[Congressional Record Volume 143, Number 82 (Thursday, June 12, 1997)]
[Senate]
[Pages S5584-S5589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  BIRTH DEFECTS PREVENTION ACT OF 1997

  Mr. LOTT. Mr. President, I ask unanimous consent that the Labor 
Committee be discharged from further consideration of S. 419, a bill to 
prevent birth defects by developing and implementing new prevention and 
surveillance strategies, and that the Senate now proceed to its 
immediate consideration under the following limitation:
  One substitute amendment in order to be offered by Senator Bond, no 
other amendments be in order to the bill, and there be 30 minutes 
equally divided for debate with Senator Bond in control of 15 minutes 
and the ranking member in control of 15 minutes; and, further, 
following the disposition of the amendment and the expiration or 
yielding back of time, the bill be read a third time and the Senate 
proceed to a vote on final passage of the bill, as amended, with no 
intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LOTT. I yield the floor so the Senator can begin the time on this 
bill.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       A bill (S. 419) to provide surveillance, research, and 
     services aimed at prevention of birth defects, and for other 
     purposes.

  The Senate proceeded to consider the bill.
  Mr. BOND addressed the Chair.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Missouri.
  Mr. BOND. Mr. President, I thank the majority leader.


                           Amendment No. 371

              (Purpose: To provide a complete substitute)

  Mr. BOND. Mr. President, I send to the desk an amendment providing a 
complete substitute for S. 419.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Missouri [Mr. Bond], for himself and Mr. 
     Craig, proposes an amendment numbered 371.

  Mr. BOND. Mr. President, I ask unanimous consent that reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Birth 
     Defects Prevention Act of 1997''.
       (b) Findings.--Congress makes the following findings:
       (1) Birth defects are the leading cause of infant 
     mortality, directly responsible for one out of every five 
     infant deaths.
       (2) Thousands of the 150,000 infants born with a serious 
     birth defect annually face a lifetime of chronic disability 
     and illness.
       (3) Birth defects threaten the lives of infants of all 
     racial and ethnic backgrounds. However, some conditions pose 
     excess risks for certain populations. For example, compared 
     to all infants born in the United States, Hispanic-American 
     infants are more likely to be born with anencephaly spina 
     bifida and other neural tube defects and African-American 
     infants are more likely to be born with sickle-cell anemia.
       (4) Birth defects can be caused by exposure to 
     environmental hazards, adverse health conditions during 
     pregnancy, or genetic mutations. Prevention efforts are 
     slowed by lack of information about the number and causes of 
     birth defects. Outbreaks of birth defects may go undetected 
     because surveillance and research efforts are underdeveloped 
     and poorly coordinated.
       (5) Public awareness strategies, such as programs using 
     folic acid vitamin supplements to prevent spina bifida and 
     alcohol avoidance programs to prevent Fetal Alcohol Syndrome, 
     are essential to prevent the heartache and costs associated 
     with birth defects.

     SEC. 2. PROGRAMS REGARDING BIRTH DEFECTS.

       Section 317C of the Public Health Service Act (42 U.S.C. 
     247b-4) is amended to read as follows:


                   ``programs regarding birth defects

       ``Sec. 317C. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention, shall carry out programs--
       ``(1) to collect, analyze, and make available data on birth 
     defects (in a manner that facilitates compliance with 
     subsection (d)(2)),

[[Page S5585]]

