Can Pollution Harm an Unborn Child? Despite

UNCLAS SECTION 01 OF 04 GUANGZHOU 020593

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/CM
STATE FOR EB/TPP FELSING, MASSINGA
USDOC FOR 4420/ITA/MAC/MCQUEEN, DAS LEVINE
STATE PASS USTR - STRATFORD, CELICO
USPACOM FOR FPA
STATE FOR OES/OGC, OES/ENV AND OES/PCI/STEWART
DOE FOR INTERNATIONAL/PUMPHREY
DOE ALSO FOR EERE/DIXON
USDOC FOR NOAA/OFFICE OF GLOBAL PROGRAMS/BUIZER,
EPA FOR OFFICE OF AIR AND RADIATION/MCLEAN
EPA ALSO FOR INTERNATIONAL/YANG AND THOMPSON

E.O. 12958: N/A
TAGS: SENV TBIO CH SOCI PGOV
SUBJECT: Can Pollution Harm an Unborn Child? Despite
Uncertain Science, Anecdotal Stories Fuel Local Concerns


GUANGZHOU 00020593 001.2 OF 004


(U) THIS DOCUMENT IS SENSITIVE BUT UNCLASSIFIED. PLEASE
PROTECT ACCORDINGLY. NOT FOR RELEASE OUTSIDE U.S.
GOVERNMENT CHANNELS. NOT FOR INTERNET PUBLICATION.

Ref: 05 Guangzhou 30589


1. (SBU) SUMMARY: The following cable describes the
perception and the basis for the perception many residents
in South China have that the pollution in the region is
harming unborn babies; it does not address the hard science
related to this issue. Recent press reports and anecdotal
accounts have led many local residents to believe there is a
possible association between pollution and pregnancy-related
complications, especially birth defects -- a hot potato
issue given that the one-child policy has made parents
extremely anxious about the health of their only child.
While direct evidence linking pollution to pregnancy
complications is limited, and most officials refuse to
discuss the issue, one local professor who specializes in
genetics and hereditary diseases speculated that pollution
may be causing a rise in birth defects. Some local media
sources also claim that China has a relatively high
frequency of birth defects, at about 4-6% of China's newborn
population; although official Chinese figures show a lower
rate of incidence.


2. (SBU) While government officials now call for a greater
focus on sustainable development and cleaning up
environmental problems, corruption, mismanagement, and lack
of funding and accountability promise to slow progress.
However, as top leaders, such as President Hu Jintao and
Premier Wen Jiabao, take an interest in the environment, and
as the Chinese people become ever more sensitive to the
possible harmful effects of pollution, pressure to address
the problem will grow. Post will provide a closer look at
the current environmental situation in South China septel.
END SUMMARY.

Link Between Pollution and Pregnancy-Related Complications?
-------------- --------------


3. (SBU) Over the past year, several stories in the local
press have suggested a link between pollution and pregnancy-
related complications, including birth defects and
infertility. Furthermore, Post is aware of a number of
anecdotal cases where pregnant women in Guangzhou
experienced "difficult pregnancies", i.e., ones in which the
mother experienced unusual complications requiring extra
medical care and prolonged periods of bed rest to prevent a
miscarriage. Several doctors in Guangzhou commented that
air pollution -- as well as other environmental factors such
as toxins in food and the so-called "electrical smog" found
in office environments -- was making bed rest pregnancies
increasingly common. A Hong Kong obstetrician consulted
regarding one of these cases agreed that the phenomenon of
pregnancies requiring long-term bed rest due to pollution
was quite common in major Chinese cities.

Is My Baby Going to Be Healthy?
--------------


4. (SBU) In a society where a couple is generally limited to
having only one healthy child, the concerns about delivering
a healthy baby the first time around are understandably
high. Given this concern and the fact that air pollution --
which is literally visible on many days -- is being linked
to health problems in local press reports and "through the
grapevine" accounts, Econoff endeavored to learn more about
the perceived effects of environmental pollution on the
health of a pregnant woman and her baby. Post will provide
a closer look at the current environmental situation in
South China septel.


