Sandi L. Pruitt

Response to Letters to the Editor

article on infant abandonment draws attention to practical, conceptual, and moral challenges to the evaluation of Safe Haven laws. On a practical level, our ability to evaluate these laws is limited by a lack of uniform and mandatory surveillance systems and a lack of consistent case definitions. These limitations have resulted in widely divergent estimates of the problem. For example, statistics such as those gleaned from newspaper reports provided by Adam Pertman and Georgia Deoudes are typically unofficial reports of abandoned children of any age and include children abandoned to public agencies and relatives. In my study, I applied a very strict case definition and, acknowledging the limitations of available data, aimed to present a more descriptive study of the problem of illegally abandoned and legally surrendered infants in Texas rather than simply declaring the success or failure of the Safe Haven policy as a whole. Seen from a larger perspective, our beliefs about the purpose of Safe Haven laws influence the very questions needed for their assessment. As Michelle Oberman noted, Safe Haven laws have often been invoked as moral imperatives. The “success” or “effectiveness” of a policy seen as a moral imperative is quite different from the evaluation of a more utilitarian public health policy; it may even be irrelevant. In his letter, Thomas Atwood rightly asks, “Just how many lives have to be saved to make these laws worthwhile?” If the purpose of these laws as moral imperative is simply to provide an alternative path for desperate women, the laws have already accomplished their goal. From this perspective, the associated costs, negative consequences, and impact on the number of abandoned or surrendered infants need not factor into the definition of success. On the other hand, from a more utilitarian perspective, Michelle Oberman is also correct to consider the relative public health impact of this problem and to ask whether we will ever know if Safe Haven policies change the behavior of mothers intending to illegally abandon their newborns. Taking this a step further, any attempt at assessment or monitoring will incur additional costs that should also be considered in light of competing priorities. Finally, from either perspective, we must also ask ourselves to what extent our evaluations must weigh the multiple unintentional but significant negative consequences of Safe Haven policies, as pointed out by Pertman and Deoudes. Despite our differences, the authors of these letters all seem to agree that a definitive assessment of these laws is simply not possible at this time. At a minimum, we should consider designing and supporting uniform reporting guidelines and systems to monitor newborn abandonment. More research is also needed on risk factors for abandonment and the potential impact of prevention efforts. Finally, it is essential that we retain a larger perspective and target multiple fronts in our policy solutions by improving efforts to prevent unintended pregnancy, identifying at-risk mothers and providing them with the help they require, and strengthening and improving existing child welfare safety systems.

The Number of Illegally Abandoned and Legally Surrendered Newborns in the State of Texas, Estimated From News Stories, 1996-2006

In 1999, Texas was the first of 47 states to pass a Safe Haven law allowing for the anonymous surrender of unwanted newborns at designated locations. However, state agencies do not systematically collect data on the number of illegally abandoned infants and infants legally surrendered under the law. Using the LexisNexis database of Texas newspapers, this study estimated the number of illegally abandoned and legally surrendered newborns younger than age 60 days in Texas, 1996 to 2006 and describes their demographic characteristics. Of 93 infants (53% male) identified during the study period, 82 were illegally abandoned (70% found alive) and 11 were legally surrendered. On average, 7.5 (range: 4-16) infants were illegally abandoned each year, with the greatest number found in 1999. Infants continued to be illegally abandoned following passage of the Safe Haven law. A statewide surveillance system should be implemented to evaluate this important public health problem.In 1999, Texas was the first of 47 states to pass a Safe Haven law allowing for the anonymous surrender of unwanted newborns at designated locations. However, state agencies do not systematically collect data on the number of illegally abandoned infants and infants legally surrendered under the law. Using the LexisNexis database of Texas newspapers, this study estimated the number of illegally abandoned and legally surrendered newborns younger than age 60 days in Texas, 1996 to 2006 and describes their demographic characteristics. Of 93 infants (53% male) identified during the study period, 82 were illegally abandoned (70% found alive) and 11 were legally surrendered. On average, 7.5 (range: 4-16) infants were illegally abandoned each year, with the greatest number found in 1999. Infants continued to be illegally abandoned following passage of the Safe Haven law. A statewide surveillance system should be implemented to evaluate this important public health problem.

Comunicación de los resultados de la colposcopia: contenido de las conversaciones entre pacientes y profesionales sanitarios

Objetivo. En el presente artículo se describe el contenido de las conversaciones que los profesionales sanitarios mantienen con sus pacientes tras la realización de una colposcopia y la percepción que las mujeres tienen de dichas conversaciones y sus trastornos. Materiales y métodos. Las conversaciones (n = 47) se grabaron en cinta, se transcribieron y analizaron. Inmediatamente después de las conversaciones se entrevistó a las mujeres. Resultados. Los profesionales sanitarios a menudo citaron o describieron el diagnóstico (n = 46), sugirieron una fecha para una nueva visita (n = 41) y preguntaron a la mujer si entendía el diagnóstico o tenía cualquier pregunta (n = 40). Los factores de riesgo y las causas del cáncer de cérvix, como la infección por el virus del papiloma humano, el tabaquismo y la actividad sexual, se abordaron en contadas ocasiones (n = 5). Se preguntó a la mayoría de las mujeres (n = 40) si comprendían la explicación del profesional sanitario o tenían preguntas. Las mujeres otorgaron una puntuación elevada a la calidad de la explicación del profesional sanitario que las atendía y una puntuación moderada a la gravedad de su trastorno y la preocupación que éste les despertaba. Conclusiones. Las conversaciones mantenidas tras la realización de una colposcopia se centraron en el seguimiento en cuanto a medidas de detección y tratamiento. Los factores de riesgo y las causas del cáncer de cérvix se abordaron en contadas ocasiones. ▪