Page 43 - Genomic Medicine in Emerging Economies

32 CHAPTER 3: Genomics and Public Health: China’s Perspective

woman, her ethnicity, or family history. Prenatal screening is usually strongly
recommended to those women of advanced reproductive age or to those of
advanced paternal age, since they are at an increased risk of having babies with
a birth defect. A survey of 1416 new mothers on the willingness to accept pre-
natal screening for Down syndrome after they were provided with information
on the procedure showed that 91.2% of all mothers would accept it (Qiong
et al., 2008). In metropolitan territories and regions with advanced econo-
mies, almost every hospital with a department of gynecology and obstetrics
can provide regular instruction for prenatal screening. Pregnant women are
guided by the relevant medical staff (e.g., obstetricians) to register and set up
their own healthcare documents. Thus healthcare handbooks on the prenatal
period are offered to pregnant women as long as they come to the hospitals
to demand a prenatal screening. Suggestions on medical termination of preg-
nancy will be offered by the doctor if severe fetal anomalies are detected during
pregnancy and are confirmed by subsequent DNA diagnostic testing. Screening
may also be performed prepregnancy. In China, the coverage rates of prenatal
screening are various because of the imbalanced economic development. For
example, the coverage rates in Wenzhou City and Hangzhou City in southern
China, which are economically developed, were 63.15% and 60%, respectively
in 2007, whereas in Gansu Province of on the western frontier area of China,
which is not economically developed, the coverage rate was only 31.47% in
2006. Fees for these screening tests vary from province/hospital to province/
hospital. In some advanced cities of China, such as Beijing, Tianjin, Shanghai,
and Shenzhen, pregnant women with urban census registry (Hukou) are given
the privilege of taking the special prenatal screening free of charge, and the fees
are paid by their insurance or by the public medical care service. To reduce the
rate of birth defects, some city governments with relatively good economies
began to provide free special prenatal screening to rural pregnant women, for
whom there is usually no medical insurance or free medical care provided by
the publicly funded service. For example, the government of Tianjin invested
over 2 million renminbi for such purposes in 2006. Thereby, 80% of rural
pregnant women could take the privilege, and 40,000 rural newborns would
benefit by this policy in Tianjin. Although the Chinese government has been
providing more services on prenatal screening, not everyone can benefit from
it. For example, most pregnant migrant workers are unaware of either prenatal
screening or other essential health care, as they are usually in a lower social and
economic class and thus disadvantaged by not being able to take part in public
medical care services. Dangerous deliveries and birth defects usually happen in
such communities.
Newborn Screening
There are about 20 million births each year in China. For hyperphenylal-
aninemia (including phenylketonuria) alone, there are 1600–1800 new cases