GUANGZHOU 00020593 002.2 OF 004


The Sound of Silence
--------------


5. (SBU) Attempts to discuss this issue with local health
experts proved extremely difficult. Post's official
requests for appointments at Sun Yat Sen University, the
Guangzhou Number Two People's Hospital (the city's best
obstetric hospital by most accounts),and the Guangdong
Health Department were all denied. In his explanation as to
why the Chinese were denying our meeting requests, Feng
Shaomin, the head of the Foreign Affairs Division of the
Guangdong Health Department, said Health Department leaders
held several meetings to discuss our request, finally
deciding that birth defects was "too sensitive" a topic.
Feng admitted that if the Health Department were to release
"unaudited" information, Health Department leaders would
"have to bear responsibility."


6. (SBU) Econoff was able, however, to discuss the topic
with two experts -- Professor Liang Zhicheng (strictly
protect),a retired professor of biology at Jinan University
who specializes in genetics and hereditary diseases, and Dr.
Yang Dongzi (strictly protect),chief of obstetrics and
gynecology (OB/GYN) at the Second Affiliated Hospital of Sun
Yat Sen University and president of the Guangdong Provincial
Association of OB/GYNs. Dr. Yang confided to Econoff that
the Chinese government, in her view, does "not encourage"
information about the relationship between pollution and
birth defects to be made available, even to local
researchers, and that even she had difficulty finding
information on the subject.

Pollution and Birth Defects--It's Not Just the Air
-------------- --------------


7. (SBU) Liang noted that air, water, and soil pollution may
all increase a woman's risk for having a baby with a birth
defect, although he did not elaborate. Water resources are
also often contaminated; reports indicate that most urban
ground water is polluted, and most urban and rural water
supplies are not potable. But other factors also raise the
probability of birth defects. The U.S. Department of Health
and Human Services-Centers for Disease Control and
Prevention's (HHS/CDC) birth defects Project Director told
Econoff that air pollution and other environmental toxins
have been reported to be associated with an increased risk
for birth defects and other pregnancy-related complications.

Improved Awareness of Prenatal Health Requirements
-------------- --------------


8. (SBU) Dr. Yang noted that the women she sees in Guangzhou
are using their growing knowledge of prenatal health to
proactively prevent birth defects by accessing the
relatively good prenatal care available in the city.
Nonetheless, Yang stressed that during the first trimester
of pregnancy -- when the fetus is developing its internal
organs and at greatest risk of harm -- many women may not
yet realize they are pregnant, and thus may not take care to
avoid harmful pollutants.

Testing for Birth Defects Not Popular in Guangzhou
-------------- --------------


9. (SBU) Dr. Yang said that despite women's growing
understanding of the need for good prenatal care, many of
her patients remain reluctant to undergo invasive testing
for birth defects because of the risk of miscarriage the
tests carry. She said because of China's one-child policy,
mothers don't want to submit their only offspring to a test
that could harm the child.

The Numbers Vary, But Birth Defects Appear to be Rising

GUANGZHOU 00020593 003.2 OF 004


-------------- --------------


10. (SBU) Reports on the number of birth defects in China
vary widely depending on the source. Guangdong's Southern
Metropolis Daily, citing a 1996-2004 report by "the China
monitoring system for birth defects" reported in September
2005 that China has a relatively high frequency of birth
defects, with 800,000 to 1.2 million babies with birth
defects born each year, or 4-6% of China's newborn
population; Professor Liang agrees with this estimate. This
percentage is double the figure of 2-3% percent seen in many
countries. (Note: The U.S. CDC estimates that roughly 3%
of babies born in the U.S. have birth defects. End note.)


11. (SBU) The Chinese Ministry of Health (MOH),however,
cites lower numbers. The Hong Kong press reported that MOH
figures show a 1.05% rate of birth defects in 2001; 1.11% in
2002, and 1.29% in 2003. (Note: Econoffs were unable to
independently verify the MOH statistics because the MOH
official public website does not include these statistics.
As a result, we were also unable to clarify what types of
defects were included in the statistics. End Note.) A
website affiliated with the People's Daily reported that the
birth defect rate was 1.28% in 2004. The most recent
statistics available show that Guangdong's birth defect rate
in 2002 was 1.37%, and 2.12% in 2004, according to the China
Population and Development Research Center. Birth defects
surveillance in most developing countries is incomplete at
best, according to the HHS/CDC birth defects expert, and
many severe cases are likely to die early without a
diagnosis, thus they may never be reported.

