By BloggersUnite.org _ Though the piece went up a few days back now, I wanted to wrap up, discuss the reporting process a bit more and include a source list for anyone who may be interested in one.
The piece I set out to report was not the one I found. But I’ll get to that.
I encountered a great deal more information in the two weeks transpiring between the last blog post and this one.
Numerous daily phone calls to LA County and South LA Lynwood-based St. Francis hospitals found me no further than the institutions’ PR.
And while very nice, they could not tell me what kind of preterm birth rates they saw amongst their patients, and among those, of what race and cause were these instances.
They could, however, describe the care women using Medi-Cal would receive and whether those visiting the hospital tended to use that form (they did).
My calls to King Drew were not successful, but phoning the Watts Health Center and realizing it’s the area’s largest and seemingly most reliable health resource made me want to visit.
Intersecting Compton and the city’s upper 100 streets, the health center takes up nearly a full block in what appears to be each direction.
As I entered the large clinic through the back, I was struck by what seemed to be a highly functional, hospital-resembling institution. Fair assumption or not, I have to admit I did not expect that.
After asking for the prenatal care unit, I was able to speak to one of the health educators, Marcela Rodriguez. She walked me (so to speak) through the care women receive while describing the instances she’d encountered of preterm births.
Touching upon noncompliance as a factor, she pointed to diet and stress as main instigators of preterm births. The prenatal care unit lies separate to the OB, and as I walked down the halls and past the courtyard, I noticed art pictorially describing need for racial tolerance and a lasting civic peace. Bloods embraced Crips, prisoners walked free and Hispanics stood with Blacks.
As I had come in without notice, it seemed unlikely I would be able to speak to an OBGYN this visit. But I got lucky. Dr. Deirdre Logan ushered me into her office for a very helpful conversation (which we would later conclude over the phone a few days later).
She discussed the prenatal care women using Medi-Cal or attending FDHCs receive—starting with the preliminary visits and ending with labor—while explaining that many women in the neighborhood do not open their mail and do not apply for Medi-Cal in the first place.
She said the women’s nutrition—often consisting of very salty or fattening foods—definitely contributed to the high instances of preterm births, but she said more than anything the fault likely lay with STDs and stress.
Many of the women in what is a dangerous area who have preterm births are on welfare and are single moms without a familial support system. Those stresses, she said, have an effect.
One of the challenges I found with this story was in trying to locate numbers to corroborate any of these theories. Because I couldn’t really reach the hospitals or their records, I couldn’t know for sure how many women coming in of lower means had preterm births and of those what were their races and situations and of those what had caused these early births.
In the past few years, certain South LA areas like Compton and Lynwood have experienced demographic changes. No longer predominantly African American, such areas are now anywhere from 50 + percent to 80 percent Hispanic.
The instances of teen pregnancy (healthy or otherwise) in South L.A. are still very high, and LAUSD has three schools, one, Thomas Riley, just across the street from the Watts Health Center, for high school-aged girls who are pregnant.
Yet the African American women among them still tend to have more preterm births—from what the assistant principal, Dolores Magana, with whom I spoke on the phone, has said. She also said she thinks it may be a cultural issue. She indicated she and the school teachers make sure the girls see a doctor and comply with their medical visits.
But she cannot regulate their food-intake or their private lives. And that, she said, is where the pregnancy could go awry. She explained that while Hispanic women may face the same financial and discriminatory obstacles as do African American women in South L.A., Hispanic women tend traditionally to maintain strong ties with their parents and the fathers of their children (even if they do not marry) and tend, also, to eat more balanced (or at least more varied) diets.
I realize these are huge and dangerous generalizations to be making, but I heard them cropping up again and again.
I faced the same discomfort writing about how African American women may have higher incidences of preterm births because of, as doula/masters in public health/health educator Cordelia Hanna-Cheruiyot and U-Dubb professor Amelia Gavin put it, the “institutionalized racism” that makes it more difficult for Blacks to buy houses and get loans, etc.
I see the logic behind all these arguments and am in no position to argue with them. But a dearth of hard numbers also made it difficult for me to write with ease about what are somewhat controversial topics and claims.
And I would be remiss were I not to mention that there are other causes for preterm births not stemming from socioeconomic difficulty.
For example, St. Johns Hospital OBGYN Dr. Laura Reynard, an obstetrician dealing more often with women who use private insurance, explained preterm births are common among older—often wealthy—women who use In vitro fertilization.
She also said professional women in high stress jobs—such as those within medicine or law—tend to have preterm births quite commonly.
Ana Markel, a doula dealing most often with women of high social strata as “poorer women cannot afford doulas” said the same thing.
On the other hand, Jun Wu, an assistant professor in public health from the department of epidemiology at UCI, thought preterm birth rates had little to do with prenatal care, race, class, stress or nutrition and everything to do with pollution.
She and her colleagues had published a study (linked in the article and will likely be in the source list) showing women living near busy highways tend to have a higher risk for premature birth and preeclampsia.
Yet Hanna-Cheruiyot (see above), who worked at a Pasadena clinic for many years and especially saw Black infants and women using Medi-Cal, spent a great deal of time describing what she termed the “assembly line care” these women received and how doctors will deprive these women of the choice to have a vaginal birth, for example, because it takes longer.
She then went on to highlight how, physically-speaking, women on Medi-Cal could be receiving decent care, but because no one, such as a doula, is attending to their mental well-being, they’re less likely to have healthy births.
But she emphasized that at the end of the day, Black women have more premature births because they face more discrimination.
So mid-way through all this, I became completely confused and unsure as to which path to follow, how to structure the reporting I had left and how to put together the article I was to write.
The piece I had thought to report—one showing the possibly great disparities in prenatal care in Los Angeles—was not necessarily the one I was finding.
I know that’s ok, but what I was finding seemed at first jumbled, contradictory and hard to support.
And that was where the stats Dr. Logan provided me finally made me feel like I had something that could tie all these voices together.
Having these numbers really allowed me to breathe a bit more freely as I wouldn’t simply be making allegations—through human sources on specific “sides” or otherwise—that I couldn’t back up. I couldn’t simply say “South LA tends to have the highest rate of gonorrhea in the county” until I had the numbers to support that.
Once I had these documents I could put together a bit more where Wu’s or Gavin’s statistics fit in, where I could include the Best Babies Collective information or where I would add in the facts about Medi-Cal, presumptive eligibility, the poverty line, welfare, etc.
I found reporting and writing this a challenge. Though it may seem otherwise, there has not been that much research done, and the statistics, I believe, are still somewhat shaky.
But I truly enjoyed delving into this tough subject and trying to figure out how to tell an important story.
No matter what—whether it’s faulty prenatal care, pollution, diet, sexually transmitted diseases and infections, stress, racism, or what-have-you, there are great forces at play here affecting the pregnancies and thus children of entire groups of women (as well as tax-payers), and health still does accompany wealth (for the most part), so none of this is an exercise in futility.
