Global and National Health Status of Mother and Child PDF

**[Global and National Health Status of Mother and Child]** **Total Fertility Rate** The number of children who would be born per woman (or per 1,000 women) if she/they were to pass through the childbearing years bearing children according to a current schedule of age-specific **fertility rates**....

**[Global and National Health Status of Mother and Child]** **Total Fertility Rate** The number of children who would be born per woman (or per 1,000 women) if she/they were to pass through the childbearing years bearing children according to a current schedule of age-specific **fertility rates**. This entry focuses on the number of births per woman in a population. The most commonly used metric is the Total Fertility Rate (TFR) -- or often simply \'fertility rate\' -- which measures the average number of children per woman. **Global Maternal Fertility Rate** **Total fertility rate, per woman, 2024 = 2.3** **Philippine Total Fertility Rate** **Total fertility rate, per woman, 2024 = 2.7** **Trends in Fertility** Chart and table of the World fertility rate from 1950 to 2022. United Nations projections are also included through the year 2100. The global fertility rate is expected to continue to fall from *2.5 live births per woman today to 2.2 in 2050 and further to 1.9 in 2100*. ***Total Fertility Rate Declined from 2.7 in 2017 to 1.9 in 2022.*** **Crude Birth Rate** The crude birth rate is the annual number of live births per 1,000 population. The crude birth rate is generally computed as a ratio. The numerator is the number of live births observed in a population during a reference period and the denominator is the number of person-years lived by the population during the same period. It is expressed as births per 1,000 populations. **Global Crude Birth Rate** According to the WHO, the global crude birth rate in 2022 was 16.8 per 1,000 people.  The crude birth rate has been gradually declining from 31.4 per 1,000 people in 1973 to 16.8 per 1,000 people in 2022. **Philippines Crude Birth Rate** In 2023, the Philippines registered a total of 1,448,522 live births, corresponding to a crude birth rate (CBR) of 12.8, or approximately 13 births per thousand population.1 In the past ten years, registered live births decreased by 17.2 percent from 1,748,857 in 2014 to 1,448,522 in 2023. A slight decline of 0.5 percent was observed in 2023 compared to the 1,455,393 registered live births in 2022. (Figure 1) On the average, 3,969 babies were born daily, which translates to 165 babies born per hour or nearly three (3) babies born per minute. Regions with larger populations reported the highest number of live births, both by place of occurrence and by usual residence of the mother. Of the total registered live births, 57.5 percent were born in Luzon, 18.2 percent in Visayas, and 24.3 percent in Mindanao. CALABARZON recorded the highest number of birth occurrences with 14.0 percent share. This was followed by National Capital Region (NCR) with 12.5 percent and Central Luzon with 11.5 percent. Similarly, these three regions recorded the highest number of live births by usual residence of mothers, collectively sharing 37.8 percent or about 2 in every 5 babies born in 2023 **Maternal Mortality** The maternal mortality ratio (MM Ratio) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MM Ratio includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year. the number of women who die during pregnancy and childbirth, per 100,000 live births. **Key facts** - - - - - - - Maternal mortality is unacceptably high. About 830 women die from pregnancy- or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Every day in 2010, about 800 women died due to complications of pregnancy and child birth, including severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. The risk of a woman in a developing country dying from a pregnancy-related cause during her lifetime is about 25 times higher compared to a woman living in a developed country. Maternal mortality is a health indicator that shows very wide gaps between rich and poor, both between countries and within them. **Global Maternal Mortality Ratio** From 2000 to 2020, the global maternal mortality ratio (MMR) declined by 34%-- from 339 deaths to 223 deaths per 100,000 live births, according to UN inter-agency estimates. **Philippines Maternal Mortality Ratio** **Maternal deaths per 100,000 live births 2000- 2020** **[Year] [MMR]** **2000 129** **2005 122** **2010 105** **2015 88** **2020 78** A map of the world with different colored countries/regions Description automatically generated **NEONATAL MORTALITY** **The neonatal period is the most vulnerable time for a child.