      including data on the causes of such defects and on the 
     incidence and prevalence of such defects;
       ``(2) to operate regional centers for the conduct of 
     applied epidemiological research on the prevention of such 
     defects; and
       ``(3) to provide information and education to the public on 
     the prevention of such defects.
       ``(b) Additional Provisions Regarding Collection of Data.--
       ``(1) In general.--In carrying out subsection (a)(1), the 
     Secretary--
       ``(A) shall collect and analyze data by gender and by 
     racial and ethnic group, including Hispanics, non-Hispanic 
     whites, Blacks, Native Americans, Asian Americans, and 
     Pacific Islanders;
       ``(B) shall collect data under subparagraph (A) from birth 
     certificates, death certificates, hospital records, and such 
     other sources as the Secretary determines to be appropriate; 
     and
       ``(C) shall encourage States to establish or improve 
     programs for the collection and analysis of epidemiological 
     data on birth defects, and to make the data available.
       ``(2) National clearinghouse.--In carrying out subsection 
     (a)(1), the Secretary shall establish and maintain a National 
     Information Clearinghouse on Birth Defects to collect and 
     disseminate to health professionals and the general public 
     information on birth defects, including the prevention of 
     such defects.
       ``(c) Grants and Contracts.--
       ``(1) In general.--In carrying out subsection (a), the 
     Secretary may make grants to and enter into contracts with 
     public and nonprofit private entities.
       ``(2) Supplies and services in lieu of award funds.--
       ``(A) Upon the request of a recipient of an award of a 
     grant or contract under paragraph (1), the Secretary may, 
     subject to subparagraph (B), provide supplies, equipment, and 
     services for the purpose of aiding the recipient in carrying 
     out the purposes for which the award is made and, for such 
     purposes, may detail to the recipient any officer or employee 
     of the Department of Health and Human Services.
       ``(B) With respect to a request described in subparagraph 
     (A), the Secretary shall reduce the amount of payments under 
     the award involved by an amount equal to the costs of 
     detailing personnel and the fair market value of any 
     supplies, equipment, or services provided by the Secretary. 
     The Secretary shall, for the payment of expenses incurred in 
     complying with such request, expend the amounts withheld.
       ``(3) Application for award.--The Secretary may make an 
     award of a grant or contract under paragraph (1) only if an 
     application for the award is submitted to the Secretary and 
     the application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Secretary determines to be necessary to carry out the 
     purposes for which the award is to be made.
       ``(d) Biennial Report.--Not later than February 1 of fiscal 
     year 1998 and of every second such year thereafter, the 
     Secretary shall submit to the Committee on Commerce of the 
     House of Representatives, and the Committee on Labor and 
     Human Resources of the Senate, a report that, with respect to 
     the preceding 2 fiscal years--
       ``(1) contains information regarding the incidence and 
     prevalence of birth defects and the extent to which birth 
     defects have contributed to the incidence and prevalence of 
     infant mortality;
       ``(2) contains information under paragraph (1) that is 
     specific to various racial and ethnic groups (including 
     Hispanics, non-Hispanic whites, Blacks, Native Americans, and 
     Asian Americans);
       ``(3) contains an assessment of the extent to which various 
     approaches of preventing birth defects have been effective;
       ``(4) describes the activities carried out under this 
     section; and
       ``(5) contains any recommendations of the Secretary 
     regarding this section.
       ``(e) Applicability of Privacy Laws.--The provisions of 
     this section shall be subject to the requirements of section 
     552a of title 5, United States Code. All Federal laws 
     relating to the privacy of information shall apply to the 
     data and information that is collected under this section.
       ``(f) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $30,000,000 for fiscal year 1998, $40,000,000 
     for fiscal year 1999, and such sums as may be necessary for 
     each of the fiscal years 2000 and 2001.''.

  Mr. BOND. Mr. President, I ask unanimous consent that Senator Craig 
be added as a cosponsor to S. 419.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BOND. Mr. President, I am very pleased that the Senate has chosen 
finally to address this often overlooked but very compelling health 
care problem in the United States.
  We have been working with the March of Dimes and with colleagues on 
both sides of the aisle since 1992 to deal with one of the most serious 
and compelling health care problems in America today. Many people are 
not aware that birth defects affect over 3 percent of all births in 
America, and they are the leading cause of infant death.
  This year alone, approximately 150,000 babies will be born with a 
serious birth defect, resulting in 1 out of every 5 infant deaths.
  Among the babies who survive, birth defects are a leading cause of 
lifelong disability. Medical care, special education, and many other 
services are often required into adulthood, costing families thousands 
of dollars each year.
  Let me share with you an experience I had when I was Governor of 
Missouri. In the early 1970's, I appropriated dollars to fund the high-
cost, but highly effective, neonatal care units at our hospitals.
  These remarkable institutions and the dedicated men and women who 
serve there do a tremendous job of saving low-birth-weight babies and 
babies with severe birth defects. But it is not enough. As I talked to 
the people and congratulated them on the great work they were doing, 
they said, ``Why don't we do something to reduce the incidence of birth 
defects and the problems that bring these tiniest of infants to these 
very high-tech specialized care units?''
  And despite the large number of babies born with and dying from birth 
defects, we do not even know what causes most defects or where they are 
even occurring.
  An unfortunate situation in Texas a few years ago exemplifies how the 
lack of a birth defects prevention and surveillance strategy delayed 
the response to an outbreak of birth defects and may have needlessly 
cost innocent lives. At least 30 infants in south Texas were born 
without or with little brain tissue over a short period of time.
  Because Texas did not have a birth defects surveillance system, and 
because our country did not have a comprehensive birth defects 
prevention and surveillance strategy, the severity of the problem was 
not recognized until the incidence of birth defects was so high that it 
was difficult to miss.
  To avoid tragedies such as this from reoccurring, there is something 
that we can do here today.
  Passage of the Birth Defects Prevention Act will prioritize our 
efforts and make Congressional intent clear--more resources should be 
directed for the prevention of the leading killer of babies, birth 
defects.
  S. 419 is a two-pronged approach to tackling this devastating public 
health problem.
  First, the bill calls for a nationwide birth defects surveillance 
strategy. The legislation directs the Centers for Disease Control to 
serve as a national clearinghouse for the collection and storage of 
data on birth defects and to establish regional centers for the conduct 
of applied epidemiological research on such defects.
  The bill also provides funding to public entities such as State 
governments to start up or improve existing surveillance programs. 
Today only about half of the states have some kind of birth defects 
surveillance system.
  The second focus of the Birth Defects Prevention Act is to broaden 
public and professional awareness of birth defects and prevention 
opportunities.
  Grants will be available to public entities and nonprofit 
organizations to develop and implement birth defect prevention 
strategies, such as programs using folic acid vitamin supplements to 
prevent neural tube defects and alcohol avoidance strategies to prevent 
fetal alcohol syndrome [FAS].
  It is important to note that many birth defects are indeed 
preventable. For instance, we now know that if women of childbearing 
age took a simple 400 microgram dose of the B vitamin folic acid each 
day, 50 to 70 percent of all cases of spina bifida and anencephaly 
could be prevented--saving about $245 million each year and more 
importantly, saving some families the heart ache that many of us have 
witnessed friends and families go through.
  It was a deficiency of folic acid that caused the tragedy in south 
Texas based on the diet, and it was only when we had enough instances 
were the researchers able to identify what might be the problem.
  A survey released by the March of Dimes just this week highlights the 
need for an aggressive public awareness program on this issue. The 
survey indicates that only 32 percent of women ages 18 to 45 take a 
daily multivitamin

