Monday, 22 April 2013

Evidence - Part 1, The WHO Says It's True

In my recent C-section related posts I've been moaning a lot about the lack of references and evidence for a lot of the claims that people make. It annoys me, a lot. But what really winds me up is self appointed "experts" who link to "scientific proof" that's nothing of the sort.

Pregnancy, birth and parenting advice often has very little genuine scientific evidence behind it. Given that it has all been going on for quite a while now, this came as a bit of a surprise to me when I first became pregnant. I then found out that all too often the gaps in genuine scientific understanding are plugged up with hunches, pseudoscience and outright woo. It can be very difficult to determine what has real evidence behind it, lots of "experts" claim that their techniques are "scientifically proven" or "evidence based" but that proof can be rather shakey.

In this series of blog posts I will pick up on a few of the common examples of claims that sound nice and sciencey but don't really offer the definitive proof that they claim. That doesn't necessarily mean that the practises advocated are wrong, just that more evidence is needed for the sort of authoritative claims made. If "experts" and organisations are going to declare that they have the weight of science behind them, then I believe their evidence should be genuine, high quality and open to scrutiny.

So here is my first example of evidence that isn't:

1- A respected organisation says it's true so it must be:

Well, not always. If you want to quote a well known and respected organisation to back up any claims then WHO better than the World Health Organisation (can you see what I did there?). It seems entirely reasonable to assume that any advice they give out is based on good solid evidence but unfortunately it's not as simple as that. There are two bits of WHO policy that I see quoted a lot in parenting world:

First up: "The WHO recommends that caesarean section should account for no more the 10-15% of births".

The current UK C-section rate is about 24% so you can see why the WHO figure is widely quoted by advocates of natural birth and others who want to see a reduction in the caesarean rate. However, this recommendation is nearly 30 years old (issued in 1985). In the world of medical research that's ancient history. A lot has changed in that time, surgery has improved greatly so whatever evidence the statement was based on would be entirely out of date in 2013. Worse still, the figure wasn't actually based on any evidence anyway. The WHO acknowledged this and dropped the recommendation in 2010. It now says that "what matters most is that all women who need Caesarean sections receive them"Unfortunately the 10-15% figure is still widely quoted. I'm not saying that a 24% C-section rate is optimal,  I'm not actually convinced that targets are a good idea at all,  but if we must have them they need to be based on accurate, current information.

Secondly: The WHO says "
exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond." This bit of information is current, it's based on the best available evidence and it makes perfect sense. At least it does if you live in a part of the world where food is scare, water is contaminated and anything you give your child other than free, clean and nutritious breast milk, could potentially kill them. 

Back in the wealthy world it's a bit more complicated. There is very little evidence of specific health benefits for breastfeeding longer than four to six months, the studies just haven't been done*.  Of course there is absolutely no reason why a western mother shouldn't breastfeed for two years or more, so long as it's her choice and works for her and the child. But the vast majority can't or don't. Even for those who manage the six months, returning to work, having another child or just wanting your body back might bring about the decision to stop and it's highly unlikely that this will be massively detrimental to the child. So claiming that it's harmful in order to pressurise those who don't want to continue** is surely every bit as unfair as throwing freak comments at those who do?

Moral of the story? - These are just examples, if anyone (even someone important sounding) is advising you to do something that just doesn't work for you, don't panic - question their claims, are they up to date? Do they really apply to you? Or is someone being selective to fit their own agenda? 

 Next time - It's More Natural - So It Must Be Better
(Don't worry, I'll have cute pictures of the kids in between!)


*For more information on this and many other bits of pregnancy woo, get hold of the excellent Bumpology by Linda Geddes

**I can't actually find the quote given in this blog in the document it links to, the nearest was this quote in Appendix 1:  Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year. Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired

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