Too Many Babies Are Dying, Panel Says in Call for Action

Calling the country’s infant death rate “a great national disgrace” that ranks among the worst in the industrialized world, a national commission Thursday recommended guaranteed health care for all pregnant women.

“Too many babies are dying or being born too small because their mothers did not get proper medical care” during pregnancy, said Sen. Lawton Chiles (D-Fla.), who chairs the National Commission to Prevent Infant Mortality. “A child born in Hong Kong or Singapore has a better chance of surviving its first year of life than a baby born in the United States.”

The commission called upon policy-makers “to make the health and well-being of mothers and infants a transcending national priority.”

About 40,000 infants a year in the United States die before they reach the age of 1--more than the total number of deaths from acquired immune deficiency syndrome (AIDS). Many more sickly infants survive, but only after costly medical intervention, and often with lingering mental and physical handicaps.

For every 1,000 births in this country in 1985, 10.6 babies died before reaching age 1. The mortality rate for black babies was 18.2 per 1,000. In parts of South-Central Los Angeles, the infant mortality rate was as high as 22 per 1,000.

In a report released in Washington on Thursday, the commission recommended a series of policy changes--83 steps to be taken by federal and state policy-makers as well as the private sector--to improve the health of babies nationwide. Among the commission’s key recommendations is loosening Medicaid (known as Medi-Cal in California) eligibility standards to allow more pregnant women--with incomes up to 200% above the poverty level--to qualify for the government-sponsored program.

Studies indicate that prenatal care dramatically improves birth outcomes and saves money in the long run. For every dollar spent on prenatal care, $3.38 is saved in hospitalization costs of premature, sickly infants, according to the Institute of Medicine in Washington. Much more is saved when the cost of lifelong care for handicapped children is included.

“We spend vast amounts on a compassionate effort to save sick children, when we could spend far less to assure they are born healthy,” the commission report said.

Nearly 15 million American women of childbearing age have no private or government health insurance covering maternity, according to a recent report by the Alan Guttmacher Institute. About 550,000 give birth each year without any insurance protection.

These mothers are less likely than others to receive comprehensive prenatal care, consisting of between nine and 13 checkups, beginning early in the pregnancy. Their babies, studies have shown, are three times more likely to be born seriously underweight. Infants weighing less than 5.5 pounds are 40 times more likely to die during their first month of life and five times more likely to die during their first year of life.

During the last seven years, the commission reported, there was a “disturbing” 10% increase in the percentage of babies born to women receiving late or no prenatal care. At the same time, hospitalization costs for sickly newborns has soared to $3.3 billion a year.

Rae Grad, the commission’s executive director, said the report’s recommendations are designed to establish a medical safety net to assure proper medical care for all pregnant women and also for their children up to the age of 1.

“The elderly have a safety net” in the form of Social Security and Medicare, Grad said. “We need one for babies.”

Grad estimated that loosening the Medicaid standards would cost the federal government between $400 million and $500 million a year, with the states contributing an equal amount.

The commission called upon the nation’s governors to launch a full-scale attack on infant mortality and to target so-called “infant mortality disaster areas” where death rates are clearly worse than average.

Wendy Lazarus, director of the nonprofit Southern California Child Health Network in Santa Monica, which monitors infant mortality statewide, praised the commission recommendations as “presenting a comprehensive menu” for what has to be done in California. Her research shows that in 1985, 35 states did better than California in assuring that pregnant women received adequate prenatal care. By comparison, in 1970, 15 states did a better job. During the 15-year period, she said, California’s ranking in infant deaths and low-birth-weight babies also slipped.

One discouraging move recently, she said, was Gov. George Deukmejian’s elimination from next year’s budget of about $20 million in prenatal care programs.

But Lazarus praised Los Angeles County supervisors for moving to reduce long waits at the county’s prenatal clinics by setting aside $1 million last year for additional staff, and $2.4 million for the upcoming fiscal year.

Times staff writer Mark Lawrence in Washington also contributed to this story.

INFANT MORTALITY RANKINGS

Despite major expenditures on medical technology, the United States ranks 18th in infant mortality among other industrialized nations.

1. Japan 6.0 2. Sweden 6.4 3. Finland 6.5 4. Switzerland 7.5 5. Denmark 7.7 6. France 8.2 7. The Netherlands 8.3 8. Norway 8.3 9. Canada 8.5 10. Singapore 8.8 11. Hong Kong 9.0 12. Australia 9.2 13. Belgium 9.4 14. Federal Rep. of Germany (West) 9.6 15. United Kingdom 9.6 16. Spain 9.7 17. German Democratic Rep. (East) 10.0 18. United States 10.6

The infant mortality rate is the number of babies born alive but die before one year of age, per 1,000 births. Source: National Center for Health Statistics