** Neonatal mortality rate is the number of neonates dying before reaching 28 days of age, per 1,000. The neonatal period is the most vulnerable time for a child. Neonatal deaths may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before the 28 completed days of life. **Global Neonatal Mortality Rate** Globally, 2.3 million children died in the first month of life in 2022 -- approximately 6,300 neonatal deaths every day. **Philippine Neonatal Mortality Rate** In 2021, neonatal mortality rate for Philippines was 12.3 deaths per 1,000 live births. It fell gradually from 24.8 deaths per 1,000 live births in 1972 to 12.3 deaths per 1,000 live births in 2021. In 2024, neonatal mortality rate for Philippines was 14.2 deaths from 12.3 in 2023 per 1,000 live births. **Population** Population is the total number of humans currently living. **Global Population** Global population is 8.2 billion in 2024 **Philippine Population** Philippine Population in 2024 is 116 million. The Philippines ranks number 14 in the list of countries (and dependencies) by population. **MEAN AGE AT CHILDBEARING** The mean age at childbearing is the mean age of mothers at the birth of their children if women were subject throughout their lives to the age-specific fertility rates observed in a given year. In 2020, age of childbearing for Philippines was 28.9 years. Between 1975 and 2020, age of childbearing of Philippines was declining at a moderating rate to shrink from 30.7 years in 1975 to 28.81 years in 2020. **GENETICS AND GENETIC COUNSELLING** Genetics is a branch of biology concerned with the study of genes, genetic variation, and heredity in organisms. \[Griffiths, Anthony J.F.; Miller, Jeffrey H.; Suzuki, David T.; Lewontin, Richard C.; Gelbart, eds. (2000). \"Genetics and the Organism: Introduction\". An Introduction to Genetic Analysis (7th ed.). New York: W.H. Freeman. ISBN 978-0-7167-3520-5. Hartl D, Jones E (2005); \"the definition of genetics\". www.dictionary.com. 25 October 2018. Though heredity had been observed for millennia, Gregor Mendel, a scientist and Augustinian friar working in the 19th century, was the first to study genetics scientifically. Mendel studied \"trait inheritance\", patterns in the way traits are handed down from parents to offspring. He observed that organisms (pea plants) inherit traits by way of discrete \"units of inheritance\". This term, still used today, is a somewhat ambiguous definition of what is referred to as a gene (Ibid). Trait inheritance and molecular inheritance mechanisms of genes are still primary principles of genetics in the 21st century, but modern genetics has expanded beyond inheritance to studying the function and behavior of genes. Gene structure and function, variation, and distribution are studied within the context of the cell, the organism (e.g. dominance), and within the context of a population. Genetics has given rise to a number of subfields, including molecular genetics, epigenetics and population genetics. Organisms studied within the broad field span the domains of life (archaea, bacteria, and eukarya) (Ibid). Genetic processes work in combination with an organism\'s environment and experiences to influence development and behavior, often referred to as nature versus nurture. The intracellular or extracellular environment of a living cell or organism may switch gene transcription on or off. A classic example is two seeds of genetically identical corn, one placed in a temperate climate and one in an arid climate (lacking sufficient waterfall or rain). While the average height of the two corn stalks may be genetically determined to be equal, the one in the arid climate only grows to half the height of the one in the temperate climate due to lack of water and nutrients in its environment (Ibid). **HISTORY OF GENETICS** The history of genetics dates from the classical era with contributions by Pythagoras, Hippocrates, Aristotle, Epicurus, and others. Modern genetics began with the work of the Augustinian friar Gregor Johann Mendel. His work on pea plants, published in 1866, established the theory of Mendelian inheritance (Yapijakis C. (2017) Ancestral Concepts of Human Genetics and Molecular Medicine in Epicurean Philosophy. In: Petermann H., Harper P., Doetz S. (eds) History of Human Genetics. Springer, Cham). The year 1900 marked the \"rediscovery of Mendel\" by Hugo de Vries, Carl Correns and Erich von Tschermak, and by 1915 the basic principles of Mendelian genetics had been studied in a wide variety of organisms --- most notably the fruit fly Drosophila melanogaster. Led by Thomas Hunt Morgan and his fellow \"drosophilists\", geneticists developed the Mendelian model, which was widely accepted by 1925. Alongside experimental work, mathematicians developed the statistical framework of population genetics, bringing genetic explanations into the study of evolution (Ibid). With the basic patterns of genetic inheritance established, many biologists turned to investigations of the physical nature of the gene. In the 1940s and early 1950s, experiments pointed to DNA as the portion of chromosomes (and perhaps other nucleoproteins) that held genes. A focus on new model organisms such as viruses and bacteria, along with the discovery of the double helical structure of DNA in 1953, marked the transition to the era of molecular genetics (Ibid). In the following years, chemists developed techniques for sequencing both nucleic acids and proteins, while many others