Today’s fabricated panic: “Delayed” birth interventions causing childhood obesity?


The ABC News is quoting economist Andrew Leigh as saying that the “delayed” interventions around baby bonus time is causing fatter children.

A Canberra economist says an increase in the baby bonus could lead to unhealthier children.

Research by the Australian National University’s (ANU) Andrew Leigh and a colleague suggests the introduction of the baby bonus in 2004 led to more children being born overweight, because their deliveries were deliberately delayed to obtain the bonus.

Dr Leigh says a planned increase in the baby bonus from July 1 this year could produce a similar outcome.

“I think people are very familiar with the fact that premature and very light babies tend to have worse health outcomes,” he said. “But it’s actually also the case that very heavy babies also have worse health outcomes. Undercooking is bad and overcooking is bad too.”

Since we know that most C sections and inductions performed in Australia aren’t medically necessary, the contention that there were any adverse health outcomes from the “delayed” (hrm) interventions around baby bonus cutoff times is a remarkable claim. I have seen zero medical evidence that there were any adverse outcomes. None, zip, nada. Since there was plenty of scareloring before the cutoff date, it was interesting to see that the issue sank like a stone afterwards. Could there have been no effect from the backing off on interventions? Could there, perhaps, have been a little improvement, with less iatrogenic prematurity, fewer failed inductions, fewer unnecessary operations? We don’t know. No-one seems to have looked, or if they have, they haven’t published anywhere I read.

Not only that, but Leigh is quoted as making a very specific claim: that “overcooked” babies are fatter, that “overcooked” babies grow up into obese, unhealthy children. No evidence. None.

Leigh’s agenda is that the baby bonus be abolished. Whatever; he can argue that in economic terms as much as he likes, that’s his specialty, and it’s not what this post is about. But he isn’t making an economic argument; he is making a medical one. This requires that pesky little thing called a critical examination of the scientific evidence.

I hope he is being badly misquoted, because this is a pretty extraordinary claim to be making, and superficially it looks like one designed to get sensationalist headlines and spread serious misinformation about birth.


Addit: Yes, I have more to say. This sort of thing bothers me on other levels too: primarily, from a feminist point of view, because it rests on the assumption that women are gold-digging infants who need to be told what to do. That if there is a financial incentive to decline a medical recommendation, women everywhere will cavalierly be taking risks with their pregnancy in order to grab at the cash.

There is no examination of the incentives doctors have to intervene early and without a thorough discussion of the evidence with the woman concerned; just the assumption that each and every one of the interventions performed currently is being performed at exactly the right medical time for exactly the right medical reason, and that women declining birth interventions is OMG BAD.

There is no examination of which births were “delayed”. You know, there are still obstetricians who say that “Nothing good happens after 38 weeks”. It has taken a long and bitter struggle just to get most “routine” C sections (most of which are unnecessary, for example for twins, previous C section, well controlled gestational diabetes and so on) shifted forward to 39 weeks – a time still 3 weeks before the earliest that any informed birth attendant would consider a pregnancy to be “postmature”. Which births were shifted a few days around baby bonus time? Were they social inductions, no longer quite so wanted with the few thousand dollars looming? Elective C sections shifted from 39 weeks to 40 weeks? Inductions and sections that would otherwise have been booked just before the long weekend? Or were they women with fulminating pre-eclampsia? Hmmm? What do you think? Where is the evidence?

And certainly there is no look at any of the other issues: for example, the fact that unnecessary C section before term is more likely to lead to breastfeeding difficulties, and that breastfeeding reduces the rates of childhood and adult disease.

Seriously, postdates = obese unhealthy child? Does anyone believe this? Are even any rabidly insane control-freak obstetricians suggesting that we start forcing all births to happen by 39 weeks to prevent childhood obesity? No.


Edit 21 March 2008 to add references: The paper and various conversations around it can be found here:

Original paper, self-published

“The baby bonus and obesity” on one co-author’s blog (Joshua Gans)

Discussion on the other co-author’s blog (Andrew Leigh)

The World Today: “Call to drop baby bonus”, an interview with Andrew Leigh

Peter Martin: “Tuesday column: Axe the baby bonus”

etfb: “If Only Erudito Were Into Chicks…”

Joyous Birth: “Baby bonus leading to fatter kids: economist”


[H/T to baroquestar, who summed this up so much more succintly than I: “hilarious bollocks”.]

