The goal of this two-year proposal for $180,000 is to develop a birth defect monitoring network for eventual expansion in China. China is undergoing rapid changes, including environmental and other health threats, that can be monitored by the type and frequency of birth defects.The project proposes a framework classifying 45 different kinds of common birth defects and proposes to monitor them in pilot areas -- 10 districts in each of three provinces – Beijing, Guangdong, and Zhejiang provinces. The goal ultimately is to expand this monitoring network over all of China. The project will consist of a top level policy committee; a middle level of PUMC, Zhejiang University, and Zhongshan University expert groups responsible for confirming every case with birth defect; and an operating level of primary birth-care service providers in pilot areas which include community hospitals or village clinics. It is hoped that this national system will begin the necessary process of surveillance in birth defects in China, a country undergoing rapid health change.