worked out the relationship between these two forms of biological molecules and discovered the genetic code. The regulation of gene expression became a central issue in the 1960s; by the 1970s gene expression could be controlled and manipulated through genetic engineering. In the last decades of the 20th century, many biologists focused on large-scale genetics projects, such as sequencing entire genomes (Ibid). **General Concept** Genetics: Branch of science which studies genes and the pattern of inheritance of particular diseases Inheritance: The transmission of familial elements from one generation to the next. Genetic inheritance is a basic principle of genetics and explains how characteristics are passed from one generation to the next. Genetic inheritance occurs due to genetic material in the form of DNA being passed from parents to their offspring. When organisms reproduce, all the information for growth, survival, and reproduction for the next generation is found in the DNA passed down from the parent generation. Much of our understanding of inheritance began with the work of a monk by the name of Gregor Mendel. His experiments and 'Laws of Inheritance' provide the foundations for modern genetics. In sexual reproduction, the genetic material of two parents is combined and passed on to one individual. Although the offspring receives a combination of genetic material from two parents, certain genes from each parent will dominate the expression of different traits (Yapijakis C. (2017) Ancestral Concepts of Human Genetics and Molecular Medicine in Epicurean Philosophy. In: Petermann H., Harper P., Doetz S. (eds) History of Human Genetics. Springer, Cham). Gene -- Basic unit of genetic information. Genes determine the inherited characters; functional subunit of DNA and contain instruction for making protein. Chromosomes -- storage units of genes. A structure within the cell that deliver the genetic material as DNA. DNA - is a nucleic acid that contains the genetic instructions specifying the biological development of all cellular forms of life. Molecule - encodes the genetic information. Genome -- the collection of genetic information. Genetic pedigree - a diagrammatic representation of diseases history in a family up to 3rd degree relative. A pedigree is a genetic representation of a family tree that diagrams the inheritance of a trait or disease though several generations. The pedigree shows the relationships between family members and indicates which individuals express or silently carry the trait in question. A pedigree is a representation of our family tree. It shows how individuals within a family are related to each other. We can also indicate which individuals have a particular trait or genetic condition. If we take a pedigree, which we usually try to include at least three generations, we might be able to determine how a particular trait is inherited. Using that information, we might be able to tell the chance that a given individual will have the trait themselves or could pass it on to their children. There are standard ways to draw pedigrees so that we can all look at a pedigree and understand it. We use squares to represent males and circles to represent females. We then can number our generations with roman numerals, so the top generation would be generation one, or Roman numeral I. Along this line, we\'d indicate males and females. We would indicate marriages between individuals with a horizontal line connecting the two individuals. If an individual has a genetic trait, we would blacken those individuals in or shade them so that it would be understood that they had a particular trait. We would then draw a line, a vertical line, off the horizontal line where we would indicate any of their children that they had, and we would then indicate if any of their children were infected. And we can do this for as many generations as we have. It\'s important when we draw pedigree that we try to put in as much information as possible. So for example, if there have been children that died in early infancy or were stillborn, we also want to include those individuals. And those are typically shown as very small blackened-in symbols to indicate there was a loss of a child, either in pregnancy or early in life (Suzanne Hart, Ph.D, National Human Genome Research Institute). **PATTERN OF INHERITANCE** It is important to understand the basic laws of inheritance to appreciate how conditions are passed on in a family. An accurate family health history is a valuable tool to illustrate how conditions are passed down through generations. A person has two copies of almost every gene, one copy from mom and one copy from dad. Scientists have studied human genes to learn how they normally work and how changes in genes can change how they work. Some changes are very minor and do not affect the way a gene works. These changes are often called single nucleotide polymorphisms (SNPs, pronounced "snips") or gene variants. Other changes, called mutations, affect how a gene works and can lead to disease. For some conditions, family members