers eligible for Medi-Cal.

Such programs cost money. But it costs more not to provide them. In one recent year more than 13,000 newborns required more than 85,000 days of intensive care in California at a cost to the state of more than $68 million.

Why is this happening, when for 50 years the United States has had a commitment to providing at least some health care for poor children? Dr. Arden Miller of the University of North Carolina, an expert on maternal and child health, recalls that the bipartisan commitment began in 1929 with a White House conference called by President Herbert Hoover. The breakdown came with the Reagan Administration’s policy of pushing responsibility for social programs down to the states. The poor are caught in an ideological squeeze, Miller says.

The American people, speaking through opinion polls, say that they still care about the poor. The American people need help in Washington to translate that care into national policy. They are not getting that help, and neither are the children.