March 2006


Poorly she may be, but stupid she aint!

She can’t walk or talk or any of those unnecessary things, but this morning my snotty, dribblesome baby did something much better. She knelt up in bed, crawled over to the bedside table, found herself a handkerchief and then thoroughly wiped her own face….

Now, all she needs to learn is (a) it’s best to start with a clean hanky and (b) the object is to clean your face, not move the gunk around and (c) when you’ve finished, mummy’s cooing expressions of how-clever-you-are delight will quickly turn to horror if you then use the same hanky to “clean” the pillow. Yes, you, don’t look so pleased with yourself. Drat, she’s too cute.

Stumbling around the internet today in the wake of the news from South Dakota, I found this: The Only Moral Abortion is My Abortion.

We all know that in the USA abortion causes virulent and often even violent moral and political conflict, far more so than here where we are often bemused by all the fuss. I had a college friend who worked as a volunteer helping women get through picket lines at abortion clinics. This article gives us a little insight into the mentality of some of those picketers. If it were not so achingly, outrageously horrible, the hypocrisy might even be laughable.

Meanwhile, on this general subject… my post the other day on the gender pay gap report has been bugging me. I rather made light of the need to address genuine workplace and work-related injustices and prejudicial stereotypes that disadvantage women. (Although it is hard, in fairness, to take these pay-gap reports seriously when they come out so often and are so rarely acted upon.)

What I aimed to suggest was that we have unhealthy ideas about work – including our ideas about choice, equality and success – which have their root, perhaps, in one of our government’s typically disingenuous attempts to tell its citizens what they want and need.

It dovetails nicely with a post about choice and hypocrisy, so here are some expanded thoughts.

For each individual, our best interest is served – one would think – if we work less and spend more time doing stuff we enjoy. Isn’t it? Yet I am frequently struck by the difficulty of holding, let alone expressing, that view. Our very concepts of “success” and “choice” in the workplace presuppse that in fact what we want is not less work, but more. We are successful if we earn a good wage, even if that means working every hour that God sends. The more we work, the more we earn, the more we call it “success”. And we think we have choice if we can choose between a range of different job options, even if there is no option to not work, or to work less. We think we have equality if we do the same as men, even if that means that everyone ends up overworked.

Who gave us these ideas? Was it, by any chance, the people who want us to get out and work?

It is the government that wants us all to work and be “productive”. (It’s the economy, stupid.) By working we can contribute to the GDP, or whatever else it is that economists say we all need.

That is why we end up giving work – and lots of it, hard work for preference – such elevated status, to the point where we actually believe that only earning money can make us valuable and justify our existence. (Arbeit macht frei, dunnit?) And that is why the government wants to promote “equality” for working women. It is why there is no suggestion that what is wrong with the current situation might include anyone working too hard. It is also the real motivation behind their desire to get children into childcare in ever greater numbers and at ever earlier ages – so that both parents can get to work and contribute to the precious national economy.

Don’t get me wrong: I have nothing against women working, or having the freedom and equality to choose and be successful in any career. The provision of good quality, affordable childcare helps those women who do want to “have it all”. Good for them. And thank you, world, for making “it all” possible for me – as a single working parent, boy, do I need that having-it-all stuff.

But, make no mistake, giving women the “choice” to go out and succeed at work is at best a double edged sword. It sounds like what we want but, in reality, it ends up merely substituting one kind of non-choice for another. Instead of being expected to stay at home, women are now expected, and indeed often more or less compelled, to go out to work full time. There was a time when a family could live and was expected to live on a single income without any great hardship. These days, most families need a double income just to pay the bills.

Compulsion is one thing. But is compulsion dressed as choice any better?

Unlike mumps and rubella, measles is a major cause of childhood deaths worldwide and is the subjct of a global vaccination campaign strongly backed by the WHO.

According to the WHO:

Measles remains a leading cause of death among young children… More than half a million people, the majority of them children, died from measles in 2003 (the last year for which figures are available)… Measles is one of the most contagious diseases known. Almost all non-immune children contract measles if exposed to the virus.”

However, although measles can be a killer in any country, it is worth exploring the real risks for a healthy, well-nourished child living in a developed country like the United Kingdom.

