Dear Dr. Marleen Temmerman;
I have a lot of respect for your organization and the work that it does to advance health outcomes, particularly in the regions that profoundly suffer due to a lack of resources that are commonly taken for granted in countries with advanced economies and an abundance of resources. The risks and benefits of individual choices in those countries that struggle with a lack of resources are vastly different from the risks and benefits of choices in countries with an abundance of resources. This is particularly true when it comes to both breastfeeding and childbirth.
The WHO is absolutely correct to promote breastfeeding in countries where the lack of access to clean water and refrigeration and the costs of formula means that young children will pay a dear price for formula use that is not necessary. Similarly, promoting caesareans in countries that lack access to antibiotics, reliable power, and an absolute shortage of resources for healthcare – would be irresponsible and would cause suffering to both women and children in those countries.
However, applying the same logic to women in very different circumstances (women in resource rich countries) – does those women an incredible disservice, and indeed may harm their health and well-being and that of their children. Those women are making very different choices with respect to both infant feeding and childbirth. Those women face a different set of risks and benefits – for a myriad of economic and social reasons. Telling those women that they should make the same choices as their counter-parts in third world countries is as sensible as combating world hunger by demanding children in first world countries “clean their plates”. It causes a whole other set of problems while doing nothing for those who suffer with malnutrition in resource scarce countries.
That is what the WHO has done with its latest statement on caesarean sections. It has effectively told women and healthcare providers in resource rich countries that they should focus on avoiding caesarean sections because caesarean sections are risky in resource scarce countries.
In doing so it has lost sight of the ultimate objective: the best health outcomes possible for all women and their babies and has substituted it with an ideologically driven objective – vaginal births whenever possible regardless of the impact on women and their babies. It has breathed life back into a statistic that has been used to deny access to caesareans by those who choose them – by deeming the need to bring down the caesarean rate in all countries as some kind of laudable goal when it is not.
Worse, it harms the health and well-being of women and their babies by depriving them of accurate information with respect to the choices they must make and supporting them in their rights to make those choices. It fans the flames of misogyny and denies women their basic rights: the right to informed consent (or refusal), the right to make medical decisions, and, the right to timely access to quality care.
Do you think that being told, “you cannot choose what is done to your body” does not have negative impacts on the health and well-being of women? Does the mental health of women not matter? How can their suffering be justified?
Let me be frank with you Dr. Temmerman – the rights of women and the health and well-being of women cannot be advanced in one part of the world by harming the rights of women and the health and well-being of women in another part of the world. The disparities and realities of women in different parts of the world are not ameliorated by pretending that one size fits all policy solves the problem. The focus needs to be on supporting rights and working towards the best outcomes in the context in which women live – and improving that context where it needs to be improved.
There is much work to be done, Dr. Temmerman – and fanning the flames of misogyny in resource rich countries will not do anything to ameliorate the plight of those in resource scarce countries. So rather than making global pronouncements on caesareans, why not reconnect with the purpose of the WHO and focus efforts on the myriad of ways the health and well-being of women in resource scarce countries can be improved? Why not work to highlight how great the disparities in health outcomes are and how different the context in which women make choices are, and then work to ameliorate those? Why not focus on what matters, instead of wasting time on the things that really do not matter?