[[Page S5586]]

containing folic acid. Dr. Jennifer Howse, president of the March of 
Dimes Birth Defects Foundation, also stated that ``seven out of 10 
women begin taking folic acid too late to reduce their risk of having a 
baby with a neural tube defect such as spina bifida or anencephaly. In 
order to be effective in preventing these defects, folic acid must be 
consumed before pregnancy and during the early months of pregnancy.''
  Fetal alcohol syndrome, which increases the risk that babies will 
suffer from mental retardation, learning disorders and other problems, 
is also preventable.
  Although preventable, an April 25 Associated Press article noted that 
the number of pregnant women who say they frequently drink alcohol has 
increased. The survey, conducted by the Centers for Disease Control, 
found that 3.5 percent of the respondents admitted they had seven or 
more drinks per week or binged on five or more drinks within the 
previous month.
  Clearly, we must convey these crucial messages regarding birth defect 
prevention opportunities to the American people. Passage of the Birth 
Defects Prevention Act is a first step in this process.
  The time has come for the U.S. Senate to join with groups such as the 
March of Dimes, the American Academy of Pediatrics, the Easter Seals 
Society, the National Association of Children's Hospitals, and many 
other organizations, in advocating the need for a national strategy to 
prevent these devastating defects.
  The bill also has broad bipartisan support. As of today, the Birth 
Defects Prevention Act has 33 cosponsors.
  Let me conclude by recognizing the hard work and dedication of the 
March of Dimes and their volunteers throughout America; and 
specifically, I want to single out Dr. Jennifer Howse, Jo Merrill, and 
Marina Weiss, for their daily involvement in trying to prevent the No. 
1 cause of infant deaths, birth defects.
  Our country is forever indebted to the March of Dimes and its 3 
million dedicated volunteers for their efforts.
  Mr. President, I send to the desk three articles to which I made 
reference, and I ask that they be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

More Women Know Vitamin Can Prevent Serious Birth Defects, But Few Are 
                 Taking It, March of Dimes Survey Finds

 Health Knowledge and Behaviors During Childbearing Years Are Assessed 
                         in Major Opinion Poll

