STATE OFFICE OF VITAL RECORDS Birth Certificate Webinar

Public Health Impact of Birth Certificate Data Presented to: Georgia Delivery Hospital Birth Clerks Presented by: Florence Kanu, Maternal and Child Health Epidemiology Date: Thursday, May 17, 2018

Presentation Outline 1. Birth Certificate Timeliness 2. Programmatic Impact of Your Data 3

Percent of Georgia Birth Certificates Registered Within 5 Days Jan-Apr 2017 vs. Jan-Apr 2018 100 97. 4 100. 0 92. 0 97. 3 Goal 85 Percent (%) 75 73. 6 73. 7 Jan Feb 80. 0 80. 8 Mar Apr 50 25 0 2017 2018 Goal Data Source: 2018 Birth Data Quality Report, Office of Vital Records 4

Impact of Your Data 5

Impact: Georgia PRAMS Project • PRAMS: Pregnancy Risk Assessment Monitoring System • Used to plan/evaluate programs and policies aimed at reducing health concerns among mothers and babies • Birth certificates are used to randomly select women to participate in PRAMS survey 6

Impact: Georgia PRAMS Project • Oversample based on data on birth certificate – Draw stronger conclusions about people of interest • Currently oversample mothers who delivered an infant less than 37 weeks’ gestation (prematurely) – Unable to properly oversample mothers with premature infants if birth certificate data are inaccurate/missing – Oversample may not be representative of mothers with premature infants – Inapplicable recommendations for mothers with premature infants 7

Impact: Georgia PRAMS Project • Many elements of the birth certificate are part of related PRAMS analyses (e. g. , race/ethnicity, WIC status) • Used to answer questions of interest to guide several programs • Inaccurate/missing data hinders the ability to measure factors of interest correctly – Smoking cessation for pregnant White women – Access to adequate prenatal care for Black women • Can lead to inaccurate understanding of programmatic needs – Lack of knowledge on where/who to target regarding smoking cessation or access to prenatal care 8

Impact: Birth Defect Registry • Birth certificates are the first access point for infants to receive necessary services • Birth Certificates used to flag infants with birth defects • Accurate flags impact ability to capture valid data from birth certificates • Increases efficiency in identifying infants who need follow up services and • Increased efficiency allows for timely follow up 9

Impact: Birth Defects Registry • 2 out of 5 infants flagged as having a birth defect do not actually have a condition • 1 out of 10 infants are not flagged but have a birth defect 10

Impact: Children 1 st • Early identification of children at risk for poor health or development and linkage to early intervention services • With improvements to birth certificate data, more infants can be referred to services earlier, which benefits their health • Birth certificate data are screened for risk factors – Example: baby born too early or too small 11

Impact: Children 1 st • Families of identified children contacted using information on the birth certificate – Accurate name and phone number for mother needed for linkage to early intervention and treatment services • Inaccurate/missing data for risk factors impacts Children 1 st follow-up – Delay linkage to early intervention services – Delayed interventions are typically more costly and less effective than earlier interventions 12

THANK YOU! YOU play a key role in helping us to: – Identify newborns who need services to give them the best chance at healthy growth and development – Determine the effectiveness of programs and interventions and identify opportunities for improvement – Monitor changes in MCH indicators and measure progress toward goals – Identify subpopulations at high risk to target programmatic efforts 13

Paternity Acknowledgment

Paternity Acknowledgment Definition: The Paternity Acknowledgement (PA) is used to add a biological (natural) father to a child’s birth record, and to initiate a parent-child relationship with legal responsibilities. This could also be the first step toward the legal process of Legitimation. The Paternity Acknowledgement – Form 3940 (Rev 03/18) must be: • Signed by both parents • Notarized • Filed with the State Office of Vital Records VR Regulation 511 -1 -3 -16

Paternity Acknowledgment Form 16

PA July 2016 Changes • Governor Deal signed SB 64 into law effective July 1, 2016 • Major changes – Can no longer do a voluntary legitimation; must be a court ordered legitimation or dad must marry mom and recognizes child as his own – PA form 3940 revised • Form 3940 is on the Vital Records website • Previous versions will not be accepted • Since 2016, there has been some updates to the form – PA form must be filed with the State Office within 30 days of execution/signature date 17

