Latino Infant Death Rate Climbs Sharply in County

Health officials have sounded an alarm about a dramatic rise in the infant and fetal death rates among Latinos in Los Angeles County.

The infant mortality rate--the rate at which babies die before age 1--has risen by more than a third for Latinos since 1987, according to county health statistics released in July.

The rate of stillbirths among Latinos during the same period increased by 45%.

“The realization that many, if not most, of these deaths are unnecessary and preventable mandates immediate, strong and effective action on the part of the public and private sectors of our community,” said Dr. Irwin A. Silberman, the county’s top maternal health official.

“It seems almost unbelievable that at the end of the 20th Century, when we can fly to the moon and have developed technology that allows us to see the three-dimensional images inside of our bodies, we still have children dying at birth,” said Dr. Aliza Lifshitz, a local internist who is a board member of the California Hispanic American Medical Assn.

Infant mortality is considered by many a barometer of a society’s health and the condition and priorities of its health-care system. Patterns of infant and fetal death often reflect other social patterns in income, education and opportunities.

The Latino infant death rate has been as much as 40% below that of Anglos and 66% below that of blacks. Health officials have attributed those differences in large part to strong family and community support for pregnant Latinas.

Now, the Latino death rates are rising in the county at a time when Anglo rates are dropping. Officials trace the rise among Latinos in part to poverty, lack of education and lack of access to prenatal and pediatric care, and in part to assimilation into U.S. society.

Some Latina immigrants, Silberman said, “are acquiring many of the characteristics of the established populations . . . such as alcohol, smoking and substance abuse (and) being subjected to the stresses and strains of living in poverty communities.”

Tobacco smoking and alcohol and drug use during pregnancy are prime causes of birth defects, disabilities and low birth weight. Babies born weighing 5 1/2 pounds or less are 40 times more likely than others to die during the first four weeks of life.

Stress on the mother also has been linked to premature labor and preterm birth.

Other officials cited additional possible explanations for the rise in the infant death rate.

Lifshitz, for example, listed “ignorance of the need to get prenatal care, lack of knowledge in how to access health-care services, delays in getting an appointment once a woman finds out that she is pregnant, and poverty--the inability to pay to get health care services.”

Latinos tend to seek medical advice later than other patients--in the case of prenatal care, often because of ignorance of its importance, Lifshitz said. Some women, particularly those who already have children, “think (they) know everything there is to know about pregnancy,” she said.

“Many women are unaware that, regardless of their legal status, when they get pregnant, if they cannot afford health care because of their income, they can qualify for Medi-Cal (the state health insurance program for the poor) during this period.”

“Unfortunately,” she pointed out, “the system does not run as smoothly as it should and in some instances the process can take longer than we would like to see. People should not give up. They have to persevere or get advice from community-based organizations to expedite the process.”

A lawsuit was filed in federal court earlier this month alleging that pregnant women are waiting as long as 14 months before qualifying for Medi-Cal.

According to Silberman, the Latino infant death rate rose from 5.8 deaths per 1,000 live births in 1987 to 7.4 in 1988 and 7.9 in 1989. By contrast, the Anglo infant death rate dropped from 10.0 in 1987 to 8.8 in 1988 and 7.4 in 1989.

The black infant mortality rate is substantially higher. It rose from 16.3 in 1987 to 21.1 in 1988.

The fetal death rate among Latinos rose from 6.0 stillbirths per 1,000 live births and fetal deaths in 1988 to 8.3 in 1989. The Anglo rate dropped from 6.0 to 5.2 between 1987 and 1988; the black rate rose from 13.4 to 15.1.

PRENATAL CARE

Prenatal care for a pregnant woman and her unborn baby seeks to ensure that both are healthy at delivery. It usually includes tests on the woman and fetus to detect disease, defects or other risks, and advice on nutrition and exercise during pregnancy. The process should begin as soon as a woman knows that she is pregnant. Information: (213) 250-8055.