The public health versus clinical approaches to maternity services: the emperor has no clothes

Abstract

This paper explores the conflict between practice based on science, or based on peers, and between the recommendations of public health agencies and the recommendations of organizations of clinicians, with specific reference to maternity services. The WHO European Regional Office, as a public health agency, has been bringing to the attention of the public and of governments two serious problems brought about by the present hegemony of the clinical approach: (1) The reliance on standards of practice rather than scientific evidence, and (2) Having doctors decide health policy, leading to the failure to honour the self-determination of the individual and family and basic human reproductive rights.