       White Plains, N.Y., June 10.--A new nationwide survey shows 
     that while more American women of childbearing age have heard 
     of folic acid, a B vitamin that can greatly reduce their risk 
     of having a baby with serious birth defects of the brain and 
     spine, the proportion of women actually taking a multivitamin 
     on a daily basis remains low.
       Only 32 percent of women ages 18 to 45 take a daily 
     multivitamin containing folic acid. Among women who were 
     pregnant in the two years preceding the survey, only 23 
     percent reported taking a daily multivitamin before pregnancy 
     began.
       ``Seven out of 10 women begin taking folic acid too late to 
     reduce their risk of having a baby with a neural tube defect 
     such as spina bifida or anencephaly,'' said Dr. Jennifer L. 
     Howse, president of the March of Dimes Birth Defects 
     Foundation, which commissioned the survey. ``In order to be 
     effective in preventing these birth defects, folic acid must 
     be consumed before pregnancy and during the early months of 
     pregnancy. Much remains to be done to ensure that more women 
     get folic acid at the critical time and in the right amount 
     to improve their chances of having a healthy baby.''
       The survey follows up a benchmark poll conducted two years 
     ago by the March of Dimes to assess women's knowledge and 
     behavior on a variety of issues relating to healthy 
     pregnancy. In the 1997 survey conducted for the March of 
     Dimes by The Gallup Organization under a grant from the U.S. 
     Centers for Disease Control and Prevention, 2,001 women 
     between the ages of 18 and 45 were asked questions designed 
     to measure changes in awareness and behavior from 1995.
       Awareness of folic acid jumped 14 percent points over the 
     two-year period, from 52 percent of women in 1995 to 66 
     percent in 1997. Awareness of the U.S. Public Health Service 
     recommendation that all women capable of having a baby 
     consume 400 micrograms of folic acid daily to prevent neural 
     tube defects rose from 15 percent in 1995 to 22 percent in 
     1997. Specific knowledge of the health benefits of folic acid 
     nearly doubled: whereas only 9 percent of women knew in 1995 
     that folic acid can prevent birth defects, this figure rose 
     to 16 percent in 1997.
       Asked in 1995 and 1997 to name a food that is a good source 
     of folic acid, about half of all women who had heard of folic 
     acid were unable to do so. However, in 1997, 16 percent who 
     had heard of folic acid correctly named orange juice as a 
     good source, up from just 6 percent in 1995.
       Although nearly all women agree that it is important for a 
     woman who is planning to have a child to see her doctor 
     before she is pregnant, only 27 percent of the women who have 
     had a pregnancy say they actually made a visit to the doctor 
     prior to conceiving.
       Since 1995, the March of Dimes has conducted a public 
     health education campaign called ``Think Ahead'' to inform 
     women of childbearing age of some simple steps they can take 
     before pregnancy to improve their chances of having a healthy 
     baby, including consuming folic acid and getting a medical 
     checkup.
       ``There were some significant improvements over the 1995 
     findings, but they fall far short of the levels that the 
     March of Dimes would like to see,'' Dr. Howse said. ``The 
     survey shows that awareness of important health messages can 
     increase when these messages are repeated continuously over 
     time, but that behavior changes more slowly. Younger women 
     especially could benefit from further education efforts.''
       She noted that women under age 25 are the least likely to 
     consume vitamins daily, with only 23 percent reporting that 
     they do so. However, this age group accounts for 39 percent 
     of all births in the United States.


                      importance of the news media

       Dr. Howse pointed out the importance of the news media in 
     informing women about folic acid. The survey found that 36 
     percent of women who have heard of folic acid say they 
     learned about it from a magazine or newspaper article, and 22 
     percent learned of it from radio or television. Fifteen 
     percent of women say they received this information from 
     their doctor.
       Dr. Howse noted that although enriched flours for products 
     such as bread, pasta, and cereal will be required to contain 
     folic acid as of January 1, 1998, the amount of folic acid 
     will not be sufficient to remove the need for daily 
     multivitamin use.
       She also said the March of Dimes urges passage of the Birth 
     Defects Prevention Act (S. 419 and H.R. 1114), a bill 
     currently before Congress that would establish a national 
     birth defects surveillance, research, and prevention system. 
     This system would include research and demonstration projects 
     for the prevention of neural tube defects.
       U.S. Secretary of Health and Human Services Donna E. 
     Shalala said, ``It is very important that we take advantage 
     of the prevention opportunity offered by folic acid. We still 
     have a lot of work to do to ensure that preventable birth 
     defects do not continue to occur.''
       The March of Dimes survey results are based on telephone 
     interviews with a national sample of 2,001 women ages 18 to 
     45 conducted between January 21 and March 3, 1997. For 
     results based on samples of this size, one can say with 95 
     percent confidence that the error attributable to sampling 
     and other random effects could be plus or minus 2 percentage 
     points.
       Copies of the March of Dimes survey, ``Preparing for 
     Pregnancy II,'' item #41-948-97, can be obtained for $4.50 
     plus shipping and handling costs by calling toll-free 1-800-
     367-6630.
       The March of Dimes is a national health agency whose 
     mission is to improve the health of babies by preventing 
     birth defects and infant mortality. Through its Campaign for 
     Healthier Babies, the march of Dimes funds programs of 
     research, community service, education and advocacy.
                                  ____