Measles is unpleasant but does not normally cause serious or permanent complications. Severe cases are most likely in malnourished children, especially those who are Vitamin A deficient, or children whose immune systems are already compromised, such as by HIV. Where death occurs, it is usually caused by complications such as pneumonia, serious diarrhoea, ear infections and the like – all conditions that are easily treatable in a modern healthcare system. As the WHO reports: “Severe complications from measles can be avoided through proper clinical management.”

The WHO reports that: “The case fatality rate in developing countries is generally in the range of 1 to 5%, but may be as high as 25% in populations with high levels of malnutrition and poor access to health care.”

No figures are given for well-nourished, healthy children in developed countries with good access to healthcare, but it is safe to assume that the case fatality rate is significantly less than the 1 to 5% reported in developing countries. I do not know when the last measles death occurred in the United Kingdom, but certainly such deaths are very rare today.

According to the NHS MMR website death occurs in about 1 in 2,500-5,000 cases, although it is not stated whether this is UK-specific or not. Complications requiring hospitalisation are said to occur in about 1% of cases.

It is also worth noting that measles is in fact a very uncommon illness in the UK. This is largely because of high vaccine coverage. The incidence of measles may have been falling before introduction of the vaccines, but vaccination does appear to have made a dramatic difference nonetheless.

It could be argued that, given the low incidence and low risk of the disease in the UK, it is not worth immunising against it. Moreover, given that the risk from the disease itself appears to be very low, the risk of vaccination side effects might even be higher.

Against that, the NHS makes two counter-arguments.

Firstly, measles is highly contagious. As a result, if vaccination levels were to drop it is possible and perhaps even likely that the incidence of measles would rocket. As the WHO reported (see above), almost all non-immune children exposed to the virus would catch the disease. It is therefore said to be wise to maintain high levels of immunisation even in the UK.

Secondly, the NHS points out that although measles is rare in the UK it is very common in other parts of the world. As such non-immune people would still be at risk of catching measles either while travelling abroad or while mixing with other people who have come from or been to a country where measles is common.

So, measles is not a particularly serious illness in the UK, although in a few cases it can cause complications. However there is, arguably at least, good reason to consider immunisation even in this country. The decision must rest on a careful consideration of the risks of measles against the risks of vaccination. In developing countries, it is clear that the balance of risk must favour vaccination. The decision is in my view less clear in a developed country, where good nutrition and good healthcare facilities mean that the measles is unlikely to cause any serious complications.

The WHO recommends use of the mumps vaccine primarily on economic grounds:

High-quality mumps vaccines generally confer substantial protection and will reduce the costs associated with patient care and lost working days due to mumps. WHO therefore recommends the use of such vaccines in all countries with well-functioning childhood vaccination programmes, provided that sustained high-level coverage is afforded and that reduction of mumps is a public health priority.”

and:

In view of the moderate morbidity and the low mortality of this disease, its socioeconomic impact is essential when deciding on the priority of mumps vaccination in national immunization programmes. Assessment of that impact requires careful evaluation of disease burden and costs associated with purchase of the vaccine and vaccination, including the economic impact of possible adverse effects.”

The WHO also states that mumps vaccine should only be considered in countries that already have measles and rubella vaccination strategies, since those illness are considered to be a higher priority. It is recommended that “National decisions to implement large-scale mumps immunization should be based on careful cost-benefit analyses, including the comparative analysis of mumps control versus the control of other vaccine-preventable diseases in the countries concerned.”

So it is clear that mumps vaccination is low priority. Mumps vaccination is portrayed by the WHO as a “nice-to-have”, an add-on to existing vaccination programmes. If you are doing measles and rubella, you might as well add mumps and call it MMR… because then parents will need to take fewer days off work to care for their sick children and so the economy will benefit.

The mumps vaccine is considered very safe. It does have a number of side effects, notably meningitis and parotitis (i.e. mumps). These are not thought to cause any long term damage.

However, it is acknowledged that mumps itself is generally a very mild illness which only rarely causes serious complications in childhood cases. It causes complications more frequently when it occurs in adults. Given this, it is worth noting that the immunity provided by mumps vaccines appears to wane. The WHO warns that mumps vacciantion campaigns can, particularly if coverage is less than about 80%, cause an “unfortunate” shift so that although overall mumps cases may reduce there is a greater incidence in adolescents and adults, who are more likely to suffer complications.

