REPORT HIGHLIGHTS PROGRESS IN ESTIMATING FREQUENCY OF BIRTH DEFECTS

There has been "substantial progress towards improved national prevalence estimates for 18 selected major birth defects," according to a report published in the January 6, 2006, issue of the Morbidity and Mortality Weekly Report. To date, no national estimates based on population-based surveillance data have been available for specific types of birth defects other than neural tube defects (spina bifida and anencephaly). The report describes estimates of national prevalence and number of affected births in the United States each year during
1999-2001 for 18 selected major birth defects using population-based active birth defects surveillance data.

Data for the analysis were drawn from the National Birth Defects Prevention Network (NBDPN). NBDPN collects population-based surveillance data for up to 45 major birth defects from 34 participating states. Pooled data from the 11 states that had (1) active case-finding for 18 selected birth defects for 1999-2001 birth years and (2) data reported to NBDPN for all 3 years (1999-2001) were used to calculate prevalence estimates. Selected defects were chosen because they are recognizable at or shortly after birth, and their ascertainment is less likely to be affected by regional differences in referral and clinical management practices than is the ascertainment of other types of defects. National estimates were adjusted by race and ethnicity and by maternal age.

The authors found that

* Ten of the 18 birth defects affected more than 1,000 infants each year in the United States.

* The conditions with the highest prevalence included orofacial clefts, which affect approximately 6,800 infants annually, and Down syndrome, which affects approximately 5,500 infants annually.

The authors conclude that these findings "can help determine resource needs for basic and public health research and assist in planning for the health care and educational needs of the U.S. population."

Canfield MA, Ramadhani TA, Yuskiv N, et al. 2006. Improved national prevalence estimates for 18 selected major birth defects -- United States, 1999-2001. Morbidity and Mortality Weekly Report 54(51&52):1301-1305. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a2.htm.

MCH Alert, January 13, 2006

STUDY ASSESSES EFFECT OF WELFARE REFORM ON PRENATAL CARE AMONG HISPANIC WOMEN

In this study of 3,242 childbearing Hispanic women in California, Florida, and New York, state of residence, a measure of PRWORA [Personal Responsibility and Work Opportunity Reconciliation Act] policy changes, was associated with use of prenatal care," state the authors of an article published in the January 2006 issue of Obstetrics & Gynecology. The 1996 PRWORA (i.e., welfare reform legislation) imposed new restrictions on the use of federal Medicaid funds for some groups of documented immigrants and retained prohibitions on the use of federal Medicaid funds for undocumented immigrants (except for emergency services). Under PRWORA, states were given the option of providing benefits to federally ineligible groups using nonfederal sources of funding. The article presents findings from a large, prospective, multistate study to assess whether state-based differences in the implementation of PRWORA influenced access to and use of prenatal care among Hispanic women.

Women who delivered at one of seven hospitals in one of three states (New York, California, and Florida) between March 1999 and February
2001 were recruited for the study. (Florida implemented the eligibility restrictions, while California and New York preserved eligibility.) Women were interviewed during the delivery hospitalization to assess immigration status, demographic and other maternal characteristics, and barriers to prenatal care. Information about use of prenatal care (onset of care and number of prenatal visits) was abstracted from the maternal medical record. The first analyses compared the distribution of maternal characteristics by state immigration status groups and assessed differences in onset of prenatal care and number of prenatal visits by state of residence. The final analysis estimated the effect of all variables on the risk of inadequate use of prenatal care (initiated during the first trimester and less than six prenatal visits or initiated after the first trimester).

The authors found that:

* In Florida, U.S-born citizens, foreign-born citizens, documented immigrants, and undocumented immigrants were all more likely to have inadequate use of prenatal care than U.S-born citizens in New York.

* In New York, documented immigrants were 90% more likely to have inadequate use of prenatal care than their U.S.-born citizen counterparts.

"Our findings imply that the potential adverse effects of the PRWORA on perinatal outcomes may be attenuated by state-level efforts to maintain Medicaid eligibility for pregnant women, regardless of immigration status," conclude the authors.

Fuentes-Affleck E, Hessol NA, Bauer T, et al. 2006. Use of prenatal care by Hispanic women after welfare reform. Obstetrics & Gynecology 107(1):151-160. Abstract available at http://www.greenjournal.org/cgi/content/abstract/107/1/151.

MCH Alert, January 13, 2006

   Leading Medical Association Rejects Abstinence-Only Policies—Programs at Odds With 

                                   Medical Ethics and Basic Human Rights

The Society of Adolescent Medicine, in one of the most exhaustive reviews to date of government-funded abstinence-only programs, has rejected current administration policy that promotes abstinence as the only sexual health prevention strategy for young people in the United States and abroad.

To read the press release, and the report, please visit:
http://www.advocatesforyouth.org/news/press/010506.htm

January 2006 update on new publications, actions you can take, and more! Advocates for Youth's e-News Update

                     Will the Politics of Teen Sex Stop a Cancer Vaccine?

After a decade of development, two drug companies—Merck and GlaxoSmithKline—are close to marketing the first ever vaccines that show 100 percent efficacy in combating the most dangerous strains of the human papilloma virus (HPV), the cause of almost all cervical cancers.

However, groups that promote an abstinence-only-until-marriage approach to sex education intensely market the threat of HPV as a reason for promoting abstinence only. They claim a vaccine will promote promiscuity by lessening people’s fears regarding HPV and cervical cancer.

To read the Media Brief, please visit:
http://www.advocatesforyouth.org/publications/cancervaccine.htm

January 2006 update on new publications, actions you can take, and more! Advocates for Youth's e-News Update

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