Prenatal Education, Care Rising for Latinas

Orange County health officials are crediting outreach efforts and reduced fears of deportation for a dramatic surge in the number of Latina mothers receiving prenatal care and parenting lessons.

The percentage of Latina mothers receiving early prenatal care jumped from 64% in 1992 to 77% in 1997, the largest increase of any ethnic group, according to a report published in July by the county Health Care Agency.

The increase is important because Latina mothers are responsible for the largest number of births in the county and are traditionally the least likely to seek prenatal care, officials say.

The rates of prenatal visits for Latinas remain below those of women of other ethnicities, the report shows. In 1997, 91% of non-Hispanic white mothers, 87% of Asian mothers and 83% of African American mothers received early prenatal care.

As Orange County health officials work to encourage more Latina mothers to seek prenatal care, they hope to learn from the women as well--through research into their unexpectedly low rates of infant mortality. Following a nationwide pattern that has baffled researchers for years, Latino infant mortality rates in Orange County are generally lower than those of non-Hispanic whites, despite higher poverty rates and chronically low rates of prenatal doctor visits.

In six of the last eight years, babies born to Latinas in Orange County were less likely to die than those of any other ethnic group. In 1997, the last year for which numbers are available, the Latino infant mortality rate was 4.0 per 1,000 births, compared with 4.4 for whites.

The phenomenon is known in the medical field as the Hispanic epidemiological paradox, a health care contradiction that, so far, has defied explanation, said Dr. David Hayes-Bautista, professor of medicine and director of UCLA’s Center for the Study of Latino Health.

Health care officials generally link higher incomes, higher education levels and access to prenatal care with higher survivability for infants, Hayes-Bautista said. But babies born to Latina immigrants, who generally have lower incomes, less education and less prenatal care in the first trimester, are surviving more, he said.

Good Health Goes Beyond Survival Rate

“Culture is a factor that we need to look at,” including knowledge that goes back centuries to the Aztecs, Hayes-Bautista said. “The behavior, attitudes and practices of pregnant women tend to be enveloped in a strong family network. There’s also the issue of spirituality. There’s a whole host of things we need to understand, and I’m the first to say we don’t understand it very well.”

While the high survival rates are encouraging, they do not mean that Latinas have less need for prenatal care, said Yvette Bojorquez, program director of the nonprofit Maternal Outreach Management System Resource Center in Santa Ana. Armed with information and helped by a doctor, women can deliver healthier babies, Bojorquez said.

“Even though our babies are surviving, a lot of them are born with low birth weight,” Bojorquez said. “That child might develop problems later. What we want is for babies to be healthy. That goes beyond survival.”

Social service and medical workers who serve low-income pregnant women have witnessed recent increases in the number of Latinas seeking prenatal care and pregnancy education. County home visitation programs by nurses and other support services have helped officials reach more Latinas regardless of their legal status, said Dr. Mark Horton, the county’s director of public health.

Health workers attribute some of that improvement to reduced concerns over the 1994 passage of Proposition 187, which would have denied most government-funded health care to illegal immigrants. Although the state referendum was approved by 60% of voters, a federal judge declared that most of it was unconstitutional.

In 1997, while implementing welfare reform in Orange County, the Orange County Board of Supervisors cited prenatal care for illegal immigrants as a long-term benefit for all residents. The county saves money on emergency medical costs by offering such care, officials said.

Proposition 187 “scared people away,” said Jacqueline Cherewick, chairwoman of the Orange County Coalition of Community Clinics. “But now we’re seeing people coming back. Although immigration is a legitimate issue that needs to be taken care of, it is not a health care issue anymore.”

Through a program at the MOMS Resource Center in Santa Ana, 73 Spanish-speaking women attend prenatal classes in seven cities each month, Bojorquez said. With 23,000 babies born to Latinas every year, there is plenty of room for improvement, she added.

By posting fliers in community clinics, doctor’s offices, beauty shops, Laundromats, churches and grocery stores, MOMS outreach workers hope to attract more pregnant women to their free classes, Bojorquez said. Latina immigrants generally do not rush to the doctor when they suspect or know they are pregnant, said Rosa Solis, one of the program educators. But as they assimilate, that is changing, Solis said.

“We have a really nice number of young mothers wanting to be able to do the right thing,” Solis said. “They no longer want to do it the way Mom used to do it or the way Grandma did it. I think that’s very healthy.”

‘I Didn’t Really Know There Were Classes’

Soon after Maria Mendoza, 25, migrated from Mexico to Orange County in 1992, she became pregnant. Six months passed before she sought medical attention.

“I didn’t have much information and I was scared to get around alone,” said Mendoza, who is now five months pregnant and attends prenatal classes at the Laguna Beach Community Clinic. “I used common sense to take care of the baby, but I didn’t really know there were classes available or that I should have been going to the doctor. When I finally went, the doctor reprimanded me very strongly. He scared me.”

This time, when she suspected she was pregnant, Mendoza went to the Laguna Beach clinic for a test. There, she learned that in addition to her medical appointments, she could attend free prenatal, childbirth and parenting classes sponsored by MOMS.

“I am enjoying this pregnancy so much more,” Mendoza said. “I’ve learned how the baby was formed, how much he weighs, how long he is. I never imagined that the baby was sensitive to light, that when it moves it means he’s healthy, that he sucks his thumb. He is a little person.”

Although Mendoza cared for her first pregnancy almost entirely on her own, she delivered a healthy 6-pound, full-term baby.

Diet is among the elements that researchers are studying to explain low infant mortality rates among Latinos, Hayes-Bautista said. Another factor to consider is that Latinas are less likely to use tobacco, alcohol or drugs, he said.

Cultural Factors Still to Be Explored

But it is the cultural aspect--traditions Latinas bring with them when they migrate--that should be most closely examined, health care workers agree. Latinas, for example, regard children as gifts of God and place the well-being of their children above all else, Solis said.

“What I’ve noticed from my point of view is that these mothers tend to have a really quick bonding process with the babies,” Solis said. “They connect with the babies when the babies are in the uterus. That’s not to say that other women don’t or can’t. But that bonding process, that connection, is something that should be studied.”

Although the research is years from being completed, Horton said he looks forward to implementing what officials learn from the Latino population in other communities.

“Overall, Orange County is doing pretty well,” Horton said. “The real challenge, if we’re going to continue to progress, is to know what the difference is in these populations and then use that knowledge to make sure that all women have access to quality prenatal care and that it starts early. It’s an exciting time.”

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Healthy Babies

Orange County infant mortality rates are generally lower for Latino families than for any other ethnic group, despite lower incomes and less access to health care. Figures indicate death rates per 100,000 live births.

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1990 1991 1992 1993 1994 1995 1996 1997 Total 7.7 6.2 5.3 5.7 5.9 5.6 4.4 4.4 White 8.8 7.2 5.4 7.1 5.5 6.8 4.5 4.4 Latino 7.4 5.7 5.5 5.0 6.1 4.7 4.1 4

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Source: Orange County Health Care Agency