            More U.S. Women Drink While Pregnant, Study Says

             Increase Raises Risk of Fetal Alcohol syndrome

       More pregnant women are drinking than in 1991, raising the 
     risk that more babies will suffer mental retardation, 
     learning disorders and other problems, the government 
     reported yesterday.
       A telephone survey by the Centers for Disease Control and 
     prevention found that 3.5 percent of 1,313 moms-to-be in 1995 
     admitted they had had seven or more drinks per week or binged 
     on five or more drinks at once within the previous month. 
     That's up from 0.8 percent of 1,053 pregnant women in 1991.
       The sample suggests that 140,000 pregnant women nationwide 
     were frequent drinkers in 1995, compared with 32,000 women in 
     1991. The CDC also said 16.3 percent of pregnant women 
     surveyed in 1995 had at least one drink in the preceding 
     month, compared with 12.4 percent in 1991.
       The reason for the increase is unclear, but CDC researchers 
     plan to reexamine the survey to try to find out. Drinking 
     while pregnant can cause infants to be born with fetal 
     alcohol syndrome, a lifelone condition that can include 
     retardation, facial abnormalities, stunted growth and 
     learning disorders.
       The 1995 survey questioned 33,585 randomly selected women 
     pregnant or not--ages 18 to 44. Of the total, more than half 
     said they drank at least once within the past month, and 12.6 
     percent were frequent drinkers, those who have at least seven 
     drinks a week or five or more at once. The percentages were 
     similar to the 1991 figures, the CDC said.
       Claire Coles, an expert on fetal alcohol syndrome, 
     speculated that people may simply be more honest about their 
     drinking

[[Page S5587]]

     than in the earlier survey. In any case, she said, 
     obstetricians and gynecologists need to talk to their 
     patients about the dangers of alcohol.
                                  ____


                    [From USA Today, June 10, 1997]

           Few Women Take Folic Acid To Prepare for Pregnancy

                          (By Steve Sternberg)

       Although many women of childbearing age now know that folic 
     acid taken daily can avert birth defects, 78% still take a 
     risk rather than a multivitamin, a new survey shows.
       The survey of 2,001 women ages 18 to 45, released today by 
     the March of Dimes Birth Defects Foundation, indicates that 
     66% know the value of folic acid in fetal development, up 14 
     percentage points from the March of Dimes' first such survey 
     two years ago. Yet just 23% reported taking a multivitamin 
     before their pregnancy began.
       ``The brain and the spinal cord develop in the first four 
     weeks of pregnancy,'' says Richard Johnston, medical director 
     of the White Plains, N.Y., foundation. As a result, he says, 
     women must begin taking folic acid before the pregnancy for 
     it to lower the child's risk of birth defects.
       Folic acid is found in green leafy vegetables and liver. In 
     1992, the U.S. Public Health Service advised all women who 
     could become pregnant to take 400 micrograms of folic acid a 
     day to boost their odds of having a normal infant. The 
     recommended daily allowance is 200 micrograms.
       The nutrient is so critical for fetal development that the 
     U.S. government last year required that 140 micrograms be 
     added to cereals and bread, trying to boost women's dietary 
     intake without masking a rare but dangerous form of anemia.
       The March of Dimes and other groups have spent the last two 
     years trying to get the message out.
       If taken within a few weeks of conception, folic acid cuts 
     by two-thirds the risk of two devastating birth defects: 
     spina bifida, a paralyzing abnormality that leaves the nerves 
     of the spine exposed, and anencephaly, in which an infant is 
     born without a developed brain.
       Each year, at least 2,500 children are born with one of 
     these defects.
       Joseph Molinari, a birth defects epidemiologist at the 
     Centers for Disease Control and Prevention in Atlanta, says 
     of the survey, ``We think it's important, because it tells 
     that women are learning about folic acid but not changing 
     their behavior.''

