Rise in Infant Deaths Laid to Drugs, Prenatal Neglect

Infant deaths and the number of babies born underweight in Los Angeles County are rising dramatically, according to the latest county statistics. Experts trace the trend--which is most striking among blacks--to increasing drug use and shortages of obstetric and prenatal care.

The infant mortality rate among blacks and Latinos rose 17% in 1988 over 1987, while dropping 12% among Anglos. The percentage of babies born weighing less than 5 1/2 pounds--a key predictor of mortality and disability--rose 17% overall and 32% among blacks.

Those numbers represent “a turn for the worse” after several decades of improvement, a top county health official said Friday. In the previous year’s statistics, the infant mortality rate had dropped below the statewide average for the first time in 20 years.

“It’s very disappointing to see things turn around like this,” said Dr. Irwin Silberman, director of maternal health and family planning programs for the county. “And I think it’s going to be worse in 1989.”

Experts attributed the shift to several factors. They include the rise of crack cocaine addiction among child-bearing women, the county’s syphilis outbreak, difficulties in getting prenatal care and, among some women, ignorance of the need for that care.

In hopes of addressing those problems, the March of Dimes Birth Defects Foundation announced in Los Angeles on Friday a national campaign aimed at preventing infant mortality and so-called low birth-weight births through public education and changes in public policy.

“It’s our belief that the most important thing is to get people motivated to get prenatal care,” said Jennifer Howse, president of the foundation. “ . . . Then we can point to the lack of capacity” in prenatal care programs.”

The county’s preliminary 1988 statistics, released Friday, include the following:

The overall infant mortality rate in the county rose from 8.2 deaths per 1,000 live births in 1987 to 9.6 in 1988. Among blacks, the rate rose from 16.3 to 21.1; among Latinos, from 5.8 to 7.5.

The percentage of babies born weighing less than 2,500 grams, or 5 1/2 pounds, rose from 5.3 to 6.2. Among blacks, the percentage rose from 10.4 to 13.7--”a dismaying 32% increase for black babies,” Silberman said.

One in four pregnant women in Los Angeles County did not begin prenatal care in the crucial first trimester of pregnancy. The rate is more striking among minorities--37% for Latino women and 32% for black women.

Babies born to mothers who receive no prenatal care are four times as likely as others to die during the first year of life, specialists say. The infants are three times as likely as others to be born weighing less than 2,500 grams.

“I think we have two challenges here,” said Wendy Lazarus of Children Now, a statewide advocacy and policy group. “One is to make sure there are open doors for those women who want to get prenatal care. . . . The second is to really reach out in those communities.”

How does Los Angeles County compare to other areas? Up-to-date statistics are hard to come by. However, several organizations compile data that suggest that Los Angeles County and California are not the worst off, but are far from the best.

Nationwide, infant mortality has been declining steadily. In 1987, the rate was 10.1 per 1,000 live births, compared to 12.6 deaths per 1,000 live births in 1979, according to the federal National Center for Health Statistics.

The national percentage of low birth-weight births was 6.9% in 1987--the highest rate since 1979, when it was also 6.9%. The percentage of women receiving prenatal care in the first trimester has hovered at about 76% during that period.

The Southern California Child Health Network recently ranked Los Angeles County 32nd among 37 California counties in a study of low-birth-weight babies. The best county, ranked No. 1, was Santa Cruz; the worst was Alameda.

Among the same counties, Los Angeles ranked 31st in percentage of women receiving late or no prenatal care. The ranking ranged from Sonoma County at the top to San Joaquin County, which had the most women receiving inadequate care.

As for California, Children Now ranked the state 36th out of 50 in the number of women receiving late or no prenatal care. But in infant mortality, the group ranked California eighth.

According to Lazarus, the apparent discrepancy between those two rankings suggests a disturbing fact: Many women receive inadequate care, but their babies are then kept alive through lengthy and costly hospitalization.

“We’re doing it the expensive way, and the way that’s hard on babies,” she said in a telephone interview. She said that approach produces “real problems in growth and development” of the babies in later life. Experts said the differences in infant mortality rates among states and counties reflect their racial and socioeconomic makeup as well as the amount of money and effort devoted by local governments to providing prenatal care.

“When you compare like states, the state efforts make a big difference,” said Joseph Liu of the Children’s Defense Fund in Washington, D.C. “In the overall ranking, it is sort of unfair to compare a Mississippi to an Iowa.”

Several experts said Friday that the infant mortality problem in the county is made worse by the paucity of services for drug-addicted mothers. Private physicians and hospitals often shun them, and there are few drug treatment programs that serve that group, they said.

MATERNAL HEALTH

Preliminary Los Angeles County statistics released Friday show a dramatic reversal of recent declines in infant mortality. They also trace a jump in the percentage of babies born weighing less than 5 1/2 pounds, a key predictor of mortality and disability.

1987 1988 INCREASE Anglo 4.6 5.4 17% Black 10.4 13.7 32% Latino 4.3 4.9 14% Overall 5.3 6.2 17%

INFANT MORTALITY

(per 1,000 live births)

1987 1988 Anglo 10.0% 8.8% Black 16.3% 21.1% Latino 5.8% 7.5% Overall 8.2% 9.6%