L.A. County’s Infant Death Rate Appears On the Rise

Infant mortality in Los Angeles County appears to be on the rise, after declining at a steady pace each year since the late 1970s, according to the county’s latest health statistics.

In 1985, the most recent year for which statistics are available, there were 10.4 infant deaths for every 1,000 live births. Before 1985, that rate had been declining every year since 1978, when 13 of every 1,000 newborns died. The rate in 1984 was 9.8 deaths per 1,000 live births.

The statistics reveal that the increase in infant mortality had occurred in every ethnic group in the county, with the greatest increase among black babies.

A top county health official blamed the rise on the rapid increase in the number of births in the county since 1978 and on the county’s inability to keep up with the growing demand for prenatal services.

System Under Pressure

“We have expanded as fast as we can, but it (the system) is still overburdened,” said Dr. Ellen Elkon, medical director for public health for the county Department of Health Services. In 1978, 117,889 babies were born in the county; in 1985 there were 151,513, she said.

The mortality data prompted the Southern California Child Health Network, a Santa Monica-based nonprofit child advocacy organization, to call on community and government leaders to increase the availability of prenatal health care.

Infant mortality is one of the most commonly used indexes of the quality of a community’s health-care system.

The network, going beyond the mortality data, surveyed the county’s prenatal clinics in order to assess the accessibility of prenatal services.

It found that pregnant women seeking appointments had to wait six weeks or longer at 10 of the 13 clinics surveyed. The county’s stated goal is to provide such appointments within 10 working days of a request.

Inadequate prenatal care is a major contributor to infant illness and death.

“There are clear warning signs that this limited access to prenatal care is needlessly endangering the health of babies born in the county,” said William P. Hogoboom, a former Los Angeles County Superior Court judge who is special adviser to the child health network.

“The percentage of women receiving care in the crucial first trimester of pregnancy has declined for every racial and ethnic group,” he noted.

According to the child health network, its survey found that women using the Hollywood-Wilshire Health Center, for example, had to wait 16 weeks for an appointment, and 12 weeks at the Hubert Humphrey Comprehensive Health Center. At Lawndale, North Hollywood and Canoga Park, the waiting period was 10 weeks.

Restricted Access

At some county clinics, first-time patients may call only during the last week of each month to schedule an appointment, according to the child health network. And almost always, by the second day of that week, all available appointments are filled. This means, the report said, that women unable to get appointments must wait another month before they are able to see a doctor for the first time.

Elkon confirmed the network’s infant mortality data. It was the network that released the statistics, accompanied by its own survey and recommendations.

On July 15, the County Board of Supervisors approved a $1-million increase in funds for prenatal care. And Dr. Irwin Silberman, chief of the county’s maternal services, said on Tuesday that all of the money will be used to expand prenatal services countywide, with an emphasis on regions with the greatest unmet needs.

The network suggested that waiting times could be reduced by improving intake and scheduling systems and by expanding county-operated clinics in high-use areas. It said the county also should begin contracting with private clinics for prenatal care and establish information and referral services for women who need help in obtaining care.

The network in February issued another report that outlined a steadily worsening picture of prenatal care in California as a whole. That report ranked California as 14th best among all the states for low infant mortality in 1983--a drop from seventh place in 1970.