In short, there does not appear to be any real medical need for a vaccination against mumps – only a potential economic benefit in reducing the incidence of the disease. My own conclusion on the mumps vaccine must be similar, then, to my conclusion on rubella vaccines. Only more so…

The WHOrecommends the use of rubella vaccine in all countries with well-functioning childhood immunization programmes where reduction or elimination of CRS is considered a public health priority.

According to the WHO, “the primary purpose of rubella vaccination is to prevent the occurrence of congenital rubella infection including CRS, which is an important cause of deafness, blindness and mental retardation.”

Rubella itself is a mild and generally harmless illness. The trouble arises when a woman in the early weeks of pregnancy catches the disease and puts her baby at risk of birth defects or even death. Rubella (CRS) is a condition affecting around 90% of babies of mothers who contracted rubella in early pregnancy. The rates of CRS are not, however, numerically very high and especially not in countries such as the United Kingdom.

What is the real risk of giving a pregnant woman rubella if you fail to vaccinate your child?

This is important because it is a moral reason frequently cited by those who argue in favour of vaccination. They say that it is incumbent on all of us to protect unborn children by vaccinating the population at large. However, it appears from the WHO information that a foetus will in fact be almost completely protected from rubella if its mother has immunity.

The WHO says:

Natural rubella infection normally confers lifelong immunity. There have been rare cases of serologically documented re-infections either after earlier natural infection or after vaccination. Re-infection in pregnancy resulting in CRS has occasionally been reported in women with natural or vaccine-induced immunity, but the risk to the fetus is low.”

So the only babies having a material risk of CRS are those whose mothers have chosen not to be vaccinated and have no natural immunity: and even then the risks are relatively low because of the low incidence of rubella in this country. So where is the moral imperative on parents to vaccinate to protect these unborn children? The mothers can give protection, simply by ensuring that they have themselves been vaccinated.

What if the child catches rubella herself when older? Shouldn’t she be immunised now to avoid that risk? Well, no. There is absolutely no reason why she could not be immunised at a later date – when she is considering pregnancy or, at least, is old enough to make up her own mind.

The WHO itself recognises that in order to prevent CRS a strategy of immunsing adolescent girls or women of childbearing age is perfectly adequate.

I believe that it follows from the points made above that there is no real moral or medical case for immunising babies against rubella. The vaccination is thought to be very safe, which is perhaps why it is universally given as part of the MMR vaccine. That does not make it necessary.

The nominations were:

  • People Who Don’t Know They’re Dead: How They Attach Themselves to Unsuspecting Bystanders and What to Do About It, by Gary Leon Hill
  • Bullying and Sexual Harassment: A Practical Handbook, by Tina Stephens and Jane Hallas
  • Rhino Horn Stockpile Management: Minimum Standards and Best Practices from East and Southern Africa, by Simon Milledge
  • Ancient Starch Research, by Robin Torrence and Huw J Barton
  • Soil Nailing: Best Practice Guidance, by A Phear
  • Nessus, Snort and Ethereal Powertools

And the winner is….

People Who Don’t Know They’re Dead: How They Attach Themselves to Unsuspecting Bystanders and What to Do About It

Whilst furgling about on the internet I found the following relevant parliamentary questions and answers in Hansard.3 November 2005

Breast-feeding

26. Mrs. Hodgson: To ask the Minister for Women and Equality what steps the Government are taking to encourage acceptance of breastfeeding in public places. [24360]

Meg Munn: The Government are committed to the promotion of breastfeeding. We are examining women’s experiences of feeding in public places through the National Infant Feeding Survey 2005, to inform our thinking in this area.

Through the annual National Breastfeeding Awareness Week, the Department of Health encourages breastfeeding in public places.

19 January 2006

Breastfeeding

25. Jo Swinson: To ask the Minister for Women and Equality if she will make a statement on Government policy on breastfeeding in public places. [43252]

Meg Munn: Breastfeeding is the best form of nutrition for infants and we are aware of the important contribution it can make to the health of mothers and infants. The Government are collecting data through the National Infant Feeding Survey 2005 on women’s experiences of breastfeeding in public.

(Meg Munn is Junior minister for women and equality.)

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