County Found Lagging in Prenatal Care

Despite its improving record on infant mortality, Orange County lags far behind other California counties in offering adequate prenatal care, according to an independent statewide study of infant health around the state.

Orange County’s overburdened prenatal clinics turned away 2,000 indigent patients in 1985, and while half of those pregnant women were able to find care elsewhere, the remaining 1,000 received no medical attention before giving birth, according to a study by the Southern California Child Health Network and the Children’s Research Institute of California, two nonprofit citizens groups.

“What’s clear is that there is an increasing number of families who are uninsured and are turning to county services that are overloaded,” said Wenday Lazarus, director of the Southern California Child Health Network and principal author of the study.

Lagging prenatal care is a problem throughout the state, she said, but Orange County ranked 23rd of 38 counties in providing medical attention to pregnant women in 1984. According to the study, 8.2% of pregnant women in Orange County received late or no prenatal care that year, compared to an average of 7.2% in the years 1982, 1983 and 1984. The statewide average for inadequate prenatal care in 1984 was 7.1%.

“Prenatal care is the best vaccine we know for protecting a baby’s health,” Lazarus said.

Nonetheless, Orange County scored well with its infant mortality rate, that is, the percentage of babies who die within a year of birth. The rate was 7.9% in 1984, placing the county seventh among 23 counties with numbers large enough to rank. The state’s average infant mortality rate was 9.4%.

The county did not fare as well with the newborn mortality rate--the number of babies that die within 28 days of birth--at 5.3%, or eighth among 18 counties ranked.

“The most significant thing (about Orange County’s statistics) is that the access problems for prenatal care seem to be getting worse,” Lazarus said. “The challenge for all of us together is to have the prenatal services keep pace with the increasing number of babies and the increasing numbers of uninsured.”

“Even in Orange County, which most people tend to consider prosperous, there is a percentage who need to take advantage of this service,” said Kevin Sloat, aide to state Sen. Marian Bergeson (R-Newport Beach). “These are women who make enough money so that they don’t qualify for Medi-Cal but who don’t have insurance, or their insurance doesn’t cover prenatal care.” Bergeson intends to introduce legislation that would implement some of the study’s recommendations, which include eliminating red tape in the Medi-Cal program that deters eligible women from seeking care and expanding health outreach and counseling programs for pregnant women.

Seeking Solution

Rex Ehling, Orange County public health officer, said the county is aware of the problem and is working with Lazarus’ group in an attempt to find a solution.

The county’s four prenatal clinics offer care to about 1,200 women a year, but in 1985 an estimated 2,000 could not immediately find care because they could not afford it, were not eligible for Medi-Cal and did not have any place to go, Ehling said. (Women enrolled in Medi-Cal can obtain care from 84 other locations in the county, according to the report.) “If you only have space for 1,200, you can’t see them all.”

Ehling said the county attempts to help the women who are turned away by directing them to private low-cost clinics in the area. In addition, public health nurses attempt to identify whether any of the turned-away women have high-risk pregnancies. “If they find somebody with a really high-risk pregnancy, they can be referred immediately” to one of the county clinics, and room is made for the patient, he said. As for the remainder, he said, the public health nurses “do some teaching and supervision” to help the women take proper care of themselves during their pregnancies.

“We try to detect problems, prioritize them and go after real potential problems. But by keeping them (the women who cannot obtain care) in the network and by keeping an eye on them, we try to see that they get in somewhere, even if it’s an emergency room, if that’s what’s needed,” Ehling said.

According to the study, 34,343 babies were born in Orange County in 1984, accounting for 7.7% of all the births in the state that year. Teen-agers bore 8.4% of the babies, compared to the statewide average of 11.2%, according to the report. The county ranked 13th in the state for babies born under 5 1/2 pounds, an indicator of poor health.

INFANT MORTALITY RATES 1982-84

Rankings for selected California counties over a three-year period. Infant mortality rates ranged from 8.1 in Ventura County (the lowest) to 11.3 in Kern County (the highest). Orange County ranked No. 7 in 1984, the latest year in which figures are available.

1984 Change from 3-year average 1984 County Rate ’83 to ’84 from ’82 to ’84 Rank* Contra Costa 7.5 Improved 8.7 6 Kern 13.1 Worsened 11.3 23 Los Angeles 10.0 Improved 10.3 19 Orange 7.9 Improved 8.8 7 Riverside 10.6 Worsened 10.7 21 San Bernardino 11.1 Worsened 11.0 22 San Diego 9.5 Worsened 9.1 10 San Francisco 8.8 Improved 10.2 18 Santa Barbara 8.7 Worsened 8.2 2 Ventura 7.6 Worsened 8.1 1

*Latest available rankings

Source: Southern California Child Health Network