State’s Poor Priced Out of Prenatal Care; Infant Mortality Up

California, which once ranked seventh best in the nation in preventing infant mortality, has fallen to 14th place largely because of the rising number of women who receive late or no prenatal care, according to a private study released Monday.

An estimated 40,000 California babies this year will die at birth or soon thereafter, or will begin their lives at risk for serious medical problems that are largely preventable through adequate prenatal care, according to the report.

It said pregnant women who use Los Angeles County’s overburdened public clinics must wait as long as 19 weeks to get an appointment for prenatal care.

The report said that Orange County’s clinics turned away 2,000 indigent patients in 1985 because of “limited resources,” and that public clinics in San Diego County “turned away 1,245 pregnant women during a recent three-month period for the same reason.”

Elsewhere, 14 of California’s 58 counties have no state or federally funded clinics offering prenatal care, the report said.

It blamed the lack of prenatal care in part on high malpractice insurance rates that have caused many obstetricians to stop offering maternal care.

The report said local governments can make maternity care more available by removing fees that discourage early care. For example, since the 1970s Los Angeles County has charged women who have no insurance $20 to $30 for each prenatal care visit up to seven visits.

Such fees “represent a real obstacle to prenatal care (that) clearly is having an impact,” said Dr. Ezra C. Davidson, chief of obstetrics at Martin Luther King Jr. General Hospital in Watts.

He said that many of the uninsured women forgo the prenatal care in order to save their money for the actual delivery, for which the county charges about $800.

The report recommended that California provide financial assistance to encourage health professionals to set up practices in under-served communities, eliminating red tape in the Medi-Cal program that now deters eligible women from seeking care, and expanding health outreach and counseling programs for pregnant women.

The report was issued by the Southern California Child Health Network and the Children’s Research Institute of California, two nonprofit citizens’ groups. The statistics they gathered came from state and county health departments.

Separately on Monday, the California Conference of Local Directors of Maternal, Child and Adolescent Health, a statewide organization of local health officers, issued a statement saying it joined with the report in asking for a “statewide comprehensive perinatal policy and plan which addresses the needs of all women in California.” Such a plan, it said, would require a “massive cooperative effort” between the public and private sectors.

The report said many of the babies who receive late or no prenatal care will face “bleak” consequences. “Many of these babies begin their lives in hospital intensive care units--sick or disabled--at an average cost of $19,000,” the report said. “These babies account for 7% of births, but 20% of the newborn deaths.” About 470,000 babies are expected to be born in California this year.

Between 1970 and 1983, the report said, California fell from 10th in the nation to 29th in the percentage of women receiving prenatal care in the crucial first trimester of pregnancy, and from 12th to 17th on percentage of babies born with a low birth weight. The absence of prenatal care is a major contributor to babies being born underweight.

Entitled “Back to Basics: Improving the Health of California’s Next Generation,” the report, which took 18 months to research, was released at a news conference at Childrens Hospital of Los Angeles.

At the news conference Monday, William P. Hogoboom, president of the California Children’s Lobby and a former Los Angeles County Superior Court judge, said the cost of treating childhood defects due to a lack of prenatal care is 20 times that of providing the prenatal care.

According to James T. Yoshioka, chief financial officer of Childrens Hospital, each year between 10,000 and 13,000 underweight babies eligible for Medi-Cal are admitted to neonatal intensive care units in the state--at an average cost of $19,000 each. He said one-third of the admissions could have been avoided if the infants’ mothers had received adequate prenatal care.

The report, authored by Wendy Lazarus, director of the Southern California Child Health Network and former health director for the national Children’s Defense Fund, said the recommendations would more than pay for themselves by reducing costly hospitalization of newborns and remedial services that for many children can last a lifetime.

The report said California would save at least $22.4 million annually if it provided prenatal care for the 32,000 pregnant women who now go without it. If future costs of caring for disabled children are taken into account, the program could save up to $256 million annually, it said.