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Breastfeeding rates reached their highest recorded levels in the United States in 2002, according to the “Ross Mothers Survey” of Abbott Laboratories’ Ross Products Division, which showed that 70.1 percent of mothers initiated breastfeeding in the hospital, up from 54.2 percent a decade ago. When their babies reached age 6 months, 33.2 percent of mothers still were breastfeeding, up from 18.9 percent in 1992. Despite the continued rise in breastfeeding rates overall, rates are significantly lower at 6 months for women who work outside the home. Similarly, women who participate in the supplemental nutrition program for Women, Infants and Children (WIC) are less likely to breastfeed both in-hospital and at 6 months. Women who work full-time start breastfeeding at almost the same rate as all mothers–69.0 percent compared with 70.1 percent—but by 6 months, breastfeeding rates for full-time working mothers dropped approximately 25 percent below those of mothers who did not work outside the home. The rates for 2002 showed improvement toward achieving the Healthy People 2010 national goal of 75 percent breastfeeding initiation in the hospital and 50 percent at 6 months.

The U.S. Department of Health and Human Services’ Office on Women's Health and the Advertising Council has launched a new national publicity campaign, “Babies Were Born to be Breastfed,” which encourages first-time mothers to breastfeed exclusively for 6 months (Ad Council News Release June 4, 2004). The campaign communicates the importance of breastfeeding and suggests that audiences talk to their health care provider or contact the National Women's Health Information Center's free breastfeeding helpline at 1-800-994-WOMAN or visit the web site at http://www.4woman.gov.

Cesarean delivery rates in Canada increased to 21.2 percent in 2000–2001, decreasing from 18.2 percent in 1991–1992 to 17.4 percent in 1994–1995, according to the Canadian Perinatal Health Report, 2003. The report is an initiative of the Canadian Perinatal Surveillance System and provides an updated description of determinants and outcomes related to fetal, infant, and maternal health. The rate of operative deliveries remained fairly constant (16.3% of vaginal deliveries in 2000–2001 and 17.4% in 1991–1992), and whereas forceps use declined greatly (16.2% vs 11.2%, respectively), a concurrent increase in vacuum extractions was reported (10.5% vs 6.8%, respectively). Episiotomy rates continued to decrease to 23.8 percent of vaginal deliveries in 2000–2001 from 49.1 percent in 1991–1992. The full report is available at the Health Canada web site: http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/cphr-rspc03/index.html.

The adolescent birth rate in the United States dropped to a record low in 2002, but a slight increase occurred in the infant mortality rate, according to America's Children in Brief: Key National Indicators of Well-Being 2004, the U.S. government's 8th annual monitoring report on the well-being of the nation's children and youth. Birth rates for adolescents have declined steadily since 1991, reaching a record low in 2002—23 births for every 1,000 girls ages 15 to 17 years, compared with 39 in 1991. In 2002, 7 of every 1,000 infants died before their first birthday, increasing from a record low of 6.8 per 1,000 in 2001. Preliminary analyses indicated that most of the increase in deaths occurred among infants less than 28 days old. The rate of low-birthweight infants also rose slightly in 2002, to 7.8 percent, up from 7.7 percent in 2001. The increase is part of a continuing slow, steady rise in low birthweight, beginning at 7 percent in 1990. The rate of low-birthweight infants was highest for black, non-Hispanic infants, at 13.4 percent. “Growth in multiple births (largely due to increasing use of fertility treatments) partially explains the low birthweight increase, but low birthweight also increased among singleton infants,” the report said.

