While raising her daughter, Stevie, in Santa Barbara hasn’t been a cakewalk, Annette Ramirez exemplifies the privileged position of most South County mothers when it comes to social determinants of health. | Credit: Ingrid Bostrom

When Annette Ramirez, 23, gave birth to her daughter, Stevie, earlier this year, she was happy to welcome a healthy baby girl into the family. (Disclosure: Stevie is part of my extended family.) As she held her daughter in her arms for the first time, she probably wasn’t thinking about how demographics played a role in the outcome of her and Stevie’s health. 

But Ramirez does fit into a demographic. She and her daughter live in southern Santa Barbara County in a safe neighborhood, and she has more than a high-school-equivalent level of education, is financially stable, has a multiracial background, and has access to health care. 

A majority of Ramirez’s characteristics are a green flag for delivering a healthy baby in Santa Barbara County. However, as reflected in the county Public Health Department’s recently released Birth Report, there are a number of varying factors, and some glaring disparities, that affect what raising a child in Santa Barbara — from pregnancy to birth and everything that follows — will look like from one family to another.

The report, which analyzed local birth data from 2017 through 2021, found significant differences in the socioeconomic characteristics of North County and South County mothers and the related health outcomes of their children. Among the health issues adversely affecting North County mothers and their babies to a greater extent than their South County counterparts are lower life expectancy, a greater number of gestational diabetes diagnoses, decreased access to health insurance and care, and higher rates of preterm births and low birth weights, which greatly affect the child’s life expectancy and raise the risk for infant death.

“Place, or region, is the overwhelming determinant of birth rates in the county,” said Lanny Ebenstein, a past member of the Santa Barbara Board of Education and an economist at UCSB. “Santa Barbara County births are disproportionately in northern Santa Barbara County, especially Santa Maria, which is a largely lower socioeconomic area.”

Births in Santa Barbara County have been on the rise since the low count of 5,252 births in 2018, jumping to 5,489 births recorded in 2021. According to Ebenstein, birth rates around the country have been in decline for years and have not returned to what they were before the Great Recession. In the midst of the COVID pandemic, birth rates in Santa Barbara took another downturn and are only now gradually inching back to the 5,506 count recorded in 2017.

Overall, the 2021 county birth rate was 57.7 births per 1,000 women of childbearing age, an increase from the previous year. There were also significant differences in birth rates based on the race and ethnicity of the mother; in 2021, Black mothers had the lowest birth rate at 26.5 births per 1,000 population compared to Hispanic mothers with the highest rate of 80.3 births per 1,000 population.

Joy Jacobsen, County Public Health’s senior epidemiologist, said that the report was one of the first times that they focused on social determinants of health and birth outcomes in Santa Barbara.

Social determinants of health — “the conditions in the environments where people learn, work, and play” — vary across regions in the county and have a notable impact on people’s quality of life and well-being. Striking inequities are revealed when comparing the economic stability, access to quality education and health care, affordable housing, and community resources available to the county’s different neighborhoods. 

Those inequities are reflected in each community’s Healthy Place Index (HPI) score, which takes into consideration different socioeconomic characteristics, such as income and education, to determine how healthy a community is and, subsequently, the health of mothers and newborns. Isla Vista’s overall HPI score was the lowest in the county, at 11.7 percent, and Montecito’s score, at 89.4 percent, was the highest.  

“When we look at the healthy place index by region, we see differences across the county,” said Maternal, Child, and Adolescent Health Director Kelley Barragan. “North County had several birth measures that fared worse than Central and South County.” 

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The report’s findings mainly demonstrate the importance of a mother’s education in the health outcome of her baby. Education, or years of schooling, influenced whether a mother sought early prenatal care — health care initiated in the first three months of pregnancy.

“Prenatal care represents an important opportunity to detect, monitor, and address health conditions and behaviors among expectant mothers that can really impact birth outcomes,” Barragan said. 

Ebenstein noted that, in reference to the differences in education of mothers by region, “Santa Barbara and Santa Maria are almost the inverse of each other.” Most births in the City of Santa Barbara were to mothers with some college or a BA, and very few were to individuals with less than a high school degree. However, in Santa Maria, it was almost the opposite. 

