New York studies expose need for more prenatal care

An increase in New York City's infant mortality rate after a 20-year decline should be addressed with better access to prenatal care for low-income mothers, according to two reports issued yesterday by the Community Service Society of New York (CSS). ``Most people realize the rate is edging up, but there is a difference in perception of why. Most blame crack [cocaine] for the increase,'' says David Jones, general director of CSS. ``Yes, it may be a contributing factor, but there are other reasons.''

According to Mr. Jones, those factors include inadequate prenatal care because of poor financial resources, the unresponsiveness of the medical-care system, and the conditions of poverty itself - such as inadequate diet or housing.

In 1965, New York's infant mortality rate was 25.7 deaths per 1,000 live births. By 1986, the numbers had steadily declined and were down to 12.8. Preliminary statistics for 1987, however, indicate that rate was up again to an estimated 13.1. Nationally the rate is 10 per 1,000. In some New York neighborhoods, such as central Harlem, it is as high as 27 deaths per 1,000.

The first report is a statistical portrait of 12 New York City health-center districts with high levels of need based on the percentage of medicaid-financed births, births to mothers with late or no prenatal care, infants' low birth weights, and births to teenage mothers.

The other report, based on interviews with 568 low-income women and interviews with staff and patients at six prenatal clinics, looks at barriers to prenatal care.

Most medical research shows that infants with a low birth weight have a higher mortality rate, as well as a higher risk of mental retardation, learning disabilities, and physical handicaps, Jones says.

The report cites evidence that early prenatal care can improve the chances for normal births for low-income women.

Maternal conditions that are seen as harmful to unborn children - smoking, improper diet, health issues, and drug problems - can be caught and handled, he says.

The solutions are partly monetary. Since many women in the ``high-need'' areas lack health insurance, CSS recommends an expansion of medicaid within federal guidelines. But addressing the problem would involve reorganization of the medical/health system, Jones says.

Women interviewed for the second report told of seeing many doctors - rather than one - throughout their pregnancy. They also spoke of long waits, difficulty in communicating with staff, and waiting rooms without chairs that meant standing for hours.

``We need to make the system more solicitous to poor women, many of whom are working,'' says Jones. ``And there has to be outreach. We can't expect these women just to drop in.''

He says the cost of care for low birth-weight babies is astronomical in comparison to prenatal care. And, he adds, priorities need to be considered.

There is currently an emphasis on expensive, high-technology equipment in hospitals, he says. But perhaps, he suggests, putting some of that money into prenatal care would save more lives.