Shanxi has the highest incidence of birth defects in China. Environmental pollution from coal mining, bad habits in life and adverse hygienic conditions have been the main contributors. Beginning in 2001, the birth defect intervention project was piloted in several counties of the province, and has now begun to pay off.

Gao Wenlan, a 30-year-old peasant from Shanxi Province is overjoyed this year. She successfully gave birth to a healthy boy in March. The follow-up medical checks during the past five months show the baby is healthy and growing. But before she and her family were driven to the brink of desperation by the birth of two babies with brain defects. She is very grateful for the service of the Birth Defect Intervention Project launched by the State Family Planning Commission nationwide two years ago in helping her.

Shanxi tops the nation in birth defect rate

China has the largest population in the world and also has the highest incidence of birth defect, with national level at its highest in Shanxi Province. The monitoring data from 1996 showed the national birth defect rate of newborns was 99.62 per ten thousand. In Shanxi, however, the rate was 189.86 per ten thousand on average, and 39 counties had a higher rate of 200-400 per ten thousand and 13 counties had the highest rate of 400 per ten thousand.

The recent survey conducted in Heshun County shows that some 300 to 900 of each 10,000 newborns had congenital defects.

There are various contributors, according to related experts. These include environmental pollution from coal mining, bad habits in life, poor hygienic conditions, and poor educational background. According to experts concerned, in poor areas, local people often eat old sprouted potatoes, sleep on hot brick beds all year around, and have consanguineous marriages.

Many birth defects can actually be avoided, according to An Huanxiao, director of the Shanxi Provincial Family Planning Commission. For example, if pregnant women were advised to take mineral and vitamin supplements, this could prevent diseases in the baby such as caused by iodine deficiency and nerve and brain stem damage.

In 1999, the State Family Planning Commission launched the Birth Defect Intervention Project across the country. Four counties of Pingyao, Heshun, Zhongyang and Pingding in Shanxi were designated to pilot the project in 2001. In the meantime, the provincial family planning commission began to promote the service in 26 counties where high birth defects occurred.

Three-tiered intervention

Intervention work mainly involves dynamic monitoring before and after pregnancy and following childbirth, which is called three-tiered intervention.

The first tier intervention service covers newly wed couples and couples who are entitled to have a second child. Before they get pregnant, they are offered training in reproduction and advised to take supplements like folic acid and iodine. The couples who have given birth to a handicapped infant, or who live in poorer areas with high incidence of birth defect, or who have had miscarriages with unknown causes will be given the priority of a full-length follow-up service.

Because of the previous two mishaps, Gao Wenlan was put on the priority list. Several months prior to her pregnancy, family planning staff regularly went to check her health and educate her on health and reproduction, which helped her increase her confidence of bearing a healthy child.

The second tiered intervention covers all pregnant women. They are advised to continue to take folic acid and other supplements during the first three months of pregnancy. Starting from the fifth month, monitoring activities including ultrasonic checkups are conducted.

The third tiered intervention covers all children with birth defects in order to provide these children with effective follow-up treatment. Social workers with the project will cooperate with health departments to get these children into practical and effective treatment schemes.

On May 16, 2002, specialists in pediatrics and gynecology from the Beijing-based Capital Institute of Pediatrics and Shanxi Provincial Research Institute of Family Planning gave two-day volunteer treatments to 164 children with innate defects in Zhongyang County. In the meantime, county authorities in charge of civil affairs freely distributed 30 audiphones among deaf children. Those children suffering heart and brain diseases have been shown how to receive proper treatment in other places.

The pilot work of the project has began to pay off in Shanxi. According to the relevant officials of Heshun County, the incidence of birth defects in the county dropped from 427 per ten thousand in the past to 297 per ten thousand at present. “Our goal for the 2001-2005 period is to drop the birth defect incidence by 20 percent,” said An Huanxiao.

Training social workers

The implementation of the three-tiered intervention measure has actually benefited from the established technical service network of family planning departments across the country. Since the launch of the project, various pilot areas undertook grass-root investigations and collected data on birth defect incidence and categories of diseases. Files have been established covering each village in areas of high incidence.

In terms of knowledge publicity and technical service, the project also sets higher requirements of the social workers in the family planning sector. “If people can’t get satisfactory information service from our social workers, they will drive them out of their doors,” said Li Meifang, deputy director of the Jinzhong Municipal Family Planning Commission.

In order to improve the quality of social workers, the family planning departments in various counties and districts have organized training for them and fixed their monthly salary, according to Li. A large group of older and lower-educated social workers have been dismissed. In the meantime, social workers at township level each have been provided with four practical handbooks.

At present, full-time staff of the family planning departments in Pingyao, Heshun, Zhongyang and Pingding counties are busy with basic research work in villages on the Study of China’s Birth Defects and Environmental Capacity for Control. With this project unfolding, vitamins and mineral supplements will be directly added to flour available in rural markets in the future.

(China.org.cn by staff reporter Hu Huiting, translated by Chen Qiuping, September 12, 2003)