News Column

Hispanic Infant Mortality Prompts Education, Outreach

April 24, 2013

As soon as Janell Cortez found out she was pregnant, she immediately made her first prenatal appointment.

It's the same thing the 25-year-old Jerome woman has done for her past three pregnancies, and it's exactly what Family Health Services is hoping women do.

But the message might not be getting out in the Hispanic community, which has a higher infant mortality rate than non-Hispanics in Idaho.

According the Idaho Department of Health and Welfare, from 2008-2010, the infant death rate for Hispanics was 7.0 per 1,000 live births compared to 5.0 per 1,000 live births for non-Hispanics.

"It is statistically significant," said Tom Shanahan, public information manager at the Idaho Department of Health and Welfare. "... We don't know what the story is exactly."

No Easy Answer

Why do Hispanic infants die at a higher rate? There's no easy answer, but there are clues.

Dr. Camille Smith of Family Health Services in Buhl, said women who receive inadequate prenatal care are more likely to have complications with pregnancy, such as low birth weight or taking medications that cause birth defects.

According to The Hispanic Profile Data Book for Idaho, pregnant Hispanic women are more likely to receive inadequate prenatal care and wait until the second or third trimester to get prenatal care. Hispanic infants are more likely to die from maternal complications of pregnancy, short gestation or low birth weight.

"We've had a couple (Hispanic mothers) who have come in later. I wouldn't say it's common but there's been a few," Smith said. One Hispanic woman who was 20 weeks pregnant recently came to the clinic for the first time while Smith was on call.

"She'd never had any prenatal care," Smith said.

The fetus had died, and doctors don't if the death could have been prevented had the woman's pregnancy been monitored.

"We just don't know," she said.

Cortez was shocked when she found out some women in the Hispanic community wait for prenatal care.

"I've never done that," she said, shaking her head. With this pregnancy, she's being even more vigilant about appointments because she's concerned about how prior drug use might affect the fetus, she said.

Her vigilance is a good thing. During a Tuesday appointment at Family Health Services in Jerome, Cortez found out she's at risk for complications from placenta previa, where the placenta is especially close to the cervix. Dr. Matthew Duersch told her while she shouldn't be worried, they should schedule a follow-up ultrasound.

Smith said once once women do come in, most follow through with care.

"It seems like if they're willing to come in and get established, they follow the guidelines," she said.

Reaching the Uninsured

There are other apparent factors in women not seeking prenatal care.

Hispanic women are more likely to be uninsured, said Lauren Necochea, director of Idaho Kids Count, citing the Pregnancy Risk Assessment Tracking System from the Idaho Department of Health and Welfare.

"In Idaho, non-Hispanic mothers are more than twice as likely to have private health insurance prior to getting pregnant, compared to Hispanic mothers," she wrote in an email to the Times-News.

It's not all bad news, Necochea said.

"Idaho's Hispanic mothers have at least one health advantage, which is that they are less likely to smoke during pregnancy," she said.

Ethnicity, age and race play into infant mortality rates nationwide, according to the Center for Disease Control and Prevention.

While in Idaho the infant death rate for Hispanics is 7.0 per 1,000 live birth, in neighboring states it varies.

The infant mortality rate for Hispanic children is slightly higher in Wyoming, where the Hispanic infant death rate is 7.9 deaths per 1,000 live births, according to the Henry J. Kaiser Family Foundation. In Wyoming, the non-Hispanic infant death rate is 6.3 per 1,000.

The same research found the Hispanic infant death rate for Utah is 5.0 per 1,000 live births, only slightly above the non-Hispanic infant death rate of 4.7 per 1,000.

In Nevada, the Hispanic infant death rate is 5.7 per 1,000 live births; the non-Hispanic white infant death rate of 5.3 per 1,000. The non-Hispanic African-American infant death rate in Nevada is 12.5. (The foundation had no data on non-Hispanic African-American infant death rates for Utah, Wyoming or Idaho.)

Outreach Works

So what's being done for Hispanic women in Idaho?

Part of the problem is outreach, Smith said. Once a pregnant woman comes into the clinic, they can let her know that she can receive her care there. Family Health Services in Magic Valley provides services on a sliding fee scale, meaning families pay what they can afford. And no one is turned away, regardless of immigration status or ability to pay, Smith said.

As for the women who don't come in, "we don't know about (them)," Smith said. "I don't know how to get to that population."

Doctors work on outreach in other parts of the state. In southeast Idaho, the Community Council of Idaho runs health clinics for comprehensive care, including prenatal checks.

Arnold Cantu, Community Family Clinic director for the Community Council of Idaho, said bilingual nurses and clinic workers visit Head Start centers to talk to parents about the importance of wellness checks, including prenatal care.

That outreach works. Though some patients are initially hesitant to come in for cultural reasons, Cantu said, visiting with workers fluent in Spanish makes them feel more at ease. And, in his experience, younger women are more likely to come in during the first trimester than older women.

"We try to educate as many people as we can," he said.

More needs to be done, said JJ Saldana of the Idaho Commission on Hispanic Affairs. The commission's board is meeting in Burley next month to discuss outreach for health in the Hispanic community, including prenatal care.

"Our big focus for the longest time had been education and other issues, but health has become one of our other top priorities as well," Saldana said.



Source: (c)2013 The Times-News (Twin Falls, Idaho) Distributed by MCT Information Services