Prenatal Care in L.A. Worsening, Report Concludes

Times Staff Writer

Growing numbers of women in Los Angeles are not receiving adequate medical care during pregnancy, according to a report issued Monday by a nonprofit group that monitors infant mortality and the availability of prenatal care to women statewide.

The group, the Southern California Child Health Network, criticized Gov. George Deukmejian for cutting from next year's budget more than $20 million in prenatal care programs for pregnant women. This care is a proven, cost-effective way of promoting healthier babies, health experts say.

Wendy Lazarus, director of the network, called the cuts "short-sighted" and said the governor is moving "in absolutely the wrong direction."

Experts say that babies born without prenatal care are four times as likely to die in their first year of life and three times as likely to be born sick or premature.

High Hospital Costs

Hospitalization costs of these tiny infants in California amount to an estimated $126 million a year in public funds, according to a recent federal study. Experts say that much of the expense, as well as the human suffering, could be avoided if mothers received adequate--and relatively inexpensive--prenatal care. Doctors say this care should consist of nine to 13 medical checkups, beginning early in pregnancy.

For each dollar spent on prenatal care, the Institute of Medicine in Washington estimates that $3.38 can be saved in newborn intensive care costs. An additional $6 is saved when all costs associated with caring for permanently disabled children are included, according to other studies.

Across the state, more and more babies are being born sick or premature, as pregnant women face increasing difficulty in getting adequate medical attention, according to a separate report issued in March by the Southern California Child Health Network.

$21.5 Million in Cuts

Deukmejian left $28.5 million in the state's maternal and child health care budget, Lazarus said, while eliminating $21.5 million that would have funded a variety of prenatal care programs. He cut, for example, $8 million in federal and state funds that would have liberalized Medi-Cal eligibility standards for pregnant women seeking prenatal care, thereby extending coverage to thousands of woman whose income, for a family of three, amounts to $18,000.

In a formal message, Deukmejian stated that he was cutting the money because it "simply is inconsistent with the need to protect current, vital programs and provide for a prudent reserve for economic uncertainties."

The governor also cut an estimated $6.5 million that would have boosted by 18.8% the Medi-Cal reimbursement rates for obstetricians performing normal deliveries. The funding was advanced by the Legislature as an incentive for obstetricians to treat low-income women. The Southern California Child Health Network reported in March that there are 15 counties in the state where there are no obstetricians willing to provide prenatal care to pregnant women on Medi-Cal. The governor maintains that his budget already contains sufficient physician rate increases.

The governor also eliminated millions of dollars for outreach programs designed to educate women about the importance of seeking prenatal care.

"There are women out there--impoverished, uneducated, frequently drug-addicted, unmarried teen-agers--who we have to go out there and try to reach," said Dr. Irv Silberman, head of maternal health and family planning programs for the county of Los Angeles. He said that he recently met with a private group of people who are trying to brainstorm ways of reaching out to treat some of these "hard-core" cases in South-Central Los Angeles.

Silberman said he is pleased that the latest available statistics for 1986 show record lows in the number of babies who are born underweight and who die within their first month of life.

But, he acknowledged, "there are still many women who don't get adequate prenatal care." He said the county has made prenatal care an important priority in the last year and additional funding has enabled the Health Department to significantly reduce the waiting time for prenatal visits at county clinics.

A recent survey of 13 public clinics by the Southern California Child Health Network confirmed that the wait for an appointment has been cut from an average of eight weeks to about four weeks.

Lazarus said that the last year has been a period "of major progress for Los Angeles County." Yet, she added, the percentage of women receiving late or no prenatal care has grown from 9,041 in 1985 to 9,839 in 1986, amounting to an 8.8% increase.

As for those women who received no prenatal care at all, Lazarus said, these numbers grew from 2,209 in 1985 to 2,838 in 1986, amounting to a 28.5% increase.

Of the 31,000 births at county hospitals, Lazarus' report said that one in six babies were born to mothers who had received absolutely no prenatal care.

"For whites and Hispanics, the percentage of women receiving late or no prenatal care increased between 1985 and 1986," the report said. "For blacks, the already high percentage showed no improvement."

In 1986, black babies died during the first month of life at a rate of 23 infants per 1,000 births--more than twice the rate of white and Hispanic babies.

At the large county hospital in Watts, the Martin Luther King Jr./Drew Medical Center, between 27% and 30% of the babies were born to mothers who received no prenatal care, according to officials at King.

PRENATAL CARE IN LOS ANGELES COUNTY

More white and Hispanic women in Los Angeles County went without needed prenatal care in 1986 than in 1985, and the rate among black women did not improve.

1985 TOTAL LATE** 1986 TOTAL LATE** TOTAL BIRTHS* OR NO CARE TOTAL BIRTHS* OR NO CARE (PERCENTAGE) (PERCENTAGE) (PERCENTAGE) (PERCENTAGE) WHITE 42,746 1,113 49,415 1,386 (28.2%) (2.6%) (30.8%) (2.8%) BLACK 20,266 1,527 20,566 1,537 (13.4%) (7.5%) (12.8%) (7.5%) HISPANIC 74,146 5,706 75,676 6,300 (48.9%) (7.7%) (47.1%) (8.3%) ALL WOMEN 151,513 9,041 160,557 9,839 (6.0%) (6.1%)

* Births for 1985 and 1986 only include births to Los Angeles County residents that occurred in Los Angeles County. ** Beginning in the third trimester of pregnancy.

Source: Southern California Child Health Network

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