Infant Mortality Rate Falls 13% in County : Health: Officials attribute the significant decline for 1990 to better prenatal care for the poor. The drop is most dramatic for African-American babies, who still die in infancy more frequently than whites.

The infant mortality rate in Los Angeles County fell 13% in 1990, the sharpest drop in at least a decade, leading county medical officials to suggest that efforts begun in the mid-1980s to improve medical care for poor women are beginning to pay off.

In 1990, the last year for which figures are available, infant deaths fell from 9.2 to 8 deaths per 1,000 live births, according to state Department of Health Services statistics. The largest decrease was among African-Americans, whose infant death rate historically has been twice as high as that of Anglos.

There also were smaller declines in the percentage of low-weight newborns and of women who did not receive prenatal care.

Medical experts, while cautious, say that the 1990 statistics are a hopeful sign in the county’s long struggle to significantly bring down the infant death rate. Those efforts escalated in the mid-1980s when access to prenatal care for the poor was expanded, more money was paid to physicians who treat Medi-Cal patients, and the county drafted agreements with private hospitals and doctors to relieve overcrowded maternity wards at county hospitals.

“I think what these figures are reflecting is the success of the county’s efforts to expand access to prenatal care for poor people,” said Dr. Irwin A. Silberman, director of Family Health Programs in the county’s Maternal and Child Health Department.

The infant mortality rate refers to the number of deaths from birth to age 1. It is composed of the neonatal rate, which includes babies who die between birth and 28 days, and the post-neonatal rate, which covers deaths between 28 days and 1 year.

While the rate has declined in the United States over the last few years, it has done so slowly, and the U.S. infant mortality rate is higher than that of many other industrialized countries.

State health services department officials said Los Angeles County was one of only three counties that had a statistically significant drop in the rate, meaning that the improvement was not a statistical aberration. The others were Santa Clara and Madera.

Some experts were more hesitant to draw conclusions from statistics for a single year.

“This is a wonderful drop, a very significant drop,” said Rae Grad, executive director of the National Commission to Prevent Infant Mortality, based in Washington. But she added that she would reserve final judgment until seeing proof that the lower rate holds steady in ensuing years.

Dr. Paul Wise, director of the Harvard Institute for Reproductive and Child Health at the Harvard Medical School, agreed on the need for caution.

“It could be a one-year phenomenon,” he said. But he argued that the results are “an important development,” especially because the drop in the infant death rate was accompanied by across-the-board reductions in neonatal and post-neonatal death rates.

“This speaks to not only the possible success of prenatal programs but other components of the health care system,” he said.

Silberman said the decline in infant deaths is a reflection of efforts to deal with the problems that poor women were having in getting prenatal care, an important element in ensuring the birth of healthy babies.

The efforts include:

* Increased Medi-Cal payments to obstetricians, by more than $100 per delivery, starting in 1988, and eased eligibility requirements to allow women earning up to 200% of the poverty level to qualify for Medi-Cal.

* In Los Angeles County during the past five years, an increase in spending on perinatal care from $150 million to $270 million, as the county opened several community clinics and hired staff to provide prenatal care.

* A program, begun in 1990, that addressed a critical problem of overflowing maternity wards in county hospitals. The county was able to attract more hospitals and private physicians to perform deliveries by covering the doctors for malpractice claims and by using state tobacco tax money to increase the reimbursements to anesthesiologists and pediatricians, said Bob Holt, director of professional relations for the Los Angeles County Medical Assn.

One success, Silberman said, is that waits for prenatal care appointments at county clinics have fallen from as long as four months to a little more than a week, which compares favorably to the private sector.

“It took three to four years to get all the pieces in place to get the results we (have) now,” Silberman said.

Before the programs were put in place, “there was an enormous amount of concern in L. A. County,” said David Langness, a spokesman for the Hospital Council of Southern California. “In birth weights and infant mortality, we were descending to the level of a Third World country. Now we’ve stabilized and begun to come back.”

The single largest drop in the mortality rate was among African-Americans. Using slightly different statistical methods, the state calculated a 23% decline among blacks in Los Angeles County, while the county placed the figure at 27%. Still, the rate among blacks of 14.2 deaths per 1,000 births--compared to 19.4 the year before--remains higher than the rate of 9.2 for Anglos, 6.8 for Latinos and 4.2 for Asian-Americans. Rates for all racial groups declined in 1990, though not as greatly as for African-Americans.

“That’s fantastic,” Silberman said. “It was about 19 the last time I looked.”

“This is such a large decrease, this really does mean that the message is getting out about the value of early and intensive prenatal care and not abusing substances,” said Dr. Reed Tuckson, president of Charles Drew University of Medicine and Science in South-Central Los Angeles.

“This is a real encouraging sign,” he said. “It’s empowering to let us know that we are on the right track.”

The improvement in the black infant death rate was so great that some analysts are skeptical.

But after running an analysis just on the African-American rate, Les Fujitani, a technician for the state’s vital statistics section, determined that the change was statistically significant.

Silberman said African-Americans have been targeted in county efforts to improve the health of babies. He cited “Great Beginnings for Black Babies,” a continuing project that includes billboards and posters encouraging women to seek medical care early in their pregnancies.

Figures also show that the percentage of newborns weighing less than 5 1/2 pounds in Los Angeles County dropped 5% in 1990.

That figure is not considered large enough to be statistically significant. But Penny Stephenson, chief of the state’s planning and evaluation section of the Maternal and Child Health branch, called it a “pretty good” number in light of the fact that statewide figures on low birth weight have been stable for the past decade.

Dr. Marie Kuffner, president of the Los Angeles County Medical Assn., said one major cause of the decline in mortality and low birth weight could be a drop in smoking among pregnant women.

“The word has gotten out that smoking is not good for health,” she said.

The good news on infant mortality arrives at a time when the state and county are facing hard budget choices, but Silberman said the “governor and Legislature assured us services for needy women and children will be their highest priority.”

Grad worried that improvements in the infant mortality rate might lead policy-makers to become complacent and withdraw support from programs that improve infant health. She said the still-high infant mortality rate among African-Americans “says to us that we have a lot more to do.”

County Birth Statistics

Figures for the county from the last three years show that more infants are surviving and more mothers are getting care.

1988 1989 1990 Infant death rate* 9.2 9.2 8.0 Neonatal death rate* 5.6 5.7 5.1 Post-neonatal death rate* 3.6 3.5 2.9 Pct. no prenatal care 3.0 2.7 2.4 Pct. low birth weight 6.3 6.3 6.0

* Rates are per 1,000 live births

Source: State Department of Health Services