I am annoyed by a petition.  This troubles me.  Petitions are good things, they allow people to express the depth of their feelings about an issue in an easy to collect format.  You can symbolically present a scroll of names to a rictus grin and flash of cameras.  They represent people power, a self contained vote on the things that matter.

So why does The Sunday Times Safer Births Campaign to reduce the number of stillbirths in Britain make me angry?

Lost opportunity for a wider audience

We have a campaign lead by a newspaper with weight and political influence.  It makes small steps to address the stigma of stillbirth by providing a platform for the bereaved.

It does so behind a paywall and in doing so it locks out a wider audience and unintentionally demonstrates the inequities of stillbirth and reinforces them.

The Sunday Times is entitled to ask people to pay for its journalism but for a campaign such as this it could drop the wall for these articles at least.

Missed targets

While it seems to demand reasonable prevention efforts and action its actual demands are vague.

  • Reduce stillbirths of “term” babies by 60% by applying basic care guidelines on monitoring and intervention
    • This in line with the MBBRACE recommendations and seems sensible.
  • Ensure that a consultant obstetrician is present in all large maternity hospitals 24/7
    • This is where it starts to get problematic and we get into semantics over what constitutes a large hospital and why efforts should be focused on them and that’s before we get into the resource issues of 24/7 availability.  Is this conflating 24/7 emergency care with 24/7 routine care?
  • Use earlier medical intervention such as caesarean section to save babies or mothers at risk
    • It’s not clear what this is based on.  There’s no obvious reference to caesarean sections as being an effective intervention in The Lancet papers.  A recent paper suggests that “Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.”
  • Measure babies’ growth according to guidelines and act on poor growth
  • Listen to mothers who report concerns about reduced foetal movements, and investigate
  • Monitor a baby’s heartbeat and correctly interpret readings
    • Well meaning but vague.
  • Give mothers the right to a caesarean section when they express concern
    • Given the risks outlined above this seems an odd demand.  Anecdotally caesarean sections are already happening against the mother’s wishes as hospital staff are unwilling to take the risk in the absence of a consultant.

If the intention of the petition is to reduce the instance of stillbirths in the UK it should be asking for the recommendations outlined in The Lancet paper:

  • National perinatal mortality programmes need to be implemented…
  • The need to reduce stigma and fatalism related to stillbirths and to improve bereavement care are also clear, persisting priorities for action
  • In high income countries a woman living under adverse socio-economic circumstances has twice the risk of having a stillborn child…
  • Programmes at community and country level need to improve health in disadvantaged families to address these iniquities.

It’s an open goal

The petition is pitched at the Health Secretary, Jeremy Hunt.  A Minister that has already made a public commitment to halving stillbirth and infant deaths by 2030.  He did this through a press release in November 2015.  This has also been the answer to a number of Parliamentary Questions on the subject:

To support the National Health Service in achieving this ambition we also announced:

― a £2.24 million capital fund for equipment to improve safety;

― over £1 million to roll out training programmes to make sure staff have the skills and confidence they need to deliver world-leading safe care; and

― £500,000 to develop a new system that can be used consistently across the NHS to enable staff to review and learn from every stillbirth and neonatal death.

The announcement also committed to publishing an annual report to update the public, health professionals, providers and commissioners on the progress we are making towards achieving the ambition.

Many of the above points directly address the demands of The Sunday Times petition.

It also misses because it is pitched at the Health Secretary when it needs to go higher.  The Lancet paper Stillbirths: Ending an epidemic of grief (free registration required) is very clear on the need for:

“more robust action / high level political leadership not merely from a Ministry of Health”

A token gesture

Change.org petitions have their uses in raising awareness and pushing issues to the forefront of the political agenda.

They are not intended for the use of media companies who already have that level of reach and influence and these petitions are especially not for companies that put their related campaign materials behind a paywall.

There are a number of online platforms available for petitions.  A paper like The Sunday Times should already know that even if their change.org petition reaches a certain threshold it will not trigger an automatic action.

Once a petition hosted on the Parliament’s petition site reaches 10,000 signatures the Government will respond.  If it reaches 100,000 it will be considered for a debate in Parliament.

Even if the petition was hosted on the Parliament petition site and it reached the threshold for a Government response we already know what that response will be.

It’s not joined up

The petition makes the mistakes identified in the report around the need for leadership and a coordinated effort and exploitation of network links and opportunities.

A campaign based on a flimsy petition asking the Health Secretary for answers he has already given does nothing to improve on that or align its objectives with wider efforts.

Why am I being so hard on them?  Why can’t I applaud their efforts?

Because The Sunday Times is not an individual, it is not a charity and it is not an amateur.  It is a professional business.  It has immense power, money, resources and political influence it could use to effect real change alongside a wider campaign.

Instead it pisses it away on a petition and chooses to go alone rather than join an alliance that is desperately trying to lead a coordinated response addressing the multiple complex factors around stillbirth on a global level.  It wraps its impotence in self-righteousness and wastes time asking questions that have already been answered and in doing so reinforces the impression of futility.

It does little to address the underlying issues of stigma and taboo and when it does by publishing articles of bereaved parents sharing their story it hides them behind a paywall.  If it really wanted to demonstrate its commitment to the cause it could make a donation to the charities that are already doing this work.

For reference: this is how you write an article on stillbirth.

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