Fiona Stanley's commitment to maternal and child
health has made her, and Australia, a world leader in this field.
Most importantly, it has resulted in dramatic improvements in the
current and future prospects for child health, particularly with respect
to certain birth defects, and offers hope for improved Aboriginal
maternal and child health.
Fiona Juliet Stanley was born in Sydney on 1 August
1946, and moved to Perth when she was 10 years old. After attending
St Hilda's School, she studied medicine at the
University of Western Australia, where she won the Queen Elizabeth
Prize in Obstetrics and Gynaecology. Stanley then practised as a hospital
physician for two years, before undertaking postgraduate study in
the UK and USA.
During her early years as a physician in Perth,
Stanley had been frustrated by the way in which Aboriginal children
were brought into hospital suffering from health problems, were healed,
and then sent back to live in the same conditions which had caused
the health problems in the first place. This experience increased
her awareness of the way in which social conditions influence health.
In 1972, Stanley went to study at the Social Medicine
Unit of the London School of Hygiene
and Tropical Medicine, at the time the world's foremost centre
for epidemiology. A year in the USA, at the
National Institutes for Health, in 1976 offered further opportunities
and when she returned to Perth in 1977, Stanley was able to apply
her first class training in epidemiology to tackle children's health
problems in Western Australia.
By 1992, Stanley and her team were able to make
an announcement that has had a major impact on child health: the announcement
that folic acid can prevent spina bifida.
Spina
bifida, a congenital defect in which the spinal cord fails to
form properly, causes severe disability, and many babies born with
the condition die as a consequence of it. Stanley and her team were
able to demonstrate that a maternal diet rich in
folic acid - found in green leafy vegetables, fruit and wholegrains
- would significantly reduce the likelihood of having a baby affected
by spina bifida. The WA studies were one of several done internationally,
all supporting the evidence that folate was protective. The researchers
then implemented the world's first population program to reduce the
incidence of spina bifida by urging women to eat a diet rich in folic
acid and evaluated its impact. More recently, most breakfast cereals
have been supplemented with this vitamin as part of a
federal government initiative.
The consquences of these interventions have been
dramatic: by 1997, just three years after commencement of the folic
acid program in Western Australia, the rate of spina bifida in the
population has halved. Apart from the reduction in physical and emotional
distress for families, the actual economic costs saved have been to
the order of $1 million health dollars per child saved from developing
spina bifida.
Another of Stanley's major areas of research has
been the epidemiology of cerebral palsy, and in this, too, she has
made major contributions to our understanding of the disorder.
The most common physical disability in childhood,
cerebral palsy affects around 2.5 in every thousand babies born each
year. Conventional thinking has ascribed the disorder to lack of oxygen
to the baby's brain during labour, but Stanley has found that the
proportion of babies suffering the disorder has remained unchanged,
despite advances in obstetric care. Although asphyxiation during labour
accounts for some cases of cerebral palsy (probably < 5%), Stanley's
research opened up new areas of research by suggesting that events
earlier in pregnancy, such as infections, placental problems or blood
incompatibilities, disrupt the normal development of the brain. Premature
babies can also be at risk because their brains are not fully developed
at birth.
Fiona Stanley has also maintained a commitment
to the maternal and child health of Western Australia's Aboriginal
population, in particular with the launch in 1992 of Ngunytju Tjitji
Pirni, a service of enhanced care for Aboriginal women and their children
in the Eastern Goldfields area of Western Australia. This project
allows Aboriginal health workers to provide care and to collect data
on the social and medical conditions of the women and children. The
data will give a clearer picture of the needs and most appropriate
solutions for Aboriginal maternal and child health. The initiative
is, like so much of Stanley's work, the first of its kind in Australia.
The Institute now has four major Indigenous research programs, all
with Aboriginal staff, postgraduate students and health workers.
Fiona Stanley has played a pivotal role in another,
extremely significant, "first" for Australia: the
TVW Telethon Institute for Child Health Research in Perth. Stanley
and Dr Louis Landau came up with the idea for the Institute in 1985,
after becoming frustrated with the inability of population science
on its own to deal effectively with childhood diseases. They believed
that the answer lay in an institution in which collaboration between
all the disciplines of research could occur. Five years later, the
TVW Telethon Institute for Child Health Research opened, with Stanley
as its Director.
Since then, the Institute has gone from strength
to strength. It combines the three major disciplines of medical research:
basic laboratory science, clinical science and epidemiology, and under
Stanley's direction, world leaders in such fields as asthma and allergic
disease, infectious disease, birth defects, childhood death and disability,
Aboriginal maternal and child health, leukaemia and other cancers,
and adolescent mental health have come to work together.
The Institute's Maternal and Child Health population
database is unique in the world, and studies the causes of birth defects,
neurological disabilities and low birth weight. This database, established
in 1977, has provided the significant discoveries for which Stanley
and her colleagues are renowned: the connection between folic acid
and spina bifida, and the causes and prevention of cerebral palsy.
Fiona Stanley is considered a world leader in her
field, and her research achievements have brought her many honours,
including the National Australia Day Council Award of Australian Achiever
(1993), the Advance Australia Foundation Award (1995), the Companion
of the Order of Australia (AC) (1996), and an Honorary DSc from
Murdoch University (1998). Fiona Stanley's achievements are probably
best reflected, however, in the increased health and well-being of
mothers and children across Australia and across the globe.
