Prenatal Care Is Still Out of Reach for Many Poor Women

The waiting room at the county’s 17th Street maternal and child health care clinic in Santa Ana is more crowded than ever. On any given weekday, its 75 seats are filled with indigent women and their children.

Many of the women come to the clinic seeking prenatal care, something most physicians consider crucial to having a healthy baby. They are mostly poor Latino women who have neither Medi-Cal benefits nor insurance, nor in most cases legal status in this country. And, except for a few community clinics, the county is the only place they can go for care.

Though the county expanded its prenatal care program by 30% last January, county health officials say they still cannot keep pace with the demand. Health officials predict that this year, despite expanding to serve 500 more women, the county’s four prenatal clinics will turn away about 2,000 women, just about as many as they will serve.

Last year, the clinics turned away about 1,500 women. The year before, they turned away 1,650.

The four clinics cost about $1.9 million a year to operate, said Len Foster, a deputy director of the county Health Management Agency. About $1.25 million comes from the state. The remaining $650,000 comes from county funds.

“We do the best we can,” said Julia Arriaza , nursing supervisor at the 17th Street clinic. “My nurses get very frustrated. They say, ‘What do I do? Play God?’ ”

Arriaza said women with high-risk pregnancies--diabetics, for example, or those who have miscarried before--are immediately referred to UCI Medical Center, where they must be accepted. The rest, she said, are ranked according to their age, the number of their previous pregnancies and their living conditions.

Teen-agers are given priority over mature women, single mothers over married women, and women who already have five or six children over those with one or two.

Women turned away from the prenatal program receive a list of community clinics that provide various levels of prenatal care. Those eligible for Medi-Cal--only about 500 last year--are given a list of the few county doctors who accept Medi-Cal patients.

Arriaza noted that even the healthiest women can have difficult pregnancies.

“The majority of the patients here are high risk because of the environment they have,” she said, noting that many are farm workers and spend hours bent over in the fields. “They don’t know what good medical care is. They will have anemia, poor diet, odd hours.”

Some hope for these women may come with two new bills recently signed into law by Gov. George Deukmejian. One, SB 2579, sponsored by Sen. Marian Bergeson (R-Newport Beach), would increase Medi-Cal reimbursement rates to obstetricians, with the aim of encouraging more to accept Medi-Cal patients. Another, SB 175, introduced by Sen. Ken Maddy (R-Fresno), would make illegal aliens eligible for emergency and prenatal care under Medi-Cal.

Wendy Lazarus, director of the Southern California Child Health Network, believes that these two bills could substantially increase the availability of prenatal care to indigent women.

“I don’t mean to paint the rosiest of pictures, but I do think it’s a new era,” Lazarus said. “I think we will see more physicians who are willing to take Medi-Cal pregnant women. But it’s going to take some time, and it’s going to take some serious outreach to physicians.”

Of the 1,500 women turned away from county clinics last year, Foster said, social workers have been able to keep track of about half. Half of those tracked, he said, eventually find prenatal care, either by reapplying at county clinics under false names or through community clinics.

A 1984 study by the state Department of Health Services estimated that for every dollar spent on prenatal care, there is a saving of between $1.70 and $2.60 because children whose mothers receive good prenatal care are born healthier and require less treatment after birth. Prenatal care, Foster said, “makes good sense, medically and financially.”