The "One Percent Doctrine" Undermines Reproductive Health and Politics

By Christine Cupaiuolo — August 7, 2007

The rate of caesarean sections is rising rapidly because of a new culture of fear and expediency in healthcare.

Eugene Declercq, professor of maternal and child health at the Boston University School of Public Health, and Judy Norsigian, executive director of OBOS, argue in a Boston Globe op-ed that “births are increasingly treated as potential emergencies requiring expensive, high-tech interventions.”

Yet treating birth as a medical emergency has medical and economic consequences. Declercq and Norsigian see compelling parallels between the justifications for more caesareans — the rate of which increased from 20 percent in 1996 to a record high of more than 30 percent in 2005 — and the skewed priorities of the Bush administration’s war of terrorism.

Vice President Dick Cheney has justified the extreme policies of the war on terrorism based on a “One Percent Doctrine” — Ron Suskind’s term for Cheney’s “principle that if there’s even a 1 percent chance of a terrorist attack, we must prepare as if it were a certainty.” In a similar manner, doctors are beginning to advocate for caesareans based on the even remoter chance of potential disaster — even going so far as to hail “the benefits of a 100 percent caesarean rate (you read that right) in avoiding these outcomes in 3 in 10,000 cases.”

Likewise, a 2006 position statement from the American College of Obstetricians and Gynecologists states that “Labor and delivery is a physiologic process that most women experience without complications,” but then goes on to emphasize the 1 percent doctrine: “… serious intrapartum complications may arise with little or no warning, even in low risk pregnancies.” The statement and the doctor’s claim are true, of course — anything can occur — but does that mean that society benefits when every birth is handled as a disaster (or worse yet a lawsuit) waiting to happen?

No one wishes a health problem on any mother or child, but the “1 percent” advocates of higher caesarean section rates assert they care more about infant outcomes than those who oppose them. However, the consequences of universal caesarean sections on a largely healthy population are profound in both the short run (longer recovery, greater postpartum pain, higher maternal rehospitalization rates for surgical complications, higher costs) and long run (higher rates of subsequent stillbirths, greater risk of future uterine rupture, longer stays requiring more hospital space). The 1 percent doctrine cares little about such consequences since its focus is on winning the current argument.

And that doctrine only does damage — in politics and healthcare.

One response to “The “One Percent Doctrine” Undermines Reproductive Health and Politics”

  1. What a great op-ed. Cheney’s “doctrine” is a perfect metaphor for a serious problem that is pervasive throughout the American health care system.

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