with the same mutation may not have the same symptoms. For other conditions, individuals with different mutations can have similar characteristics. This is because gene expression is influenced by genes, as well as by the environment. Diseases caused by mutations in a single gene are usually inherited in a simple pattern, depending on the location of the gene and whether one or two normal copies of the gene are needed. This is often referred to as Mendelian inheritance because Gregor Mendel first observed these patterns in garden pea plants. Most single gene disorders are rare; but, in total, they affect millions of people in the United States. Several basic modes of inheritance exist for single-gene disorders: autosomal dominant, autosomal recessive, X-linked dominant, and X-linked recessive. However, not all genetic conditions will follow these patterns, and other rare forms of inheritance such as mitochondrial inheritance exist (Gene Tests \[2017\] [[www.genetests.org]](http://www.genetests.org).). Dominant mutations are expressed when only one copy of that mutation is present. Therefore, anyone who inherits one dominant disease mutation such as the mutation for Huntington's disease will have that disease. Dominantly inherited genetic diseases tend to occur in every generation of a family. Each affected person usually has one affected parent. However, dominant mutations can also happen in an individual for the first time, with no family history of the condition (spontaneous mutation). Recessive mutations require two mutated copies for disease to develop. Recessive genetic diseases are typically not seen in every generation of an affected family. The parents of an affected person are generally carriers: unaffected people who have a copy of a mutated gene. If both parents are carriers of the same mutated gene and both pass it to the child, the child will be affected. Inheritance patterns differ for genes on sex chromosomes (chromosomes X and Y) compared to genes located on autosomes, non-sex chromosomes (chromosomes numbers 1-22). This is due to the fact that, in general, females carry two X chromosomes (XX), while males carry one X and one Y chromosome (XY). Therefore, females carry two copies of each X-linked gene, but males carry only one copy each of X-linked and Y-linked genes. Females carry no copies of Y-linked genes. Diseases caused by mutated genes located on the X chromosome can be inherited in either a dominant or recessive manner. Since males only have one X chromosome, any mutated gene on the X chromosome, dominant or recessive, will result in disease. Because females have two copies of X-linked genes, they will not be affected by inheriting of a single recessive mutation on an X-linked gene. For X-linked recessive diseases to occur in females, both copies of the gene must be mutated. Families with an X-linked recessive disorder often have affected males, but rarely affected females, in each generation. For X-linked dominant diseases, however, a mutation in one copy of an X-linked gene will result in disease for both males and females. Families with an X-linked dominant disorder often have both affected males and affected females in each generation. A striking characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons; fathers only pass X chromosomes to their daughters and Y chromosomes to their sons. In contrast, mothers pass X-linked genes to both sons and daughters (GeneTests \[2017\] [[www.genetests.org]](http://www.genetests.org).). **Genetic counselling** Genetic counseling is the process of advising individuals and families affected by or at risk of genetic disorders to help them understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. \[\"National Society of Genetic Counselors: NSGC Professional Status Survey\". www.nsgc.org. Retrieved 2018-10-11.\] Genetic counseling is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. This process integrates the interpretation of family and medical histories to assess the chance of disease occurrence or recurrence, education about inheritance, testing, management, prevention, resources and research, and counseling to promote informed choices and adaptation to the risk or condition" (NSGC, 2018). Counselling provides information regard health and support by a specialist doctor "a geneticist" to client (a person who perform genetic test). This complex process can be seen from diagnostic (the actual estimation of risk) and supportive aspects (ibid). The process integrates: Interpretation of family and medical histories to assess the chance of disease occurrence or recurrence Education about inheritance, testing, management, prevention, resources Counseling to promote informed choices and adaptation to the risk or condition (Ibid). **Aims:** To provide the family with complete and accurate information about genetic disorders by. 1\. Promoting informed decisions of involved family members 2\. Clarifying the family's options available treatment and prognosis 3\. Explaining alternatives to reduce the risk of genetic disorders 4\. Decreasing the incidence of genetic