Numbers of Merced County women getting prenatal care worst in the Valley, a study shows

Expectant mothers in Merced County are among the least likely in California to have regular prenatal care, largely because of the area’s shortage of providers, according to health care reports and experts.

Out of California’s 58 counties, Merced County ranked second-to-last in terms of the percentage of pregnant women who receive adequate prenatal care, according to the Women’s Well-Being Index compiled by the California Budget and Policy Center. Slightly more than 60 percent of women in the county received regular prenatal care between 2011 and 2013, a portion above only Imperial County’s 58 percent.

Compared with other counties in the San Joaquin Valley, Merced County’s ranking is far worse even though it has similar demographics. The top ranking among all California counties, in fact, is Fresno County, where more than 89 percent of pregnant women received adequate care; Stanislaus County’s rate is nearly 70 percent; Madera County’s is 66 percent.

One of the main factors is the lack of access to care. All of Merced County is considered a “health professional shortage area,” according to the 2016 Community Health Assessment by the county Department of Public Health. Merced County places 43rd out of the 58 counties in California on primary care physician-to-patient ratio.

While Merced County has two hospitals, there are seven in Fresno County, noted Rose Mary Rahn, maternal child adolescent help director for the Fresno County Department of Public Health.

“I think we probably have enough OB providers in areas of need,” Rahn said.

Marianne Biangone, assistant director for the Merced County Department of Public Health, said, “More hospitals and providers in Fresno does create more opportunities; we just need to get there.”

Prenatal care has the potential to improve the health of future mothers and growing babies, whether it be to detect a health defect or abnormality of the unborn child or prevent pregnancy complications for the mother, said Lise Talbott, director of patient education at Golden Valley Health Center.

“It’s crucial,” Talbott said. “A lot of women don’t realize they should see a doctor in the first trimester. You want to make sure the pregnancy is going normally.”

In Merced County, it seems more difficult for pregnant women to receive adequate prenatal care, according to the assessment from the California Budget and Policy Center, an independent organization based in Sacramento.

Determining whether prenatal care is adequate is based on two types of data from the Department of Public Health, said Steven Bliss, director of strategic communications for the group. How early prenatal care is started and how frequently women have prenatal visits are accounted for, Bliss said.

In recent prenatal care data from the Department of Public Health, Merced County stayed about the same in the years 2012-14, reaching 60.3 percent, still the lowest ranking county in the Valley and one of the lowest in the state.

Fresno County’s percentage stayed about the same as well in recent data, coming in at 89.5 percent.

Compared with Merced County, Rahn said, Fresno County has similar communities when it comes to diversity and high migrant populations. One of the main differences is the larger “urban core” in Fresno when compared with downtown Merced.

The number of people living in each county also plays a part, Rahn said, because more people means a higher demand for medical services, prenatal care being one of them. According to the U.S. Census Bureau, Fresno County’s population was estimated at more than 970,000 people as of last year. Merced County’s was put at 260,000.

“There’s a broader infrastructure (in Fresno), and women know these hospitals and know they need prenatal care,” Rahn said.

Another service offered in Merced and Fresno counties is the Comprehensive Prenatal Services Program, or CPSP, that helps pregnant women on Medi-Cal obtain prenatal services from conception to 60 days after birth.

According to Biangone, there are 12 CPSP offices in Merced County. Fresno County has 55, and Rahn said that can contribute to the vast difference in prenatal care access.

One problem in Merced, Biangone said, is not only the amount of providers but the access to those providers.

Medical professionals and county officials said the high reliance on Medi-Cal in Merced County plays a part, too. Medical professionals can make more money in cities such as San Francisco and Los Angeles.

This story was originally published October 31, 2016 at 5:11 PM with the headline "Numbers of Merced County women getting prenatal care worst in the Valley, a study shows."