SCIENTIFIC DECLARATION
IN SUPPORT OF
RESEARCH TO IMPROVE
MATERNAL, FETAL §& CHILD HEALTH

The United States has a rare opportunity to improve maternal,
fetal and child health and, by so doing, to build a healthier
America.

This chance exists because of medical and scientific dis-
coveries of the last 25 years. For the first time in human his-
tory it has become possible to intervene therapeutically to
facilitate as well as prevent conception, to treat the human
fetus as a patient, to prepare mothers through diet education
and hormones for healthier pregnancies, to "see'' the fetus via
amniocentesis and ultrasonography and to prescribe for some fetal
problems, in fact to aid and abet in the production of healthier
and stronger human beings. One Nobel Laureate in genetics has
predicted that man will be "the first species in history able to
control its own evolution."

These developments may well be only the beginning of a new
era in medicine--the molecular, genetic, hormonal era of the
future.

The scientific discoveries which make this new era possible
are significant for all living organisms; but, the human species
can and should be the first to employ this information and tech-

nology to its own advantage.
This objective can be most economically and efficiently
achieved, in our judgment, by concentrating on mothers and their
children because the best way to use new information to improve
the nation's health is to improve the beginning of life--con-
ception, implantation, fetal life, and the earliest years of
childhood. This is the best, most efficient and least expensive
way to preventive medicine--avoiding mistakes at the beginning or
even before conception.

The focus for this kind of research has been the National
Institute of Child Health and Human Development with both its
worldwide extramural and intramural programs. Started by President
Kennedy in 1963, this Institute has become the focus for research
in reproductive biology, developmental biology, fetal medicine,
early child development, maternal medicine, and preventive health
for mothers and children. But its effectiveness and leadership
potential can be significantly enhanced by providing for the
critical needs of the intramural program which has been unnecess-
arily restricted by:

1. No home in which to conduct a coordinated
program of either basic or clinical research.

2. No adequate training program for want of
Space, patient clientele, and money.

3. Inadequate permanent cadre of scientists,
some of whom have refused to stay with NICHD
because of inadequate basic research space.
After 14 full years, for example, there are

only two research obstetricians- gynecologists
in the NICHD--a tragic, even absurd, failure

by the Federal Government.

At least four essentials must be supplied to enable the

NICHD to fulfill the purposes for which it was established and

to exploit the chances science now offers to make a giant step

forward:

The NICHD must have physical facilities on

campus similar to those already enjoyed by

every Other major Institute at the NIH.

These facilities are necessary for (a)

efficient research, (b) cost-effectiveness

and (c) recruitment and retention of scientists.
The NICHD has failed to fulfill its potential
partly because it has never had sufficient

basic research facilities, and its clinical
facilities have not been appropriate for preg-
nant mothers and infants. Therefore, the

NICHD should be given both basic and clinical
research facilities immediately.

Specialized clinical facilities must be created to
address research of the acute and potentially
treatable problems of the pregnant mother and her
fetus. This clinical research center must be
located near enough to the NIH campus to permit
clinical opportunities for researchers and aid in

the recruitment and retention of professionals,
especially in obstetrics. At the same time, the
clinical component must be contiguous to excellent
obstetrical care to assure access to adequate numbers
of patients in an environment of quality health care,
medical research and training, and sophisticated
attention to the bioethical aspects of the protection
of human subjects in fetal and child research.
The NICHD has been kept on a starvation diet for the
last 10 years (1968 - 1978). Its research budget has
not kept pace with inflation let alone with the expand-
ing research and clinical opportunities. Penny-wise
administrators have allowed costs for remedial medicine
to sky-rocket while cost-effective preventive medicine
has been held in a vise-like grip.
President Carter's proposed budget for 1979 includes
the first substantial increase for the NICHD in recent
years--$33 million. This is a substantial step in the

a
right direction so far as extramural research and train-
ing are concerned. But $40 million for '79 would be
closer to the need. This money would contribute to the
prevention and treatment of diseases and disabilities
such as cardiovascular problems, diabetes, mental retard-
ation, behavioral and sociological problems, reproductive
abnormalities and birth defects. Clinical research would
translate basic research, both "theoretical" and "animal,"

to pregnant women and to the human fetus.
ck 9” 1978

1701 K Street, N. W., Suite 205
Washington, D. C. 20006
March 7, 1978

The need for better maternal, fetal and child health has long
been evident. The opportunity for our renewed commitment and action
will never be more timely. We, therefore, urge the Congress to
appropriate funds immediately for the construction of the essential
research facilities described--the basic science unit already
designed for the NIH campus and the clinical science unit at an
appropriate public or private medical institute close by. These,
together with research funds, will support the necessary work both
off and on the NIH campus and will finally put the NICHD in a posi-
tion to do what can and should be done, efficiently, economically,
and in the best medical and scientific manner. In 1979, the Inter-
national Year of the Child, no expenditure could better symbolize

America's commitment to mothers, children and families.

The undersigned subscribe to the urgent need for and the con-

ceptual design of this scientific effort.

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