Artificially maintained scientific controversies, the construction of maternal choice and caesarean section rates

Abstract

Caesarean section rates are continuing to rise in many countries. This is despite mounting evidence that unnecessarily high rates are associated with adverse health outcomes for mothers and their offspring and create a significant economic burden on health systems. This article draws on Bruno Latour's account of the ‘artificially maintained scientific controversy’ to explore how professional bodies have managed to resist calls for reform by casting doubt on this evidence. Having undermined the evidence in question, these bodies insist that deference must be paid to maternal choice. However, choice is never problematised and the focus on maternal choice is used as a way of maintaining current practice. Science and technology studies has made us accustomed to being on our guard against unfounded claims to scientific certainty. This article demonstrates that we must also be wary of the opposite phenomenon, namely, of doubt being cast on a credible body of scientific evidence so as to justify inertia. When a narrative of scientific uncertainty is tied to fine sounding but ultimately spurious calls to respect patient autonomy, those with a vested interest in preserving the status quo are armed with a potent device with which to block demands for change.