disorders 5\. Reducing the impact of the disorders The goals of genetic counseling have differed over the past three decades. Two schools of thought are prominent in reviewing past literature. One upholds the goal of preventing birth defects and genetic disorders while the other promotes a goal of improved psychological well-being in client adaptation to a genetic condition or risk. Both types of goals emphasize that clients should make their own reproductive decisions; however, the former relies on clients making decisions that will reduce the impact of genetic disorders. The differences in the types of goals may be due to the training and orientation of genetics health care providers, socio-cultural views, or priorities of health care settings. Regardless, there are ample reasons to dismiss the prevention of birth defects as a goal. This mini-review recommends use of genetic counseling sub-specialties as a framework for considering different client needs and thus different counseling goals and specific aims in the reproductive, pediatric/adult, and common disease settings. Given the extent of new genetic information, technologies, and the need to evaluate genetic counseling practice, genetics health care providers should work toward arriving at consensus on the goals of genetic counseling, and in doing so, the needs of clients should be considered (Goals of genetic counseling, Biesecker BB \[2016\]). **Function of genetic counselling session** 1. Provide information 2. Available solution 3. Help person to understand and cope with his condition 4. Testing the risk of recurrence It is not unusual for multiple genetic counseling sessions to occur and, at a minimum, include a pre-testing and post-testing session. During the initial genetic counseling visit, the genetic counselor will determine why the patient/family is seeking genetic counseling, identify what information they wish to obtain from the session, collect and record a family history, and assess and record the psychosocial history of the patient. Among the topics discussed during a pre-test session are the clinical presentation of the condition(s) the patient may be at risk for, the pattern of genetic inheritance of the condition, risk of recurrence, available testing procedures and test limitations, reproductive options, and follow-up procedures if needed. General questions relating to suggested treatment, therapy, and the function of related proteins are also addressed. Referrals may be made to specialists regarding specific issues which fall outside the scope of genetic counseling practice. If the patient decides to have genetic testing performed, the genetic counselor is often the point person to communicate the results to the patient/family. However, the post-test session involves more than the provision of medical information and often focuses on helping families cope with the emotional, psychological, medical, social, and economic consequences of the test results. In particular, psychological issues such as denial, anxiety, anger, grief, guilt, or blame are addressed and, when necessary, referrals for in-depth counseling are offered. Information about community resources and support groups are provided to the patient/family. If the genetic test is positive, testing should be considered in additional relatives of this individual. Genetic counseling referrals for other family members for risk assessment are then discussed and it may be necessary to refer relatives to other genetic counselors due to geographical and other constraints. At the conclusion of the genetic counseling sessions, the patient should be offered a written summary of the major topics discussed. The summary is often provided in the form of a letter which serves as a permanent record of the relevant information discussed, as well as relaying additional information that may have become available after the final counseling session. The patient may also choose to share the letter with other family members (International Society of Nurses in Genetics [[http://www.ISONG.org]](http://www.ISONG.org) \[2017\]). **INDICATIONS FOR GENETIC COUNSELLING** 1\. Hereditary disease in a patient or family 2\. Birth defects 3\. Mental retardation 4\. Advanced maternal age 5\. Early onset of cancer in family 6\. Miscarriages 7\. Malformations 8\. Tendency to develop a neurologic condition A referral to or consultation with a genetic specialist may be indicated for several reasons. In general, a consultation with a genetic specialist should be considered if a hereditary condition is suspected. Specific clinical guidelines are available for some conditions such as cancer and diabetes. Patients meeting any of the following criteria should be considered for referral to a genetic specialist: 6.1.1 Family History One or more members with mental retardation, developmental disability, an inherited disorder, or a birth defect One or more members with early deaths due to known or unknown medical conditions One or more members with adult-onset health conditions such as cardiovascular disease, dementia, or cancer, particularly