PA July 2016 Changes Continued After the document is filed, the following persons can request a certified copy from the State Office: Any person who signed it A government agency who needs it for official purposes The child if he or she is at least 18 years old In response to a court order or subpoena The guardian or temporary representative of any person who signed it An attorney licensed in GA who needs it for purposes of legal investigation on behalf of a client The guardian, temporary guardian, or legal custodian of that child A licensed child placement agency that needs it for official purposes The child’s living legal spouse, next of kin, legal representative, or someone who has applied in good faith to become the child’s legal representative 18

Paternity Acknowledgment Child under 1 year old • 511 -1 -3 -. 27(1) Until the registrant’s first birthday, given names may be added to, changed, or corrected upon receipt of an affidavit signed by; (a) Both parents; or (b) The mother of a child born out of wedlock; or (c) Either parent in the case of the death or incapacity of the other; or (d) The legal guardian or agency having legal custody of the registrant. • 511 -1 -3 -. 27 (2) When a paternity affidavit has been completed and filed, no further amendment to the child’s name shall be made except upon receipt of an order from an appropriate court, or if the natural parents marry after the birth of the child and thereby legitimate the child. 19

Paternity Acknowledgement Child over 1 year old • 511 -1 -3 -. 27 (3) After one year from the date of birth, the provisions of Rules 511 -1 -3 -. 25 and 511 -1 -3 -. 10 must be followed to add a given name omitted on the birth certificate, or to amend a given name if the name was misspelled on the birth certificate. The State Registrar may change a given name after one year only upon receipt of an order from a court of competent jurisdiction requiring such change. • 511 -1 -3 -. 25 speaks on the amendment process 20

Paternity Acknowledgment Parameters: 1. The mother must have given birth in the state of Georgia 2. The father self-acknowledges to be the child’s biological father 3. Both parents must sign the same PA form and is strictly voluntary 4. The PA cannot be completed if the mother of the child was married to anyone within 10 months prior to the birth of the child or, if for any other reason, there is another father listed on the child’s birth certificate

Paternity Acknowledgment A signed PA form allows: 1. The parents to name the child 2. The biological father’s name to be automatically added to a child’s birth certificate 3. The father’s name to be automatically added to the Putative Father Registry

Proper Completion of Form 3940 • Form needs to be completed in black or blue ink only. • White-out, scratch-outs or mark-outs should be on this form • Make sure parents and birth clerks proofread the form for errors • Both parents need proper picture identification to complete • Mom and Dad’s sections each require a valid notary 23

Requirement vs Practice • The PA statute does not require a parent/legal guardian of a minor to sign the form. • Parental consent for minors is requested on the new form as a matter of practice and procedure, not a matter of law or regulation. – The “age of majority” in Georgia is 18 – Contract signed by a minor are voidable at the minor’s election, but not void. – A minors signature on a PA is susceptible to legal challenge. As a practical matter, what we gain from the parental co-signature is that it makes it harder for the minor (or anyone else) to argue that the minor didn’t know what they were signing. Code Sections 13 -3 -20, 13 -5 -3, 44 -5 -41 24

Requirement vs Practice An unwed parent under the age of 18 may sign without parental consent if : • He/she is on active duty • Emancipation has been granted by a court order 25

If you need to order Paternity Acknowledgment Program brochures email Adrienne Reddick Adrienne. Reddick@dhs. ga. gov 26

Regional Consultants If you have any questions, please reach out to your regional consultant. North : TBD East: Cheryl. Desbordes@dph. ga. gov 404 -956 -0124 West : Mannett. Foster@dph. ga. gov 404. 901. 1634 South: Kamilah. Traylor@dph. ga. gov 404. 901. 1615 27

Questions? Florence Kanu, Ph. D, MPH MCH EPI Surveillance Epidemiologist Florence. Kanu@dph. ga. gov 28