O.C. Infant Deaths Rose Slightly in 1989

The rate at which babies died in Orange County was up slightly in 1989, provoking concern among local health officials.

The statistics, the most recent local figures available from the Orange County Health Care Agency, showed that per 1,000 live births in 1989 there were 7.3 deaths, while 6.8 infant deaths were reported for every 1,000 live births in 1988.

Health officials say they are not sure what caused the one-year jump or whether the increase signifies a dangerous trend, but Marianne Maxwell, director of the county’s perinatal task force, said: “I think when you have a rate going up, that should put you on alert.”

Still, the county’s infant mortality rate is substantially lower than the national rate of 9.7 deaths per 1,000 live births in 1989. However, the rate of infant deaths here is rising, while the national rate recently dropped to 9.1 in 1990, according to statistics released Monday.

“Children are still the end of the stick when it comes to allocating health resources,” said Ellen Severoni, director of California Health Decisions, a local health education group. “This data is reflecting that.”

As Medi-Cal maternity wards became crowded two years ago and one local hospital began turning away some women in labor, health experts became concerned about the effects on infant mortality rates.

But Maxwell cautioned that it is too early to blame the county’s crisis in obstetrical care for the rise in infant deaths. At least another year’s data is needed, Maxwell and other health experts said. However, information on 1990 births and deaths may not be available from state officials for months.

The report from the county Health Care Agency indicates that local officials need to bring prenatal care to pregnant teens as well as to pregnant women who are substance abusers, Maxwell noted.

“And we need to continue to target all groups that don’t have prenatal care.”

The report showed that about 40% of Latino women and 45% of teen-age mothers failed to receive prenatal care in the first trimester of pregnancy, and some never got it at all. Lack of prenatal care has long been linked to low weight, premature babies, some too small to live.

The report on infant mortality is to be presented today to the county’s perinatal task force, a mix of local physicians, health-care advocates and county officials who have been trying to improve access to medical care.

In addition to an increase in the county’s infant death rate, the report showed that:

* Of 46,232 babies born in 1989, 336 died before they were 1 year old.

* The leading cause of death for babies in 1989 was “low birth weight,” with 98 babies dying at birth, all too small to survive. Normal birth weight ranges down to 6 to 7 pounds, while some of the babies who did not survive weighed less than 2 1/2 pounds at birth.

* The infant death rate increased for babies of all races from 1988 to 1989. Following national and state trends, black babies had the highest mortality rate, nearly double the previous year, with 9.8 deaths for every 1,000 live births, up from 5.4 the year before. (However, because blacks compose such a small percentage of Orange County’s population, statistics on these deaths often fluctuate sharply from year to year, county officials cautioned. The 1989 statistics included information on only 10 black infants.)

* The second highest mortality rate was among Anglo babies, with a death rate of 8.4 per 1,000 in 1989, compared to 7.9 in 1988. Southeast Asian babies had a mortality rate of 7.1 per 1,000 births in 1989, compared to 5.0 in 1988. And even though their mothers frequently received little or no prenatal care, Latino babies had a mortality rate of 6.3 in 1989, compared to 5.9 in 1988.

“Whites have a lifestyle where you have drinking, smoking, drug use (during pregnancy) and teen-age pregnancies,” Maxwell said. “Those kinds of things tend to result in higher infant mortality.” In contrast, “new immigrants--Hispanics--have historically had a good birth outcome. They eat healthy and don’t have drug use.”

Maxwell and other health officials say Latinos also appear to have an informal network of people that encourages a healthy lifestyle during pregnancy, as well as good baby care.

Many local health leaders had not seen the county’s report on infant mortality Monday and were reluctant to comment. But all were concerned with the results.

“I want to confer with our staff to try to learn what these numbers represent and what we can do,” said Gaddi H. Vasquez, chairman of county’s Board of Supervisors. Vasquez also said he was unhappy that state officials have lately delayed reporting vital statistical data to Orange County. (Local officials received the data for Monday’s report for 1989 deaths in February. In previous years, they had been able to report birth and death trends about eight months after the year ended.)

“I’d certainly like to find out why the delayed reporting process,” Vazquez said. “That’s important information; we need to take corrective action. Without it, we’re a little behind the curve.”

Also expressing concern about the rise in infant deaths was Orange neonatologist Ralph Rucker, who also serves as a director of the local chapter of the March of Dimes.

Rucker, who reviewed a copy of the report, noted that deaths of Latino babies rose significantly in 1989, to 120 from 92 in 1988, accounting for about 75% of the overall increase in deaths.

“That rate is certainly higher than we would like to see and we certainly need to continue to recognize this and target it for improvement,” Rucker said.

Orange County Infant Mortality Rate

MORTALITY RATE*

‘81: 8.5%

‘82: 9.3%

‘83: 9.0%

‘84: 7.9%

‘85: 8.4%

‘86: 6.5%

‘87: 7.6%

‘88: 6.8%

‘89: 7.3%

* Deaths per 1,000 live births

DEATH RATES BY ETHNICITY

Whites

1988: 7.9%

1989: 8.4%

Blacks

1988: 5.4%

1989: 9.8%

Latinos

1988: 5.9%

1989: 6.3%

Southeast Asians

1988: 5.0%

1989: 7.1%

Other Asians

1988: 4.1%

1989: 5.0%

Source: Orange County Health Care Agency