Categories: economics, gender & feminism, health, medicine

Tags: , , , , , ,

19 replies

  1. I found an expansion of Leigh’s argument in the Canberra Times: ”Policy pregnant with danger”. [Dum-dum-DAAAAAAH!]

    They tended to be born heavier. Whereas normally about 11 per cent of babies are born weighing an unhealthy 4kg or more, during the first week of July the proportion approached 14 per cent.
    Leigh says that’s about an extra 140 babies born unhealthily heavy as a result of Peter Costello’s baby bonus […]

    So it seems to go something like this:
    – Babies who weigh more than 4 kg at birth have a higher chance of growing up to be heavy children.
    – Heavy children are less healthy than light children.
    – Interfering to deliver early, before spontaneous labour, reduces birthweight.
    – Therefore, if we interfere early to deliver babies before they hit 4 kg, they will grow up to be be healthier children.
    – The baby bonus dissuades women from complying with this.
    Someone reality-check me on the fact that you don’t need a degree in midwifery, medicine or rocket science to drive the International Space Station through the holes in that line of reasoning?
    I’ve got that cringey feeling that I get when a sitcom character does something really, really embarrassing. I’m still hoping this is some sort of mischaracterisation of Leigh’s argument by the MSM. With the current state of health journalism being what it is, this wouldn’t be surprising.

  2. FFS…
    I have heard some crap but that is *right* up there…
    I really doubt that women are doing all the things it is said they are in order to get the baby bonus.
    And I totally think that intervention to bring babies on prior to the EDD is 99% of the time because of encouragement (or insistence) by the OB (or GP) overseeing the pregnant woman’s care.
    Bri’s last blog post..and in other news?

  3. I’ve just realised that some of you might still be catching up on just how brain-burningly ignorant the contention “But delivering potentially big babies early is good for them!” is.
    So, a few snippets of background from Pubmed, here. Please read these refs first if you’re planning to wrangle on this particular point.

  4. I’m astonished that he’s still going on and on about this.
    The potential cohort who delayed elective caesareans in order to qualify for the baby bonus is a few weeks worth of privileged middle-class women at most. It’s over and done with and no family has to choose to delay an elective caesarean birth simply to get the baby bonus anymore. This issue was pining for the fjords and has rung down the curtain and gone to join the choir invisibule.
    Also: where is his evidence that babies whose birth is forced at 38 weeks in order to get them under this “magical” 4kg limit don’t reach that weight anyway a couple of weeks later at what would have been 40 or 41 weeks gestation? What difference does it make whether those last few hundred grams are gained pre-partum or post-partum?

  5. Tigtog: I know, right? I realised late this afternoon that the reason I took so long to raise an argument against their reasoning is because… there isn’t any. It’s all hand-waving.
    Anyone who wants the original paper can get it here. The one and only piece of scientific evidence they have raised is the top half of figure 2 from this paper. It’s pretty obvious they haven’t had a medical or scientific person look it over before publication. Perhaps I should offer my services.
    I wish I had a transcript of the full interview(s) that media people have conducted with Leigh, but no such thing seems to be available.

  6. I saw this today at work and just shuddered and am so so pleased to see you tear it to shreds.
    blue milk’s last blog post..This lasted about as long as the taking of the photo

  7. Hang on… why are his 2 cents on birth-rates being “cited” as fact? He’s an economist… and last time i checked, he’s not a pediatrician or a medical doctor… unless he did some kind of Gen Ed elective or Summer school in women’s health that I wasn’t aware about! lol

  8. Hang on… why are his 2 cents on birth-rates being “cited” as fact?

    At a first approximation: Because the MSM will pounce all over any fake science that reinforces their sexist agenda like seagulls over a pack of chips. See also: Maria Cerruto.
    Lauredhel’s last blog post..Today?s fabricated panic: ?Delayed? birth interventions causing childhood obesity?

  9. Looking through his blog, there’s plenty of freakonomics style stuff there. I can’t help feeling that he’s just wanting to get into the latest economic flavour of the month, by applying economics to anything he possibly can….
    The arguemtn goes wrong from the start, where he turns a statistical likelihood into a certain outcome – your heavy baby will be a heavy child. Then he relies on the unspoken premise that being heavy necessarily means being unhealthy.
    And it’s the mothers who are at fault! Of course.
    The thing is, looking at his other work, he opposes the baby bonus. But surely he can marshall much more substantive arguments against it than this bit of misogyny disguised as concern.
    Deborah’s last blog post..Announcing The Hand Mirror

  10. OMG! I was very very overdue… several weeks overdue, and my mum figured that I’d come when I was ready. ITS HER FAULT I’M FAT! She OVERCOOKED ME!
    Oh wait. I’m not fat. Not by sane standards.
    In fact, I was a very slight child, skinny and in the pink of health until I was about 14.
    Guess overcooking didn’t do me any harm afterall.
    RhianWren’s last blog post..Feel the burn?

  11. RhianWren, I know. According to Leigh’s hypothesis it doesn’t seem to be possible that my mum has ended up as a fat grandma (her own description) when she was born woefully underweight at 28 weeks gestation.

