Monday, January 28, 2002

Unplanned pregnancies
and infant deaths are up

Programs that could have helped
women had their budgets cut,
health officials say

By Helen Altonn

Unplanned pregnancies and infant deaths have increased in Hawaii the past five years, and there is a direct correlation to budget cuts, says a state health official.

Those are only two "key health risk indicators" signaling serious problems in the "health state," according to data compiled by the state Health Department's Family Health Services Division.

"In tough economic times, prevention programs are the first to go," said Loretta Fuddy, former division director, now the department's deputy director for administration.

For example, the state cut family-planning funds 90 percent about five or six years ago because of the slowing economy, she said.

In 1992 the department had 19,000 clients through family planning. In 1997 there were 7,000, mostly with health care coverage, she said.

Unintended pregnancies have occurred among uninsured women or those with partners who cannot cover them, she said. And the uninsured rate has climbed the past 10 years, she pointed out.

Women without coverage rely on primary care centers, which depend on state subsidies, but subsidies dropped while the uninsured numbers rose, Fuddy said.

"Over the years, as monies are not available, you see the full impact," she said.

The unintended pregnancy statistics cover women over 19. Teen pregnancies have remained stable or decreased slightly, according to state health officials.

Funds also were slashed for the perinatal support program for high-risk women and the Baby Safe Program, which provides services for pregnant women who are substance abusers, Fuddy said.

Yet, she said, "We have not seen a reduction in the number of women who use drugs." Of major concern, she said, is the large number of women who smoke and use alcohol during pregnancy.

Nancy Partika, executive director of Healthy Mothers, Healthy Babies, underscored Fuddy's comments.

"If we want to have optimal perinatal outcomes in this state for pregnant women and infants, we have to pay attention to the public health structure, and it has taken a beating over the last five years or longer," she said.

"It's essential to understand there are consequences to those cuts -- not just to those women, but to us as a state. We will pay in higher outcome costs."

Programs for adolescent services also were cut 50 percent and transferred to the state Department of Education, Fuddy said. "While we feel DOE is doing a good job, they lost some of their health prevention focus."

She said the Health Department is fortunate to have use of tobacco settlement funds for prevention activities in schools, but it will take time to see the effects.

With the economy declining again after Sept. 11, Fuddy said, prevention programs, which are largely "discretionary," again are jeopardized.

"As we look to reduce funding in the department, they will be one of the primary targets," she said.

But from a public health perspective, she emphasized, "They're cornerstone programs."

She said the birth defects monitoring program lost all state funding. It has continued with a grant from the Centers for Disease Control that is lapsing.

An increase has been proposed in the marriage license fee to maintain the program, which is essential to identify trends in birth defects and effects of prevention activities, Fuddy said.

A study looking at high costs of births reported the state spent $140 million in 2000 just on hospital costs of delivery, Partika said, noting some complicated births cost more than $50,000.

"One percent of babies made up 90 percent of the cost in 2000," she said.

Partika said there are some important policy issues.

"We need to invest in the prevention end and realize that should save us money in terms of treatment, whether we are talking about family planning, prenatal care or serving substance-abusing women," she said.

Community health centers are seeing more people with no increase in state resources, said Beth Giesting, executive director of the Hawaii State Primary Care Association.

"In fact, there has been a decrease, and health centers can't keep up with the increased demand," she said.

Giesting said the state's axing of family planning was "penny-wise and pound-foolish."

"We don't often have an opportunity to see what happens when you don't provide those services. Now we do," she said. "Unfortunately, the results are very stark. It means a lot of misery for a lot of people."

Community health centers also are the prime organizations to care for women with substance abuse problems, Giesting said. "There again, because of lack of funding, services are just not available. There is no place else to cut."


These are among the effects of funding cuts over the past five years, documented by the Maternal & Child Health Branch of the state Health Department's Family Health Services Division:

>> Unintended pregnancies jumped to 52 percent from 38 percent of all pregnancies in the state over the last five years.

>> Infant deaths went to 7.8 per 1,000 in 2000 from 5.3 per 1,000 births in 1996.

>> Women seeking prenatal care in the first trimester dropped to 76.6 percent in 1999 from 81.8 percent in 1997.

>> The uninsured rate increased to nearly 10 percent overall; about 25 percent of patients in community health centers were uninsured.

>> An estimated 30,000 children lack health care insurance; 13,000 Medicaid-eligible children are not enrolled in the state's QUEST program.

>> Substance abuse among pregnant women more than doubled, to almost 12 percent from 5 percent. Families identified as at risk for child abuse rose to 30 percent from 20 percent.

>> Family violence increased, with child fatalities, severe injuries and abuse linked to escalating substance abuse.

>> Thirty percent of middle school children contemplated suicide within the last year, and 4 percent of high school students required medical attention for a suicide attempt.

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