High Cost of Neglect

Stark new numbers validate the perils of federal, state and local budget cuts in programs providing care for pregnant women. The United States now ranks highest among the 20 leading industrialized nations of the world in infant death rates. And California, once a leader in prenatal services, now ranks 14th among the 50 states in terms of infant mortality, 29th in terms of early prenatal services.

Prenatal-care programs have been the victims of underfunding and budget-slashing, but the terrible paradox is that taxpayers’ bills have gone up, not down, as a result. Prenatal service costs less than the expense for a single day in an intensive-care perinatal ward. Neglect of prenatal care radically increases the risk of underweight infants, premature birth, birth defects and retardation.

The coincidental release of two important and instructive reports may now help the nation get its priorities right. The Children’s Defense Fund reports on the 30-year slide of the United States from sixth place to last place in infant-mortality statistics among the major industrialized nations. The Southern California Child Health Network and the Children’s Research Institute of California expose in their report the deteriorating situation in prenatal care in California.

“A black infant born within five miles of the White House in our nation’s capital is more likely to die in the first year of life than infants born in Third World countries like Trinidad and Tobago or Costa Rica,” the Children’s Defense Fund found.

“California’s health record for mothers and babies, once among the nation’s best, is mediocre and getting worse,” the state study concluded.

Both reports emphasize the importance of access to prenatal care for pregnant women beginning in the first trimester.

“A key major factor that distinguishes the United States from countries that have reduced infant-mortality rates more rapidly is the provision of maternity services,” the Children’s Defense Fund reported. “Of all the industrialized countries, the United States stands alone in its failure to as sure pregnant women access to prenatal care and delivery services through either a public health service or universal health insurance.”

The Comprehensive Perinatal Provider Program of Assemblyman Burt Margolin (D-Los Angeles), which went into effect Jan. 1, may help ease some of the problems in California. But significant obstacles remain. One in five women who have babies at Martin Luther King Jr./Drew Medical Center have had no prenatal care, according to Dr. Ezra C. Davidson Jr., chairman of the department of obstetrics and gynecology at Drew. Many stay away because of the fees for clinics in Los Angeles County, raising a serious question about the validity of those fees because of their potential for creating costlier problems later. The low fees paid to obstetricians by Medi-Cal, the poverty health insurance program, have discouraged many obstetricians from participating in Medi-Cal, making access to prenatal care for low-income women practically impossible in some areas of the state. In Orange County alone in 1985, overburdened public clinics turned away 2,000 pregnant women, and only half of these were able to find any alternative care before delivery.

A solution is outlined in the California study. It would cost an estimated $32 million a year to assure universal prenatal care in the state. “This investment would yield a total savings of $54.4 million, and a net savings of $22.4 million in the first year alone,” the report asserts. The Legislature will have an opportunity to test the proposals. State Sen. Marian Bergeson (R-Newport Beach) has agreed to introduce a bill embracing the recommendations, sponsors of the report announced.

No new program has easy sailing under the budget restraints that California voters have imposed. But one fact may facilitate the process: The evidence is persuasive that every dollar spent on prenatal care saves $1.70 in the costly programs required to remedy neglect.