{"id":2794,"date":"2014-07-10T08:55:10","date_gmt":"2014-07-10T07:55:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2794"},"modified":"2014-07-10T13:32:48","modified_gmt":"2014-07-10T12:32:48","slug":"are-figos-regulations-risking-the-lives-of-pregnant-women","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/07\/10\/are-figos-regulations-risking-the-lives-of-pregnant-women\/","title":{"rendered":"Are FIGO\u2019s Regulations Risking the Lives of Pregnant Women?"},"content":{"rendered":"<p><strong>Guest post by\u00a0Douwe Verkuyl<\/strong><\/p>\n<p>The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women\u2019s Health believes that there is <em>never<\/em> an indication for a tubal occlusion (TO) to be performed at the time of caesarean section or following a vaginal delivery in cases where this sterilisation has not been discussed with the woman in an earlier phase of her pregnancy. \u00a0This applies even if there is a uterus rupture.<\/p>\n<p>But what if a mother of 5 children, living in rural Africa near a Catholic clinic, unexpectedly needs referral to a government hospital because of arrested labour, and faces a journey of at least 4 hours over a dirt road? \u00a0Does the Committee\u2019s recommendation against belated TO counselling still apply if referring establishments have deliberately ignored its advice to counsel pregnant women early in pregnancy about the option of a concurrent sterilisation in the event that a caesarean section is needed? \u00a0Catholic institutions \u2013 which are often the only health facility for miles around \u2013 not only ignore this advice, but also fail to assist a woman with \u201csinful\u201d modern contraception after she has returned with a scarred uterus. \u00a0In many Western, developed countries, Catholic contraception doctrines are mostly inconvenient, guilt-provoking and expensive. \u00a0In rural Africa, Latin America and the Philippines, they often kill.<\/p>\n<p>Imagine a 37-year-old woman in labour in a well-equipped and staffed Doctors Without Borders (DWB) emergency hospital which happened to be located near her home. \u00a0She has previously given birth, with some difficulty, six times at home, and now there is a full civil war. \u00a0The doctors detect foetal distress. \u00a0They think there might be a 10%-30% chance her child will be damaged or die before it is born. \u00a0On the other hand, with the uncertain political situation \u2013 consider that on 17 June <span style=\"text-decoration: underline;color: #0000ff\"><a href=\"http:\/\/www.msf.org\/article\/msf-hospital-bombed-sudan\"><span style=\"color: #0000ff;text-decoration: underline\">a DWB hospital was bombed in Sudan<\/span><\/a><\/span> \u2013 and poor infrastructure, it might be the case that her chance of dying from a uterine scar during a subsequent labour is around 30%, and the probability that she has continuous access to reliable reversible contraception for the next 13 years is zero. \u00a0If she would choose to have a TO with a caesarean section that would solve the quandary. \u00a0Is it really unethical to ask her, or unethical not to give her that choice?<\/p>\n<p><em>Read the full paper in the latest edition of the <\/em>JME<em>\u00a0<span style=\"text-decoration: underline;color: #0000ff\"><a href=\"http:\/\/jme.bmj.com\/content\/early\/2014\/07\/09\/medethics-2013-101827.short\"><span style=\"color: #0000ff;text-decoration: underline\">here<\/span><\/a><\/span>.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest post by\u00a0Douwe Verkuyl The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women\u2019s Health believes that there is never an indication for a tubal occlusion (TO) to be performed at the time of caesarean section or following a vaginal delivery in cases where this sterilisation has [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/07\/10\/are-figos-regulations-risking-the-lives-of-pregnant-women\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2153,443,591,2022],"tags":[304],"class_list":["post-2794","post","type-post","status-publish","format-standard","hentry","category-guest-post","category-jme","category-life-and-death","category-reproduction","tag-public-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Are FIGO\u2019s Regulations Risking the Lives of Pregnant Women? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/07\/10\/are-figos-regulations-risking-the-lives-of-pregnant-women\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Are FIGO\u2019s Regulations Risking the Lives of Pregnant Women? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest post by\u00a0Douwe Verkuyl The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women\u2019s Health believes that there is never an indication for a tubal occlusion (TO) to be performed at the time of caesarean section or following a vaginal delivery in cases where this sterilisation has [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/07\/10\/are-figos-regulations-risking-the-lives-of-pregnant-women\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2014-07-10T07:55:10+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2014-07-10T12:32:48+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Are FIGO\u2019s Regulations Risking the Lives of Pregnant Women?\",\"datePublished\":\"2014-07-10T07:55:10+00:00\",\"dateModified\":\"2014-07-10T12:32:48+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/\"},\"wordCount\":404,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"keywords\":[\"Public Health\"],\"articleSection\":[\"Guest Post\",\"JME\",\"Life and Death\",\"Reproduction\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2014\\\/07\\\/10\\\/are-figos-regulations-risking-the-lives-of-pregnant-women\\\/\",\"name\":\"Are FIGO\u2019s Regulations Risking the Lives of Pregnant Women? 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