  Mr. BOND. Mr. President, I reserve the remainder of my time.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. I yield myself 7 minutes.
  Mr. President, I want to join other Members of the Senate in 
commending Senator Bond for his work in developing this legislation and 
for his strong commitment to this program. He has been interested in 
and committed to children over a long period of time--both in the 
Senate and as a Governor. I think all of us are very much aware of his 
leadership in the family and medical leave program a number of years 
ago, and in working closely with Senator Dodd and me. This legislation 
is another indication of his strong commitment in terms of the most 
vulnerable in our society--the children, and particularly those that 
have some very special needs in the form of defects.
  I join with him, too, in commending the March of Dimes and all of the 
organizations and all of the volunteers. The individuals who are part 
of these organizations spend hours and hours doing the hard and 
difficult work--knocking on doors, spending many hours away from their 
families in this volunteer commitment to make a difference to children. 
We too often forget about all of their dedication, hard work and 
commitment.
  I think of the families in this country whose lives in one way or 
another have been touched by the March of Dimes and the voluntary 
organizations who have been supportive of the birth defects 
legislation. I join in thanking them. This is really their achievement, 
but most importantly the achievement for children; those that are born 
now and those that are yet to be born in the future whose lives will be 
enhanced and who will be enriched and will have healthier lives because 
of this legislation. Also, the parents of those children who will be 
relieved of a great deal of the anxiety and the concern as they love 
those children and see these children struggling to deal with some of 
the really serious kinds of birth defects that affect too many in our 
country.
  As the good Senator has pointed out, so many of these defects are 
preventable. It would be one thing if they were unavoidable, but they 
are avoidable. If we develop the kind of approach that I think this 
legislation provides, we can really see an important difference made 
for many, many of our children.
  As Senator Bond has pointed out, more than 150,000 infants are born 
with serious birth defects, making birth defects the leading cause of 
infant mortality in the United States. Families from all racial, 
ethnic, and economic groups share the risk of having a child born with 
a serious defect. It makes no difference from what part of this country 
you come. The danger is there of developing the kind of defects this 
legislation is focused to try to prevent.
  Birth defects are also a leading cause of childhood morbidity and 
disability. Medical care and special education made necessary by these 
defects cost families and the Government billions of dollars a year and 
consume a disproportionate share of our health care resources.
  Large numbers, as I mentioned, of these birth defects are 
preventable. For most, the cause is unknown. But each year thousands of 
children are born with defects such as spina bifida and fetal alcohol 
syndrome that are largely preventable. Fetal alcohol syndrome is a 
leading cause of mental retardation, and it affects approximately 8,000 
infants per year, yet all of these case are preventable.
  We can do much more to help States to develop surveillance programs 
which count the number of babies born with birth defects and identify 
communities and populations at higher risk. Currently, only about half 
the States have some kind of birth defects surveillance system in 
place.
  We must also develop new and effective types of early intervention 
which can be integrated into our public health and medical care 
systems. Preventing birth defects will dramatically reduce the costs of 
medical care, for special education, and for social services for 
affected individuals and families.
  The Birth Defect Prevention Act is a major step toward a national 
priority for surveillance, research, and prevention. The act will be 
overseen by the Centers for Disease Control and will provide grants to 
the States to establish a State-based birth defect surveillance program 
and establish regional centers for birth defect prevention research.
  It will provide the States with funding for demonstration projects 
aimed at birth defect prevention as well as technical assistance to 
implement programs of proven effectiveness. There will be shared 
information when we find out that some programs have been very 
effective. We will be able to get that information out to other 
communities. This will be powerful in terms of enhancing local 
communities with information that will show the advantages of some of 
the programs that are proven effective.
  It will broaden public and professional awareness of birth defects 
and prevention opportunities. There is enormous impact this can have in 
terms of sensitizing the whole medical profession about these needs and 
that can have a powerful effect in developing opportunities and 
modalities for prevention.
  In this congressional session we have an unprecedented opportunity to 
prioritize children and children's health. Along with the Hatch and 
Kennedy legislation that expands health insurance coverage to uninsured 
children and improves access to prenatal care, this act will serve to 
improve health, prevent disease, and enhance the lives of children and 
families.
  Even as we are meeting this afternoon, the Finance Committee is 
working through how to provide resources to the States to provide help 
and assistance to millions of American children that would qualify 
under the Medicare programs to make sure their health care needs are 
attended to. Senator Hatch and I are hopeful that before long we will 
have an opportunity again to address the Senate on our program which 
would ensure that good, comprehensive coverage for children in all of 
our States is fully funded and financed by an increase in the cigarette 
tax.
  We will have the additional advantage of discouraging young teenagers 
from smoking.
  So I again thank the Senator for his leadership and commend him for 
his efforts in this area. He has taken a concept and put it into 
legislation and passed it in a very, very short time.

[[Page S5588]]