South County had a 16 percent higher rate of initiating prenatal care in the first three months of pregnancy compared to North County. Barragan explained that rates of prenatal care were lowest in North County, coupled with the county’s highest preterm and low-weight birth rates, as well as the highest proportion of births to adolescent mothers (ages 15-19).

In total, the report found that births to adolescent mothers declined significantly from 2017 to 2018 (from 21.9 to 17.1 births per 100,000 teens), which is good news for the county as a whole. However, the disparities between North and South County are clear. In 2021, Santa Maria had the highest proportion of births to teenage mothers at 9.2 percent; the City of Santa Barbara, on the other hand, had the lowest, at 1.9 percent. On top of that, a 2020 report by the county Child Care Planning Council (CCPC) found that 92 percent of the teen births in 2019 were Hispanic, and 71 percent occurred in Santa Maria and Guadalupe. The report also showed a decrease that same year in services available for teen parents and their children. 

In addition, the Birth Report highlights racial and ethnic disparities among mothers across the county, including that Hispanic women were consistently 10 percent less likely to start prenatal care compared to White and Asian women, and rates of preterm and low-weight births were highest among Black, Hispanic, and multiple-race (two or more races, any Hispanic status) mothers. “This data really emphasizes the need as a community to address the social determinants of health and the impacts of systemic racism,” Barragan said.

Barragan and Jacobson both made the point that Public Health can use the Birth Report data to inform their various programs and initiatives to target specific areas in improving health equity in the county.

“We see differences in social determinants of health and health outcomes by location,” Barragan continued. “Focusing resources on enhancing the quality of life of community members — such as making healthy food more attainable, helping residents gain access to affordable housing, and investing in quality education — will positively influence health outcomes.”

The 2020 report by the CCPC highlighted that one in five people in Santa Barbara County live in poverty, with North County having “the largest number of families described as homeless,” at 66 percent. 

Ramirez, who sought prenatal care within the first eight weeks of her pregnancy, exemplifies the privileged position of most South and Central County mothers when it comes to social determinants of health. However, that does not mean that raising a child in Santa Barbara has been easy for her. Making ends meet is difficult for parents across the county, especially if they do not have outside support. 

Ramirez explained that had she and Stevie’s father not moved in with her mom, they wouldn’t have been able to afford raising a child here. “We looked for an apartment for just the two of us before moving back in with my mom, but we would have never been able to live here on our own,” Ramirez said. “Also, many doctors didn’t take Stevie’s insurance, so we had to pay out of pocket, and that was extremely hard to pay for as well.”

Ebenstein said that he believes that government agencies and nonprofit organizations in Santa Barbara generally do “a good job of addressing the health and well-being of children in lower socioeconomic families and circumstances.” 

“The problem is that, especially in North County, there are so many children in these circumstances,” he continued. “It’s important for government agencies and nonprofit organizations to prioritize northern Santa Barbara County in providing services, but without shortchanging those who are in need on the South Coast.”

See below for some of the Public Health Department’s ongoing programs and efforts:

  • The Maternal, Child and Adolescent Health (MCAH) Field Nursing Unit is staffed by Public Health Nurses who provide in-home assessments, education, linkage/referral, and comprehensive case management for women, infants, children, and their families who are at risk for adverse health outcomes.
  • Healthy Families America® is a nationally recognized program that connects expectant parents and parents of newborns with free child development assistance in their homes. Home visitors provide guidance, information, and support to help parents be the best parents they can be.
  • Bilingual lactation consultants are available through the WIC program to support mothers needing extra breastfeeding assistance.
  • MCAH, Nutrition Services/WIC, Sansum Diabetes Research Institute, and Cottage Health have partnered to plan and launch a needs assessment to better understand diabetes in pregnancy, gauge the county patient experience, learn of unmet needs, and identify existing community strengths.
  • County Nutrition Services is utilizing technology advancements to bring care to the patients through telehealth.
  • The epidemiology team is being staffed up to increase the capacity of MCAH and WIC data analysis and program assessment work.

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