Intended for healthcare professionals

Rapid response to:

Dr Foster's Case Notes

Social class and elective caesareans in the English NHS

BMJ 2004; 328 doi: (Published 10 June 2004) Cite this as: BMJ 2004;328:1399

Rapid Response:

Adherence to standards required to prevent misuse of statistics.


We are most concerned about the harm that may be done following
publication of ‘Dr Foster's case notes: social class and elective
caesareans in the English NHS’1 which for some inexplicable reason seems
to have by-passed the peer review process.

The National Statistics Code of Practice requires that official
statisticians work to a set of principles and standards in order to ensure
that statistics are relevant, of high quality and maintain the trust of
the public. This piece of work, despite having been funded by the
Department of Health and published by the BMJ, falls seriously short of
these standards. The misuse of the term ‘elective caesarean’, as if it is
synonymous with ‘caesarean for maternal request’, will add to the
confusion and misinformation disseminated by newspapers and television.
The quality of the analysis has been challenged as incomplete and
potentially leading to false conclusions. And the strategy of using a
provocative but patronizing ‘sound bite’ smacks of self promotion rather
than a measured contribution to knowledge.

Statisticians at the Department of Health have worked with The
National Childbirth Trust, UK’s largest organisation for new parents, and
with BirthChoiceUK whose website disseminates information that matters to
women, including caesarean and normal birth rates for individual maternity
units. Five years ago the NCT set up the multi-disciplinary Maternity Care
Working Party to raise awareness of the causes and effects of caesarean
section, and there is now and active all-party parliamentary group for

In contrast Dr Foster seem to be working in isolation and not
checking their analysis and conclusions prior to publication. At the very
least, serious misunderstandings are perpetuated by this article. This
leads us to conclude that the Statistics Commission are right to call for
legislation to require government departments and agencies to follow the
code of practice as a statutory requirement. Those who use government
statistics should adhere to the same standards, especially if they receive
government funding.

Yours sincerely

Mary Newburn
Head of Policy Research
The National Childbirth Trust
Oldham Terrace, London W3 6NH
Reference List

1 Jarman B, Aylin P, Bottle A. Dr Foster's case notes: social class
and elective caesareans in the English NHS. BMJ 2004;328(7453):1399.

Competing interests:
None declared

Competing interests: No competing interests

24 June 2004
Mary S Newburn
Head of Policy Research
The National Childbirth Trust, Oldham terrace, London W3 6NH