But it is certainly consistent with his longstanding interest with 
children, and we look forward to work with him on other issues as well 
that affect children in this country.
  Mr DODD. Mr. President, I rise to support the Birth Defects 
Prevention Act. I commend Senator Bond for his work on this 
legislation, and I am pleased to have been one of its cosponsors. I am 
confident that this legislation will significantly enhance our 
understanding of birth defects and lower the frequency with which they 
occur.
  Birth defects are the leading cause of infant mortality in this 
country, and in many cases, children with birth defects face a lifetime 
of disability.
  The efforts of these children to cope with and overcome their 
disabilities are an inspiration to all of us. It is tragic, however, to 
think that, for so many, their struggles could have been prevented. 
With better education and health care for mothers, many birth defects 
can be avoided entirely. Yet, our country still has no national 
strategy for reducing the incidence of birth defects. That is why I am 
rising today in support of this legislation.
  At the root of our prevention efforts is the need to increase the 
flow of information regarding birth defects. Without well-coordinated 
research efforts and surveillance, outbreaks of birth defects may go 
undetected.
  This bill would provide Federal grants to State health authorities 
for the purpose of collecting and researching birth defects statistics. 
These grants are necessary since many States have no system in place 
for the monitoring of birth defects.
  This bill would also establish at least five regional research 
programs that would collect and analyze information on the number, 
incidence, and causes of birth defects. In addition, it would institute 
the Center for Disease Control as the coordinating agency for birth 
defects prevention activities by establishing a clearinghouse within 
the CDC to collect and store data on birth defects. The CDC would also 
be responsible for facilitating the coordination of research and policy 
development to prevent birth defects.
  But while efforts to prevent birth defects begin with education, the 
task of changing the behavioral patterns is far more difficult. While 
progress is being made in this struggle, there remains a great deal of 
work to be done. The findings of a March of Dimes study that was 
released this week provides a great illustration of this point.
  A simple 400 mg daily dose of the B vitamin folic acid could prevent 
50 to 70 percent of all cases of spina bifida and anencephaly. The 
recent March of Dimes survey found that 66 percent of all women know 
the value of folic acid in fetal development, marking a 14 percent 
increase over the past 2 years. However, just 23 percent of all women 
reported taking a multivitamin before their pregnancy began. Women are 
learning about folic acid but not changing their behavior.
  As we all know, behavioral patterns do not change overnight, but if 
we continue to educate the population changes will occur, as evidenced 
by the fact that the number of women who smoke during pregnancy has 
dropped 29 percent since 1989.
  While there is nothing that can be done to prevent most birth 
defects, it is unconscionable that every day in America children are 
being born with illnesses that we could prevent, and in the most severe 
cases, children are dying. I urge my colleagues to make a commitment to 
fighting the problem of birth defects, and I ask that they join me in 
supporting the Birth Defects Prevention Act of 1997.


                               cody groce

  Mr. FAIRCLOTH. Mr. President, I would like to take a moment to tell 
my colleagues about a very special individual I met recently. Cody 
Groce is an active, healthy, intelligent 5-year-old from Elkin, NC, who 
plans on becoming a doctor when he grows up. His story seems like that 
of any young man, however, Cody is special because he was born with a 
serious birth defect.
  During a prenatal care visit Brenda Groce, Cody's mother, was told 
that the baby she was carrying had life-threatening urinary problems. 
At birth, Cody was admitted to a neonatal intensive care unit and had 
surgery to save his kidneys and his life.
  Cody is now healthy and busy sharing his story with people across the 
country as the National Ambassador for the March of Dimes. I met Cody 
in March when he came to visit my office to tell me about his story and 
this important legislation.
  There are 150,000 children, like Cody, that are born every year with 
a serious birth defect. And it is because of these children that we 
must pass S. 419, the Birth Defects Prevention Act of 1997.
  This legislation establishes a national, State-based, birth defects 
surveillance, research and prevention system to help us to find the 
causes of birth defects like Cody's and prevent them. Birth defects 
surveillance programs can count the number of babies born with birth 
defects and identify communities and/or populations with higher risks. 
In addition, this legislation develops education and prevention 
programs for birth defects with known causes.
  So, I ask my colleagues help my friend Cody and others like him by 
voting for S. 419, the Birth Defects Prevention Act of 1997.
  Mr. ROCKEFELLER. Mr. President, I am proud to cosponsor the Birth 
Defects Prevention Act and want to urge all of my colleagues to join in 
support of this important measure. I am especially pleased that the 
legislative logjam that prevented the Senate's consideration of the 
bill earlier this week has now been broken, permitting us to do the 
work of the Senate.
  In my roles as the president of the National Commission of Children 
and cochair of the Health Alliance, I have had occasion to learn 
firsthand of the daily struggles of families of children with birth 
defects. These parents must be tireless advocates for their children 
each and every day to ensure that their child's health and education 
needs are met and to see that their child has the opportunity to reach 
his or her full potential. The struggles that these families face in 
their fight to get adequate insurance coverage for their children's 
medical needs are trials that no parent or child should have to endure. 
Perhaps the greatest tragedy is that in many cases, these birth defects 
could have been prevented, if only the parents had access to 
information on adequate nutrition and to quality prenatal care, or if 
our researchers had adequate funding to pursue their questions. That's 
exactly why this bill is so important.
  The Birth Defects Prevention Act would authorize $42 million for the 
establishment of a comprehensive national system of birth defects 
prevention programs with oversight by the Centers for Disease Control 
and Prevention. This would provide for a national, State-based birth 
defects surveillance system. It would authorize funding and CDC 
expertise to establish regional prevention research centers, as well as 
local prevention and intervention programs. It would also establish a 
national advisory committee on birth defects and a National Information 
Clearinghouse on Birth Defects.
  This legislation is important because at the present time, less that 
half our States have a birth defects surveillance system. This has 
greatly limited our understanding of birth defects as well as our 
ability to prevent them. Birth defects are the leading cause of infant 
mortality, responsible for one out of every five infant deaths. Each 
year, 150,000 children are born with a serious birth defect. Birth 
defects are also the leading cause of childhood disability. Yet despite 
the high numbers of babies born each year with birth defects, we still 
do not know the causes of most birth defects. The establishment of a 
national tracking system would significantly advance our scientific 
understanding of birth defects.
  As ranking member of the Committee on Veterans' Affairs, I have seen 
the struggles of men and women who worry that exposures to chemical 
agents they may have encountered in military service in Vietnam or the 
Persian Gulf may have contributed to birth defects in their children. I 
have heard testimony of men and women who bravely served in our 
military and who now are afraid to start a family or have more children 
because of these fears. The Institute of Medicine reported an 
association among our Vietnam veterans between exposure to Agent Orange 
and a greater risk of having a child with spina bifida. Now we are 
faced with the very difficult and emotional question of whether there 
is an increased rate of birth defects among gulf war veterans. The 
studies are underway, but none has provided a

