Women and Children Suffer First : If Babies Matter, These Spending Cuts Should Not Take Place
The adage of “Women and children first” off a sinking ship may be turned on its head to “Women and children last” when it comes to the struggling Los Angeles County Department of Health Services. The department realistically needs at least $100 million just to keep afloat, according to the county chief administrative officer. Unless it gets help from the state, the Board of Supervisors will consider slashing $82 million from health services in the 1989-90 budget. Among the most vulnerable populations affected will be women and children.
Of all the pregnant women in Los Angeles County (170,000 in 1987), one-fourth seek care from the county Department of Health Services. In the past two years, lobbying and publicity focused on cutting the long waits for prenatal care has resulted in additional funding to mitigate the problem. An all-out effort to reduce the four-week-to-four-month waits has been a marked success. The county now reports an overall average wait of 2.6 weeks for the first prenatal care visit, an average that is fast approaching the county’s own goal of a maximum two-week wait.
Many of those who work within the system, however, caution against too much optimism. Health centers in many areas still have average waits of six weeks.
In many parts of the county, it remains difficult to get through on the telephone to make an appointment. Some health centers make appointments only in person. And at least one health center still makes prenatal care appointments only one day a month.
Public health nurses there tell tales of women engaging in a practice the nurses have dubbed “Dialing for Dollars.” It works this way: Several women needing prenatal appointments converge on the house of a woman with a re-dial button on her phone and dial until the health center answers. The phone is then passed from woman to woman to make the necessary appointments. A measure of average wait time for prenatal visits doesn’t take into account the unmet need of women so frustrated in the attempt to get prenatal care that they give up.
And there is no measure of the number of women who are considered too far along to be seen and are told over the phone, “Just come to the emergency room when you’re ready to deliver.”
As the wait for prenatal care has drawn attention, health officials have come under pressure to increase the number of prenatal care appointments. But they do not have the additional staff necessary to make that happen. Instead, in some clinics, personnel have been pulled away from other important duties. For example, public health nurses who normally try to locate partners of patients with sexually transmitted diseases and contacts of patients with tuberculosis now help provide prenatal care. Physicians and nurses spend less time treating and educating each patient. Caseloads keep increasing and employees burn out.
Women face another problem at the delivery stage of their pregnancy. Because county hospitals don’t have the space or the staff to meet the obstetric demands, women have been referred to private hospitals for delivery. Now, however, even these private hospitals are meeting or exceeding their planned capacity for county deliveries. For 1992, the county projects 60,000 births for a system currently struggling to provide for 43,000 births. Women occasionally go into labor in the halls at the county’s Women’s Hospital, site of the the nation’s highest annual number of births.
The newborns need six-week checkups, immunizations and well-and sick-child care. As prenatal wait times have improved, pediatric wait times have worsened. Initial pediatric visits at some clinics take four-to-six months and follow-up appointments can take as long as two months.
Will the Board of Supervisors throw a life preserver? Recent changes in the governor’s budget proposals could mean that some funds could be restored. Since the county’s chief administrative officer said the reason for the cuts was reduced state funding, the supervisors should be doing everything in their power to make sure the needed funds come to Los Angeles County. Unless this happens, however, the board will consider implementing the following actions that can only worsen the situation:
--Closure of seven public health centers that provide prenatal care, immunizations and pediatric visits.
--Closure of Pediatric Pavilion, the only public childrens’ hospital in the county.
--Elimination of pediatric and adult ambulatory care at eight health centers.
--Reduction of gynecology and obstetrical services at Women’s Hospital.
--Elimination of all family planning clinics at 41 health centers and four hospitals.
--Elimination of all outpatient medicine and specialty clinics at Martin Luther King Hospital and reduction of outpatient specialty care at the other three county general hospitals.
The irony of the proposed cuts should not be lost on anyone. Not only will women be denied access to family planning to prevent unwanted births, they also will be denied prenatal and pediatric care vital to the good health of their babies. So far, the governor’s tentative give-backs have not included funding for the Office of Family Planning.
The governor and the Board of Supervisors ought to at least consider the cost-effectiveness and public safety aspects of their decisions. Money spent on prevention is money well spent; for example, there is a 3-to-1 dollar savings in the money it cost to pay for prenatal care versus the money it cost to pay for the health care of a sick baby. The savings jump to $9 if one considers the costs to society of a lifetime of caring for a child born too soon, too small or too sick. Immunizations prevent diseases costing 10 times the cost of the vaccines and personnel time to administer them.
A recent study has shown that family planning saves more than $11 for every one dollar spent. Each of these areas needs a bigger budget, yet each is facing cuts. Who, then, is looking one, two and 10 years down the line at how much these “savings” will ultimately cost taxpayers?