  12. Yeah, when I heard this it struck me not so much as an economic or medical issue as a gender one. It’s rooted in the on-going belief that any choice mothers make is at best suspect and most likely selfish, and it’s the cousin of the claim that teenage girls had lots of fatherless babies for the cash payout. That’s right babies = plasma screen telly for women everywhere. Gawd.
    I find this kind of thing particularly annoying because it implies it is a choice irresponsible, cash hungry women make, when time and again we read of the disempowerment many women face as they move through the medical indutrial complex. We choose c-sections too early to keep our figures, too late so we can get our money – this timing is very tricky thing.
    Kris’s last blog post..Slide night :: Fashion rules are for wimps

  13. Clearly the only sane and healthy thing to do now is to force all pregnant women to take up smoking, which has been proven to reduce birth weight, thus restoring to the nation it’s pre-baby-bonus population of happy healthy skinny children.

  14. Bri:

    And I totally think that intervention to bring babies on prior to the EDD is 99% of the time because of encouragement (or insistence) by the OB (or GP) overseeing the pregnant woman’s care.

    Much intervention to bring babies on _after_ the EDD is by OB insistence, also. The EDD isn’t an “arrive by” date, it’s the arbitrary middle of a range of normal birthdates, which extend at least two weeks past EDD. On the best evidence we have right now, an average first pregnancy, left be, will go around 41 weeks.

  15. Clearly the only sane and healthy thing to do now is to force all pregnant women to take up smoking, which has been proven to reduce birth weight, thus restoring to the nation it’s pre-baby-bonus population of happy healthy skinny children.

    And diets! We must put pregnant women on fat-loss diets! That’s been shown to reduce birthweight (with a minor pesky increase in bad outcomes, but – but – skinnier babies whee!)
    …oh wait. We’re already doing that.

  16. Diets, smoking and alcoholism! The only way to have a healthy baby.

  17. Hang on a minute: someone is saying that an 8 – 9lb baby is “overweight”? Over *whose* weight?
    I’m suffering a massive disconnect here, because firstly, I’m just old enough that I remember hearing a lot about baby birthweights in pounds, rather than kilos (and thus I tend to think in terms of pounds for birthweights), and secondly because I can remember reading through my mother’s midwifery textbooks (which were, admittedly, produced back in the 1940s in Britain) and seeing 8 – 9lb recommended as a “healthy” weight. 10lb (about 5kg) was getting a bit much, though.
    The whole “have to be thin” thing is getting entirely too daft for words. Babies are *supposed* to have adipose tissue. They’re supposed to have it because it gives them insulation against the harsh realities of the world; they’re supposed to have it because it provides them with the energy to grow on, rather than scraping for every skerrick of energy available. A skinny baby is a malnourished baby, damnit.
    Oh, hang on – I’m using earth logic here, for earth conditions, rather than those in whichever media-approved alternative reality I’m supposed to be living. Forgive me.
    Meg Thornton’s last blog post..Steele Part 4 of ?

  18. Looking through his blog, there’s plenty of freakonomics style stuff there.

    Perspicacious. Turns out his co-author is currently writing “Parentonomics”.
    Lauredhel’s last blog post..Documentary, or Fragranced Toiletry Product?

  19. … and it sure becomes difficult to have a reasoned conversation with someone who believes that the Term Breech Trial proves that C sections are at least as safe as vaginal birth.
    He links to a page that says this:

    “What are the risks of cesarean delivery? The maternal mortality is higher than that associated with vaginal birth (5.9 for elective cesarean delivery v. 18.2 for emergency cesarean v. 2.1 for vaginal birth, per 100 000 completed pregnancies in the United Kingdom during 1994–1996).3Cesarean section also requires a longer recovery time, and operative complications such as lacerations and bleeding may occur, at rates varying from 6% for elective cesarean to 15% for emergency cesarean.1,4 Having a cesarean delivery increases the risk of major bleeding in a subsequent pregnancy because of placenta previa (5.2 per 1000 live births) and placental abruption (11.5 per 1000 live births).5 Among term babies, the risk of neonatal respiratory distress necessitating oxygen therapy is higher if delivery is by cesarean (35.5 with a prelabour cesarean v. 12.2 with a cesarean during labour v. 5.3 with vaginal delivery, per 1000 live births).6 Also, a recent study has reported that the risk of unexplained stillbirth in a second pregnancy is somewhat increased if the first birth was by cesarean rather than by vaginal delivery (1.2 per 1000 v. 0.5 per 1000).”

    And STILL persists in believing that C sections are safe, and that there’s no evidence they’re being systematically performed too early.
    Head. Concrete wall. I didn’t expect to have to engage in Birthing 101 with someone who is getting their “research” on birthing published in the national media.
    Wait, no, I did.

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