Breastfeeding reduces infant mortality, according to recent data released by scientists at the National Institute of Environmental Health Sciences (NIH Press Release May 2, 2004). Looking at infants between 28 days and 11 year of age, researchers concluded that promoting breastfeeding could potentially prevent up to 720 postneonatal deaths in the United States each year. Researchers compared Centers for Disease Control records of 1,204 children who died between 28 days and 1 year of causes other than congenital anomalies or cancer with those of 7,740 children still alive at 1 year. Children who were breastfed had 20 percent lower risk of dying between 28 days and 1 year than children who were not breastfed. Longer breastfeeding was associated with lower risk in both black and white children. Breastfed infants in the U.S. have lower rates of morbidity, especially from infectious disease, but there are no contemporary U.S. studies of the effect of breastfeeding on all-cause mortality in the first year of life. Dr. Walter J Rogan, an author of the study, said, “Although we knew that breastfeeding in the developing world was lifesaving, since it prevented diarrhea and pneumonia, we had no nationally representative data from the U.S. on this very basic outcome. These data show that, even in the U.S., there is a modest decrease in mortality for breastfed children.”

The World Health Organization's (WHO) first strategy on reproductive health was adopted in May 2004 by the 57th World Health Assembly (WHA)(WHO News Release May 22, 2004). Reproductive and sexual ill health accounts for 20 percent of the global burden of ill health for women, and 14 percent for men. The strategy targets five priority aspects of reproductive and sexual health: improving antenatal, delivery, postpartum, and newborn care; providing high-quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer, and other gynecological morbidities; and promoting sexual health. Each year, some 8 million of the estimated 210 million women who become pregnant, suffer life-threatening complications related to pregnancy, many experiencing long-term morbidities and disabilities. In 2000, an estimated 529,000 women died during pregnancy and childbirth from largely preventable causes. “Unsafe sex is one of the biggest risks to our health today, largely as a result of acquiring sexually-transmitted infections, such as HIV/AIDS. Reproductive and sexual health touches the lives of everyone, everywhere,” says Joy Phumaphi, Assistant Director-General of Family and Community Health at WHO.

Permission to create human embryos that are clones of patients has been granted by the United Kingdom's Human Fertilisation and Embryology Authority to a team of researchers in Newcastle (BioNews, London, Aug 11, 2004). The team, which applied for the license in June, is licensed to use embryos to make embryonic stem cells for research purposes. They plan to investigate diabetes, although their work could be relevant to diseases such as Alzheimer's and Parkinson’s. The team will use a process known as cell nuclear replacement (CNR), which involves replacing the DNA of a human embryo with the DNA from a human skin cell. CNR was used to make Dolly the sheep, but the crucial difference is that embryos created by the Newcastle team will not be implanted in a womb. Instead, the team will work on embryonic stem cells derived from the embryos. Unlike an organ transplant, stem cells are not expected to be rejected, since the CNR process ensures they have the same DNA as the patient. Since South Korean scientists announced the first use of this technology on human cells in February, support has been growing for its use in the U.K. However, the announcement has triggered outrage among pro-life and other groups, who say that human embryos should not be used as a commodity. In Germany, the president of the German Medical Association, Jorg-Dietrich Hoppe, has called for a Europe-wide ban on all forms of cloning.

An Act Respecting Assisted Human Reproduction and Related Research recently became law in Canada (Health Canada News Release, Mar 30, 2004), giving the nation “one of the most comprehensive legislative frameworks in the world regarding assisted human reproduction (AHR).” The law prohibits human cloning and payment to egg and sperm donors, and provides controls for AHR-related research, while protecting the health and safety of Canadians who use AHR. The law will lead to the establishment of the Assisted Human Reproduction Agency of Canada, responsible for licensing, inspecting, and enforcing activities controlled under the Act.

Expanded stem cell research was backed by strong majority of voters in 18 states in a recent survey in the United States. Two of three voters in 18 key states supported overriding the Bush administration's limits on federal government funding for stem cell research, according to a survey by the Results for America project of the Civil Society Institute (News Release Apr 26, 2004). In August 2001, the Bush administration established a new restriction on federal funding for embryonic stem cell research, meaning that research on stem cell lines created before August 2001 can receive funding, but it is prohibited for research on stem cell lines developed after that date. Full survey findings are available online at http://www.ResultsForAmerica.org.

