The Dying Babies

This year nearly 4,500 babies will die in California before they are 1 year old. That’s a dozen every single day of the year. Some of this tragedy could be prevented if babies’ mothers had proper medical care while pregnant.

Instead of taking strides forward, California is falling behind by almost every measure of its performance. That was the view of Dr. Ezra Davidson, head of Drew Medical School’s obstetrics department, in discussing a new report from the Southern California Child Health Network. In 1985, the last year for which complete statistics are available, 6 infants out of every 1,000 died before they were 28 days old; the year before, the figure was 5.9 per 1,000. Nearly twice as many black newborn babies as whites died.

The increase was small, and preliminary figures for 1986 show that the statewide rate has started to improve again. But the same 1986 figures show that more, not fewer, babies are being born weighing too little to thrive. That would be less likely to occur if more of their mothers were able to get good advice about nutrition and otherwise taking care of themselves while they’re pregnant.

California used to do better. In 1970 California ranked fifth among the states in keeping newborn babies alive. Now it ranks 17th. This relates directly to prenatal care. California now ranks 36th in providing adequate medical care during pregnancy, down from 16th in 1970.

The statistics represent real babies who, when they do survive premature births, often face staggering physical and mental problems and require enormous investments in care. Lori, whose mother had not received prenatal care, was born three months early and suffered a brain hemorrhage and a collapsed lung. She had to have heart surgery. Now 3 years old, she may have cerebral palsy. She can’t walk, and must have physical therapy three times a week.

The prescription for averting these tragedies is the same as it was at this time last year when the Child Health Network issued its first major report: Make sure that all women, regardless of income, receive adequate care during pregnancy. The Legislature voted last year to pay higher rates to doctors who see pregnant women under the MediCal program, to keep physicians from dropping out of the program; Gov. George Deukmejian vetoed the bill. The Legislature also voted to pay doctors more if they would see women early and often during pregnancy; the governor vetoed that, too. The governor has proposed a 16% increase in Medi-Cal prenatal fees for doctors, starting in May, but that would bring their pay up to only $765 for the entire pregnancy, with an additional $150 if they agreed to provide comprehensive care. That is an improvement, but still far short of the funding needed to assure universal access.

Many pieces of legislation addressing the needs of pregnant women and their babies have been introduced in Sacramento. One, by Assemblyman Burt Margolin (D-Los Angeles), would provide health care for all uninsured women as well as children under 5. More modest measures would ensure prenatal care for women whose family income is too high to qualify for subsidized programs but too low to enable them to buy private insurance, or who are excluded from state help because of their immigration status. One measure would change billing procedures in state health programs that deter doctors from providing care, and another would do away with eligibility rules that keep pregnant women from seeing doctors early in their pregnancy.

There are a few bright spots. Los Angeles County increased its own spending to improve prenatal care by $1 million last year, but many women still face long waits for appointments. Orange County increased the number of women whom it serves by 25%. “There is some momentum for change building,� said Wendy Lazarus, the Child Health Network’s director.

Clearly the progress is inadequate. Too many babies still are born unhealthy, and too many die as the Legislature and the governor postpone the providing of adequate funds for this extraordinarily cost-effective program.