[[Page S5589]]

clear answer that will adequately address our concerns. The studies 
will continue, but some of our difficulty in answering questions about 
veteran populations has to do with our poor understanding of birth 
defects. This legislation will help with these issues by increasing our 
scientific understanding of birth defects and increasing current 
prevention efforts in all populations. Therefore, I am proud to 
cosponsor this important bill.
  Mr. BOND addressed the Chair.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Missouri.
  Mr. BOND. Mr. President, unless someone else wishes to speak, I think 
the distinguished Senator from Massachusetts and I are prepared to 
yield back.
  I express my sincere thanks to Senator Kennedy, who has long been a 
champion in this area. His very excellent statement does indicate the 
tremendous and compelling nature of this problem. This is a problem, 
unfortunately, that affects 150,000 children a year, but it never seems 
to get up on the radar screen.
  Now, the fact that we are going to pass this on a voice vote--we had 
33 sponsors. Actually, I ask unanimous consent that Senator Hutchison 
be added as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BOND. That brings it to 34. I hope that will make the point that 
we are serious about it. That this is the fifth year, Mr. President, 
this has got to be passed is an outrage; this is a bill that nobody 
objects to. I think anybody would think it is common sense. But it just 
gets crowded off the agenda. I do not intend to let it get crowded off.
  I thank the Senator from Massachusetts, the distinguished chairman of 
the committee, the Senator from Vermont, and their staffs. We included 
as a substitute the measure as originally passed last year, and I know 
that we can count on the committee to insist upon it. I cannot believe 
we will fail this year once again to pass a measure which can do so 
much to reduce hardship and suffering and needless heartbreak 
throughout America.
  Mr. President, I am prepared to yield back my time.
  Is there anyone else seeking time?
  Mr. President, I yield back my remaining time and would not ask for 
the yeas and nays per the previous agreement. I ask it be adopted by 
voice vote.
  Mr. KENNEDY. Mr. President, I yield back the remainder of my time.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  The amendment (No. 371) was agreed to.
  Mr. BOND. Mr. President, I move to reconsider the vote.
  Mr. KENNEDY. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  The PRESIDING OFFICER. The bill having been read the third time, the 
question is, Shall it pass?
  The bill (S. 419), as amended, was passed.
  Mr. BOND. Mr. President, I move to reconsider the vote.
  Mr. SANTORUM. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. BOND addressed the Chair.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Missouri.
  Mr. BOND. Mr. President, I will take only 1 minute and say a sincere 
thanks to Joe Pierle of my staff, who has worked on this measure and 
has had great cooperation with the Labor Committee. I also would thank 
previous staffers, Mark Hayes and Leanne Jerome, who have worked on 
this for 5 years now. And we hope this is the last time we have to do 
it.
  Again, as I mentioned in my remarks, we very much appreciate and 
thank the leadership of the March of Dimes and the 3 million dedicated 
volunteers across this Nation.
  I thank the Chair. I yield the floor.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Since this is the time for commendation, I would just, 
if I could, note that Governor Bond, then, in 1981, was effective in 
developing a long-range prevention, screening and health care 
initiative in response to Missouri's infant death rate being among the 
highest in the Nation, and in the 1989-90 period the Better Child Care 
Act that was developed here in legislation. Just looking through the 
Senator's achievements--and, as I mentioned earlier, his work on family 
and medical leave--it is a very clear indication of the Senator's very 
strong commitment to children. It is something all of us know here, but 
I think it is well worthwhile having that referenced at the time that 
we pass this very important piece of legislation.
  Again, I commend him and will try to find, if we can, other ways of 
working on children's issues as well.
  I thank the Chair.
  Mr. BOND. Mr. President, I thank the distinguished Senator from 
Massachusetts. It is always a pleasure to work with him in the many, 
many areas in which we agree. It is not all of them, but when we do 
agree it is a real pleasure to work with a champion of children's 
health and well-being.
  I thank the Chair.
  Mr. KENNEDY. I thank the Senator.

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