What follows is the written statement on behalf of the March of Dimes Birth Defects Foundation, submitted to the hearing on “Addressing Unmet Needs in Women’s Health” held by the Health, Education, Labor, and Pensions Committee, Subcommittee on Public Health.
April 25, 2002

Mr. Chairman, and Members of the Subcommittee, the 3 million volunteers and 1600 staff members of the March of Dimes strongly support the Safe Motherhood Act for Research and Treatment (SMART Mom bill). The Foundation applauds the bill’s sponsors Senators Tom Harkin (D-Iowa), Edward Kennedy (D-Mass.), Barbara Mikulski (D-MD) and Christopher Dodd (D-CT) for introducing this bill which is designed to
address health problems related to pregnancy and ensure that mothers receive the information they need to take care of themselves during their pregnancy. The SMART Mom bill is an important step towards improving the health of pregnant women and their infants and is completely congruent with the mission of the March of Dimes, which is to improve the health of babies by preventing birth defects and infant mortality.

Of particular interest to the Foundation is the bill’s provision to expand research into preterm labor and delivery. A healthy pregnancy and a pregnancy that is sustained for term is critical to the well-being of the child and the mother. Any infant born before 37 weeks of gestation is considered premature. The average lifetime medical costs of a premature baby are conservatively estimated at $500,000.¹ Low birthweight (often a result of premature birth) accounts for 35% of all health care spending on infants and 10% of all health care spending on children.² Prematurity/low birthweight was the leading cause of neonatal mortality in 1999 and the leading cause of infant mortality among blacks.³

Since the early 1980s the rate of preterm birth has increased more than 23 percent and the rate of low birthweight has risen nearly 12 percent. Each year, more than 460,000 newborns, 11.6% of all babies born in the United States, are born too soon (less than 37 weeks gestation).⁴ Many must spend time in a Neonatal Intensive Care Unit (NICU). The hospitalization of a baby in a NICU is a difficult experience for the entire family, and complications that result from preterm birth can affect families and individuals for years after the actual event.

Most disturbing, despite unprecedented growth in the understanding of almost every dimension of human biology at a cellular and genetic level, the rate of preterm birth has climbed slightly over the past decade from 10.6% in 1990 to 11.6% in 2000. ⁵

Prematurity is a perinatal health problem that profoundly affects too many children, threatening all racial, ethnic and socio-economic groups, but placing a particularly heavy burden on minority populations and families with limited incomes.

The Smart Mom bill authorizes the expansion of research on the causes of pre-term labor and delivery. More research into the causes opens the way for development of effective clinical trials, interventions, treatment and even prevention.

In addition, it is critical that women and their health care providers be educated about what they can do to help improve birth outcomes. This bill calls for expanding public education and outreach; an area of particular interest for the March of Dimes. The Foundation is also very supportive of the provisions in this bill that are designed to increase the quality of information made available to pregnant women, health care practitioners and the public. The March of Dimes looks forward to working with the bill sponsors and ultimately with the federal agencies charged with carrying out the activities authorized by this bill. In particular, the Foundation hopes to participate in the dissemination of educational materials through our Pregnancy and Newborn Health Education Center.

Finally, the National Institute for Child Health and Human Development’s National Children’s Study is long overdue. This important analysis of environmental influences on children’s health and development is needed to inform bench scientists as well as the general public and health practitioners about the effects of environmental factors on children’s health. The Smart Mom bill’s addition of pregnant women to
aspects of the study will add value to the database being developed through the National Children’s Study.

The March of Dimes looks forward to working with Senators Harkin, Kennedy, Mikulski, Dodd and others to complete action on the SMART Mom bill and to obtain the necessary funding before the end of this Congress.

^{1 Walker, C.K. 1991. “Healthy Babies for Healthy Companies.” Business and Health.
2 Lewitt EM, Baker LS, Corman H, Shiono PH. The direct cost of low birthweight. In: The Future of Children. Vol 5, no 1. Los Altos, CA: The David and Lucille Packard Foundation, 1995: 35-56.
3 Mathews TJ, MacDorman MF, Menacker F. Infant mortality statistics from the 1999 period linked birth/infant death data set. National vital statistics reports; vol 50 no 4. Hyattsville, Maryland: National Center for Health Statistics. 2002.
4 Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: Final data for 2000. National vital statistics reports; vol 50 no. 5. Hyattsville, Maryland: National Center for Health Statistics. 2002.
5 Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: Final data for 2000. National vital statistics reports; vol 50 no. 5. Hyattsville, Maryland: National Center for Health Statistics. 2002.}