[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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