Studying the Effects of a Controversial Adoption-records Policy
Wanda Barfield, a neonatologist who had worked for the Army before entering the EIS in 2000, never imagined that she would be testing her epidemiological skills to evaluate how a public health department responded to a policy, rather than studying the effects of a disease on a population.
Barfield had spent the previous four years working at a Neonatal Intensive Care Unit in Tacoma, Washington, a facility that cares for approximately 30 seriously ill newborns a day from military families based in the Pacific Northwest. She transferred from her military assignment into the EIS in 2000.
In her second month as an EIS officer, Barfield and another EIS officer, Julia Rhodes (EIS '00), were called to Oregon to analyze the Oregon Department of Human Services' handling of requests from adoptees, who had been given permission to obtain their previously sealed pre-adoption birth records. The controversial ballot measure, which voters had passed in November 1998, had not been implemented until June of 2000 because of opposition from birth mothers. The result for the health department was a backlog of 4,700 requests to be processed and filled.
"Adoptees would be able to look at the name and other demographic information of their birth parents," said Barfield. "There was also the expectation that they would be able to obtain medical information. But generally, birth certificates provide just basic demographic information."
"Our challenge was to find out how this legislation affected the health department, particularly in terms of resources, and also to determine if the information that the adoptees received was useful to them," Barfield said.
For a three-week period, Barfield and Rhodes conducted their investigation, and, according to Barfield, the health department handled a challenging situation with professionalism and with a commitment to accuracy.
"They had to implement this mandate, while simultaneously handling responses that came from opponents and advocates of the legislation. The health department had to interact with the public a lot. They remained objective and really took on a leadership role," Barfield said, noting that an added challenge was ensuring the accuracy of archived birth records that dated back to the 1920s, with many of the certificates having incomplete information such as no father's name listed.
Late in the process, Oregon's governor had approved the use of a contact preference form, which gave birth parents the opportunity to indicate if they preferred being contacted by adoptees and in what manner and to provide their medical information anonymously.
"One of our recommendations for other states considering this sort of legislation is to create a way that birth parents could state their preference for contact prior to the release of forms," Barfield said. "Another option is using existing adoption registries. These registries allow birth parents to include medical or other information as part of the background provided to the adopting parent.
"Other states can learn a lot from the Oregon experience," concluded Barfield, who noted that Washington state is considering similar legislation. "Oregon is already improving its process. They're thinking of ways to reorganize archived adoption records to allow better accessibility."
This unusual first assignment gave Barfield a chance to combine her interest in epidemiology with public policy.
Barfield's interest in public health began while in medical school at Harvard University, where she also earned a master's degree in public health. She then worked as a pediatric resident at Walter Reed Army Medical Center and completed a fellowship in perinatal medicine at Children's Hospital in Boston. From there, she entered the Army, most recently serving as director of the Neonatal Intensive Care Unit at Madigan Army Medical Center in Washington.
As an EIS officer, Barfield is most interested in continuing her work in epidemiology, and specifically, studying the underlying causes of fetal and infant mortality. Called perinatal mortality, this under-reported area refers to a combination of infant deaths that occur at less than seven days of age, or stillbirths that occur late in pregnancy. Out of almost four million live births in 1998, over 27,000 resulted in perinatal deaths.
"This is an important area that hasn't been looked at very rigorously in the United States, yet it's an area where intervention could have a major impact," Barfield explained. She noted that linking maternal and child health disciplines more closely together throughout the process could lead to better understanding of the root causes of perinatal deaths and to better preventive strategies. She also believes that policy plays an important role in the public health arena.
"With all the advances we have in medical care, their effectiveness is only as good as the access people have to them," Barfield said. She added that there are several low-tech and inexpensive ways to reduce infant deaths. "Steps people can take include promoting maternal and women's health, following good nutrition, ensuring everyone has access to good healthcare, obtaining immunizations for their children and placing babies on their backs to sleep. These examples are very straightforward measures that can be implemented relatively easily," she said.
Barfield is tackling these issues by working closely with world-renowned maternal and child health experts, including those working alongside her at CDC's pregnancy and infant health program. She counts among her mentors Drs. Kay Tomashek (EIS '97), Solomon Iyasu (EIS '89) and Branch Chief Hani Atrash (EIS '79).
She is looking forward to continuing her affiliation with CDC once her EIS assignment ends in 2002.
"I see the EIS experience as the perfect opportunity to link a lot of the clinical issues that I've learned as a practicing physician, with the broader issues of healthcare access and social policy. I am excited by the opportunity to learn the tools of epidemiology in order to push those things forward," Barfield concluded.