if onset is early in adulthood Couples who would like testing or more information about genetic conditions that occur with higher frequency in their ethnic group 6.1.2 Delayed Growth and Development Those who have or are concerned that their child has developmental delays that may be due to an inherited disorder or birth defect Parents whose infant has a genetic disease diagnosed by newborn screening 6.1.3 Reproductive Issues Women who are interested in genetic testing or screening and women who have experienced multiple pregnancy losses or babies who died in infancy People concerned that their jobs, lifestyles, or medical history may pose a risk to the outcome of a pregnancy. Common causes of concern include exposure to radiation, medications, illegal drugs, chemicals, or infections Couples who are first cousins or other close blood relatives Pregnant women whose ultrasound examinations or blood testing indicate that their pregnancy may be at increased risk for certain complications or birth defects A genetic specialist can provide assistance in several ways: a formal or informal consultation, genetic counseling session, or genetic evaluation. A genetic specialist can provide an accurate assessment or confirm the diagnosis of a genetic disease. A diagnosis may be made primarily through genetic testing or a combination of testing, clinical examination, and family history. Genetic specialists are able to provide management options or referrals to specialists as needed; provide advice to primary-care practitioners about a genetic condition, prognosis, treatment, and long-term outcome; and recommend educational materials to patients and families (National Society of Genetic Counselors [[www​.nsgc.org/resourcelink]](http://www%E2%80%8B.nsgc.org/resourcelink). cfm.). The primary genetic specialists considered for referral are clinical geneticists and genetic counselors. Although these specialists can play a major role in the diagnosis and education of family members with a genetic disorder, other medical specialists such as surgeons, cardiologists, or ophthalmologists may be required for appropriate treatment or intervention. The services of other allied health professionals such as nutritionists, social workers, psychologists, and occupational and physical therapists may also be necessary (Ibid). **Components of the Genetic Counselling Process** - - - - - - - A typical genetic counseling session can last 1 to 1.5 hours. There is extensive case preparation that typically needs to be done before a patient is seen, and resources to accomplish this work can be found in Uhlmann and Guttmacher (2008) and Uhlmann (2009). Conducting a literature search is important for ensuring that information is up-to-date given the rapid pace of advances in genetics. In addition to literature searches, key resources for obtaining information about genetic conditions. Med Gen (www.ncbi.nlm.nih.gov/medgen), Gene Reviews (www.ncbi.nlm.nih.gov/books/NBK1116/) and Online Mendelian Inheritance in Man (OMIM; [[www.ncbi.nlm.nih.gov/omim]](http://www.ncbi.nlm.nih.gov/omim)). Obtaining a three-generation pedigree from the patient up through grandparents is standard in genetic counseling and is used not only for the basis of risk assessment but also can provide insights about the patient's family dynamics, support and psychosocial issues (Bennett et al., 2016). Like any medical interaction, genetic counseling consists of both obtaining and providing information. What differs is the nature of the interaction, approach and time involved. The National Society of Genetic Counselors has information about genetic counseling for patients and providers and videos of simulated counseling sessions available at their website. The American College of Medical Genetics and Genomics, the Genetics in Primary Care Institute (www.geneticsinprimarycare.org) and the National Coalition for Health Professional Education in Genetics/The Jackson Laboratory (www.nchpeg.org) have developed clinical resources and point of care tools for physicians and providers that explain basic genetics concepts and genetic testing. GENETIC COUNSELORS Experience in the areas of medical genetics and counseling. Able to identify family at risk, investigates the problems present in the family, interpret information about the disorder, analyze inheritance patterns and, risk of reoccurrence & review available option with the family. Serves as educators and resource people for other health care professional sand for general public. Some work in administration capacities. Genetic counselors are an important part of the healthcare team. They work with patients and their families to help them understand genetic testing, guide them through the process and help them make informed choices based on their genetic testing results. Some also work in laboratories and help physicians select the most appropriate genetic test, determine the likelihood that the test will be useful, discuss the test's limitations and help ensure the results are understood. Genetic counselors collaborate with a variety of specialties