And Infertility is Rising Too
--------------


12. (SBU) According to the Hong Kong press, during the past
two decades, the infertility rate in China has climbed from
3% -- among the lowest in the world -- to 12.5%, coming
closer to the 15-20% range in developed countries. (Note:
While the article did not specify its definition of
infertility, a common definition is one year or more of
involuntary childlessness. End Note.) The director of
infertility services at a Beijing hospital was quoted in the
report as blaming "environmental factors" for the spike,
although he did not elaborate. Meanwhile, Dr. Yang
suggested changing lifestyles may also be to blame. She
said that Chinese women are increasingly engaging in
premarital sex, which may lead to sexually transmitted
diseases that can cause fertility problems later (see
reftel). Meanwhile, more premarital sex has led to an
increase in unplanned pregnancies, which in turn leads many
young women to seek abortions, which can lead to
complications affecting the recipient's reproductive health.
Finally, Yang commented that many professional Chinese women
are waiting until they are in their 30s to have a baby, when
it becomes more difficult to conceive and to sustain a
pregnancy. (Note: For many years the vast majority of
Chinese married at exactly age 20, the then legal marriage
age, and conceived immediately thereafter. As a result,
women avoided getting pregnant too young, as is a problem in
many developing countries, and actually attempted to have
children at exactly their most fertile age. Changing
lifestyles have led to later marriages, when the infertility
rate is higher. End note.)

Rural Women: Slightly Higher Rates of Birth Defects
-------------- --------------


13. (SBU) A website affiliated with the People's Daily
reported a rate 1.27% birth defects in urban areas, and
1.33% in rural areas. Dr. Yang also commented that, in her
experience, birth defects are higher in the countryside than
in the city. Dr. Yang explained that rural women may come

GUANGZHOU 00020593 004.2 OF 004


into direct contact with polluting chemicals such as
pesticides. Moreover, prenatal care and maternal nutrition
in the countryside is inferior to that in the cities.

Concern That Pollution May Impact Pregnancies
--------------


14. (SBU) Wang Bin, director of the women's health division
at the MOH, said publicly in early 2005 that the increase in
children in China diagnosed at birth with health problems is
due to environmental pollution. Wang acknowledged that
improved diagnostic standards have enabled better detection
of health problems. Liang Zhicheng also publicly attributed
the rise in birth defects to pollution in a Hong Kong press
report. Regardless of the scientific connection, or lack
thereof, or of other factors such as poor prenatal medical
care, genetics, bad prenatal health decisions by the mother,
stress, etc., there is growing public concern in South China
that high levels of air, water, and other environmental
pollution may be contributing to a number of reproductive
health problems.

Comment
--------------


15. (SBU) Environmental issues are of growing concern to
both the Chinese public and the national government. Child
health is also a critical issue to the public. It is
therefore unsurprising that public attention would focus on
the potential impact of environmental pollutants on child
and maternal health, rather than on the more fully
documented environmental links to adult heart, respiratory
and other illnesses. The rumors circulating in Guangdong
provide an interesting window into how China's family
planning policy and the importance of healthy children
affects the public.


16. (SBU) What is clear is that more data on birth defects
and maternal and child health in general as well as on
environmental health are needed. China simply does not yet
produce the quality of data needed to look at how specific
environmental contaminants affect specific health issues,
and this leaves the public confused and worried.


17. (SBU) HHS/CDC has a long-standing birth defects study
that to date has focused on improved maternal nutrition - a
key intervention in reducing the incidence of birth defects.
It is our understanding that this study may now address some
environmental questions. These studies should prove
invaluable in shedding light in an area which thus far has
been the purview of rumor and anecdote.


18. (SBU) This cable has been cleared by Beijing Embassy
ESTH.

DONG