Infant Mortality Dips in 6 Southland Counties

Infant mortality rates in Los Angeles and five other Southern California counties dipped and birth outcomes mostly improved in the first half of this decade as more women sought prenatal care in their first trimester of pregnancy, according to a March of Dimes report released Wednesday.

“In general, the health of babies and mothers has improved during the 1990s,” said Dr. J. Robert Bragonier, director of maternal health and family planning programs for Los Angeles County and a March of Dimes board member.

Agency officials attributed the brighter picture in large part to changes in and expansion of the Medi-Cal program, which removed financial barriers to prenatal care for many women without private health insurance. More than half the births in the region are paid for by the state and federal Medi-Cal program.

The officials hastened to add that these modest gains are threatened by proposals to cut Medi-Cal eligibility back to pre-1988 levels for many immigrant women. And they worried that massive implementation of managed care programs for Medi-Cal recipients, which Los Angeles County is starting to do, could lead to confusion and reduced access to care for pregnant women.

Also, in some counties the rosy regional profile was marred by high teenage pregnancy rates and by the long-standing problem of dangerously low birth weights and higher mortality among African American children.

The March of Dimes study, the first to look at such a wide region, examined trends from 1992 through 1995 in Los Angeles, Ventura, Santa Barbara, San Louis Obispo, Riverside and San Bernardino counties. The six counties are home to 14 million people, or 42% of the state’s population. Los Angeles County accounted for the largest number of births by far, well over twice as many as the other five counties combined.

All six counties reported that increasing numbers of women are receiving prenatal care in the first three months of their pregnancy, which can reduce the number of infants who die, are born premature or too small, or who suffer birth defects. Ventura County led the pack, with 86% seeking such care in 1995, followed by Los Angeles County with 80%. The federal goal is 90% by 2000.

In all of the six counties studied, the rate of infant mortality (death before age 1) decreased. That is considered a general sign that the health and the economic well-being of the population improved.

Los Angeles County’s infant death rate fell from 7.7 per 1,000 births in 1992 to 6.7 in 1995, sliding under the federal goal of 7 by 2000.

But the death rate for African American infants here was more than 14 per 1,000 live births in 1995, far higher than the rate for Latinos, Asians and whites. The African American rates were even higher elsewhere: 15 per 1,000 in Riverside County and more than 20 in San Bernardino County.

Another troubling problem stressed by March of Dimes officials was the high rate of teenage pregnancy, both in the six-county area and statewide.

According to the report, the teenage birth rate is in decline nationally, but is substantially higher in California than elsewhere in the country, with the largest concentration of such births in Southern California. Five percent of the births in Los Angeles County in 1995 were to mothers under 18--about average for California--but San Bernardino, Riverside and Santa Barbara counties exceeded the statewide average.

Young teenagers, in particular, are less likely than older mothers to seek early prenatal care; their children are more likely to be small or to die during their first year of life. A few young mothers were summoned by the March of Dimes to explain their plights at a news conference Wednesday.

“I hadn’t told my mom,” said Karen Perez, 18, who waited five months to get prenatal care for her first child, Alejandra, now 3. “I didn’t know . . . how I was supposed to take care of myself. My stomach kept growing. I was, you know, confused.”

Eventually, her mother noticed her swollen abdomen, and the girl sought care at a home for pregnant teenagers. Her baby was born healthy.

Perez urged other teenagers not to do what she did. “Look for help,” she said. “There is help out there.”