Latin America has one of the highest rates of cesarean delivery, approximately one-fourth of all deliveries, in the world. Results of a randomized trial of Latin American hospitals suggest a mandatory second opinion policy as a way of reducing the costs associated with unnecessary cesarean section deliveries (Lancet 2004;363:1934–1340). Fernando Althabe from the Centro Latinoamericano de Perinatologia, Montevideo, Uruguay, and colleagues assessed whether a compulsory second opinion from another obstetrician could reduce the frequency of cesarean births at 36 Latin American hospitals (Argentina 18, Brazil 8, Cuba 4, Guatemala 2, Mexico 4), a total of about 150,000 deliveries. Hospitals were randomly assigned to intervention (mandatory second opinion for nonemergency cesarean section) or standard treatment. Mandatory second opinion reduced the incidence of nonemergency cesarean section by about 7 percent. No difference occurred between the two groups for maternal and infants’ outcomes, and women's perceptions and satisfaction with the care provided. Althabe commented: “The implementation of a mandatory second opinion policy in public hospitals on an indication of intrapartum cesarean section could prevent 22 cesarean sections for every 1,000 women in labor without harmful effects on the baby or the mother.” In an accompanying editorial, Maureen Porter from the University of Aberdeen, United Kingdom, concluded: “Althabe and colleagues’ trial is important because it suggests a sense of corporate responsibility on the part of the participating countries to tackle spiraling rates of cesarean sections where the problem is most pressing. Their study joins the ranks of only three reported trials in this clinical area, and opens up possibilities for others that aim to reduce maternal exposure to unnecessary surgery.”

Twin births continued to increase in the United States, rising 3 percent between 2001 and 2002 to 31 twin births per 1,000 births (Natl Vital Stat Rep 2003;52(10):21–22). This rate has risen 38 percent since 1990 and 65 percent since 1980. However, the rate for triplets and other higher order multiple births dropped slightly to 184 per 100,000 in 2002, the third decline in the last 4 years after an increase of more than 400 percent between 1980 and 1998. The report notes, “The higher the plurality of a pregnancy, the greater is the risk of poor perinatal outcome. The typical triplet weighed about half of its singleton counterpart (1,687 grams) at birth … and triplets/+(are) 12 times as likely to die by their first birthday. … Survivors are at increased risk of long-term disabilities.” The Centers for Disease Control reported that the average number of embryos transferred in assisted reproduction technology (ART) dropped for women under age 35 years, from 3.0 per patient in 1999 to 2.8 in 2001. The Society of Assisted Reproduction, which represents 95 percent of in vitro fertilization (IVF) units in the U.S and sets policies that are considered the governing standards for infertility medical practices, has announced that it “is working to substantially decrease the problem of high order multiple gestations in ART”(http://www.sart.org). In addition, the Council of Physicians and Scientists of IntegraMed (COPS), a clinical group representing 138 physicians and scientists in 72 locations across the U.S., plan to develop and implement a nationwide trial of elective single embryo transfer (eSET). The trial could involve potentially hundreds of women volunteers undergoing IVF treatment, who would each have a single fertilized egg implanted in the uterus, in contrast to the convention of transferring multiple embryos to enhance the probability of pregnancy.

Depo Provera appears to increase the risk for chlamydial and gonococcal infections by approximately threefold, when compared with women not using a hormonal contraceptive, according to a recent study by the National Institute of Child Health and Human Development and the U.S. Agency for International Development's Office of Population and Reproductive Health (Press Release, Aug 23, 2004). The injectable contraceptive depot-medroxyprogesterone acetate (DMPA), marketed under the product name Depo Provera, is injected into either the arm or buttocks four times a year. The study was unable to determine why DMPA might increase the risk for these infections. Three groups of women (n = 819) were compared, those starting oral contraceptives, those starting DMPA injections, and those women who did not use hormonal contraceptives. After enrolling in the study, they were tested for chlamydial and gonococcal infection after 3, 6, and 12 months. By the time the study had ended, 45 women had developed a chlamydial or a gonococcal infection. The researchers also tested another type of contraceptive formulation, oral contraceptives containing both estrogen and progestin, and concluded that oral contraceptives do not appear to significantly increase the risk of chlamydial infection and gonorrhea.

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