TWIN FALLS - As soon as Janell Cortez found out she was pregnant, she made her first prenatal appointment. It's the same thing the 25-year-old Jerome woman did for her past three pregnancies, and it's exactly what Family Health Services wants women to 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 to the Idaho Department of Health and Welfare, from 2008-2010, the infant death rate for Hispanics was 7 per 1,000 live births. It was 5 per 1,000 for non-Hispanics.
"It is statistically significant," said Tom Shanahan, the department's public information manager. "... We don't know what the story is exactly."
NO EASY ANSWER
Why do Hispanic infants die at a higher rate? There are some clues.
Dr. Camille Smith of Family Health Services in Buhl said women who receive inadequate prenatal care are more likely to have complications, 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 care and to wait until the second or third trimester to seek care.
"We've had a couple (of Hispanic mothers) who have come in later. I wouldn't say it's common but there's been a few," Smith said.
One woman who was 20 weeks pregnant recently came to the clinic for the first time. "She'd never had any prenatal care," Smith said.
The woman lost the baby.
Cortez was shocked when she found out some women in the Hispanic community wait to get the necessary 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 - meaning the placenta is especially close to the cervix.
Smith said 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.
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.
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.
Rates in neighboring states vary.
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; it had no data on non-Hispanic African-American infant death rates for Utah, Wyoming or Idaho.
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."
Arnold Cantu, Community Family Clinic director for the Community Council of Idaho, said bilingual nurses and clinic workers visit Head Start centers to talk 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.
More needs to be done, said JJ Saldana of the Idaho Commission on Hispanic Affairs. The commission's board meeting in Burley next month will 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.