including pediatrics, neurology, cardiology, prenatal and cancer. Genetic counselors work with doctors and other members of the health care team to help patients understand what their family history means to them, decide what genetic tests to have, and know how to use the test results to make the best treatment choices. ROLE OF GENETIC COUNSELORS Provide genetic information to clients. It is their counselling skills, including their ability to empathically connect with their patients that leads the demands for their skills. Uses non-directive counseling method to provide the best service to those who need them To develop a mutual relationship with the client, to understand her or him, to relieve any psychological distress, promote a sense of control, and help find solution to specific problems. Assess the client's strengths, values and needs; provide an individualization and flexible counseling style to suite each client's need and agenda; develop an awareness of self; and attend to their own inner life. The counselor tends to give advice, make decision, be coercive, persuasive, influencing, directing and controlling. The counselor communicates, enables, explores, encourages, informs, offers choices, discusses, promote autonomy, is empathic, non-judgmental, and respectful of the client. Sharing family stories can do more than bring relatives closer together. When the stories are about health, they can help family members make the right medical decisions. Genetic counselors play a key role in helping patients and their families get the care that's right for them. Genetic counselors work with doctors and other members of the health care team to help patients understand what their family history means to them, decide what genetic tests to have, and know how to use the test results to make the best treatment choices. This is especially helpful today as medicine becomes more personalized, and treatment plans increasingly are tailored to a patient's individual needs. **Genetic counselling ethics** - Respect the right of individual - Non- directive approach - Keep privacy of individual and family - Maintain the communication between counsellor and his client Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient's family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient's community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term (Ethics in genetic counselling: Angus J. Clarke corresponding and Carina Wallgren-Petterson \[2019\]). **Genetic screening** A search in apparently normal population for individual with abnormal genes which increase their risk or their offspring of being affected by a disease. Genetic testing is not a simple blood test. There are many considerations that arise with every family. A complete cardiogenetic evaluation is required, which includes a thorough cardiac investigation and a clear diagnosis in the proband, the need for genetic counseling to ensure that the family understands the possible outcomes of genetic testing, and taking a detailed family history to get a sense of disease penetrance and patterns of disease (). The cornerstone of the utility of genetic testing is accurately defining the clinical phenotype both in the individual patient and the family. The highest yields from genetic testing are often based on patient cohorts with confirmed disease. For example, in clinical hyperthropic cardiomyopathy (HCM), careful attention to the family history, clinical symptoms, and defining the extent, distribution, and severity of hypertrophy are all considered essential in clinically distinguishing HCM from other HCM mimickers (or phenocopies), such as Fabry disease or glycogen storage diseases, which have different genetic etiologies. **Types of genetic screening** 1\. Carrier identification 2\. Prenatal diagnosis 3\. Newborn screening 4\. Forensic screening (paternity test) **References:** Knoema. (2019, August 28). Philippines age of childbearing, 1950-2023. Knoema. https://knoema.com/atlas/Philippines/topics/Demographics/Fertility/Age-of-childbearing Philippine Statistics Authority. (2024, January 5). Vital statistics. Republic of the Philippines. https://psa.gov.ph/statistics/vital-statistics UNICEF. (2023, November 14). Maternal mortality rates and statistics - UNICEF DATA. UNICEF DATA. https://data.unicef.org/topic/maternal-health/maternal-mortality/ UNICEF. (2024, March). Neonatal mortality - UNICEF DATA. UNICEF DATA. https://data.unicef.org/topic/child-survival/neonatal-mortality/ United Nations. (2020). Ten key messages for the World Fertility and Family Planning 2020 highlights. https://www.un.org/en/development/desa/population/publications/pdf/family/Ten\_key\_messages%20for%20WFFP2020\_highlights.pdf United Nations Population Fund. (n.d.). World population dashboard. United Nations Population Fund. https://www.unfpa.org/data/world-population-dashboard United Nations Population Fund. (n.d.). World population dashboard: Philippines. https://www.unfpa.org/data/world-population/PH Worldometers. (n.d.). World population. Worldometers. https://www.worldometers.info/world-population/