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A Long Road to Prenatal Medical Care

Antelope Valley infants are at risk from lack of readily available services. L.A. County is worried.

June 06, 2005|Carla Rivera | Times Staff Writer

In a cramped Palmdale apartment, Andrea Williams wakes at 6 a.m. for a 10 a.m. doctor's appointment. Her destination is Olive View-UCLA Medical Center in Sylmar, 40 miles and a bus and shuttle ride away. It is an all-day ordeal for Williams, who is eight months pregnant and who lost part of her leg to cancer as a child.

Because her pregnancy is high risk, she couldn't find a doctor in the Antelope Valley willing to take her as a patient.

"I don't like having to come to Olive View," Williams, 21, said recently before setting off from her home in a wheelchair for the county-run facility. "But it's the only choice I have. It's the only way to check up on the baby and know he's fine."

Williams is not alone. More than anyplace else in Los Angeles County, pregnant women in the Antelope Valley confront hurdles that make it difficult to obtain high-quality care. As a result, authorities say, these women suffer disproportionate numbers of problem pregnancies, and their babies are nearly twice as likely to die in their first year as those in the county as a whole.

The problems are especially acute among African American women. Health officials are trying to pinpoint factors in the black community that might contribute to the higher rate of deaths, and have initiated outreach and education programs to improve babies' chances.

The desert communities of Palmdale and Lancaster -- urban outposts in a region that stretches more than 2,200 square miles to the Kern County border -- are two of the fastest-growing cities in Los Angeles County. But the neat rows of new middle-class housing developments mask pockets of poverty, joblessness and crime.

Outside of those cities, the Antelope Valley is sparsely populated, with fewer than 250 people per square mile. The state considers the region rural for purposes of health planning, but the federal government recently reclassified it as urban, an action that renders it ineligible for federal healthcare dollars designated for rural areas.

County health officials say it is exactly this rural nature -- with the lack of convenient transportation and paucity of maternal medical services -- that is feeding high infant mortality. The Antelope Valley also has some of the highest rates in the county of tobacco use, obesity, adult and childhood asthma, and hypertension.

Studies show that poverty and being a minority heighten the risks of infant mortality. But experts also say that environmental and social conditions -- geographic isolation from family and friends, loneliness, brutally long commutes, few amenities such as grocery stores -- are taking a toll on pregnant women in the Antelope Valley.

"It's really worrisome what's going on up there," said Michael Lu, a UCLA assistant professor who studies infant health. "We're beginning to look at place-based studies: What is it about a neighborhood or community that promotes healthy births or increases the risk of premature birth? There are some studies linking the quality of air and water to bad outcomes. For some, though, it could be the lack of social support, social isolation."

This is Williams' first pregnancy. She and her boyfriend have been staying with a friend because they cannot afford their own place.

The apartment, on a rough west Palmdale street dotted with older, rundown houses, is crowded with roommates and offers little privacy, she said.

"Sometimes I pray, sometimes I cry," she said. "Other times I try to not even be bothered with it, I try not to think about it."

She is not sure what will happen after the baby is born. The couple have applied for low-income housing but have been told to expect to wait several months. Her mother, who lives with her grandmother and cares for Williams' younger siblings, can offer little help.

Because it was hard for her to find prenatal care, Williams went four months without a checkup, which left her anxious. She is at high risk for complications because of her history of cancer and use of anti-cancer drugs.

Doctors have told her that her pregnancy is proceeding normally. But getting to and from the clinic has its own problems. She recently set out about 7 a.m. for an appointment three hours later in Sylmar and did not return home until after 2 p.m.

She took a shuttle that could accommodate her wheelchair from the hospital to Lancaster City Park and then had to catch a city bus home. During her appointment, Williams learned that Olive View will provide door-to-door transportation for her remaining clinic visits because she is a high-risk patient.

"It's hard being on a bus and being eight months pregnant," she said. "It's definitely stressful. But there's not a lot I can do to change things right now."

The Antelope Valley's infant mortality rate in 2003, the most recent year for which data were available, was 9.7 deaths per 1,000 live births, compared with 10.6 deaths in 2002. The countywide rate was 5.4 deaths per 1,000 live births, down slightly from 5.5 in 2002.

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