Pregnant woman faces a challenging decision, balancing medical advice with personal beliefs.

The Ideological Battle in Obstetrics: Are We Losing Sight of Women's Health?

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"A critical look at how ideology may be overshadowing scientific evidence in obstetrics, potentially impacting patient care and outcomes."

For many healthcare professionals, the pursuit of evidence-based practice is paramount. Midwives and obstetricians alike strive to provide the best possible care, grounded in scientific research and rigorous analysis. However, a recent letter to the editor published in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) raises a critical question: Is ideology overshadowing science in modern obstetrics?

The letter, penned by Susanne E.M. Langer, a midwife and academic at Nepean Medical School, University of Sydney, critiques two articles from the April 2017 issue of ANZJOG. Langer expresses concern that the authors of these articles may have allowed preconceived notions and politically correct narratives to influence their research, potentially compromising the validity and objectivity of their findings.

This article delves into the arguments presented by Langer, exploring the potential impact of ideological biases on obstetric practice. It aims to unpack the complexities of balancing evidence-based medicine with patient autonomy and cultural sensitivity, while ensuring that women's health remains the central focus.

Are 'Refugee' Women Really Getting Poorer Prenatal Care?

Pregnant woman faces a challenging decision, balancing medical advice with personal beliefs.

Langer's first critique targets an article titled 'Poorer detection rates of severe fetal growth restriction in women of likely refugee background.' She argues that the title itself is misleading and unsupported by the data. According to Langer, the study's results suggest that 'refugee' women (a term she finds questionably defined) are, in fact, doing well in terms of prenatal outcomes.

She highlights that these women require fewer cesarean sections, and a subgroup analysis was seemingly employed to reinforce the politically motivated claim that refugee women need more services. Langer points out a critical statistical anomaly: there is no significant difference in intrauterine growth retardation (IUGR) between the 'refugee' population and the general population (60/1547 vs 786/18 020, P = 0.4). This indicates that 'refugee' women are not more likely to have babies with IUGR than anyone else.

Misleading Titles: Titles should accurately reflect the study's findings and avoid sensationalism or bias.
Data Interpretation: Statistical analyses must be transparent and avoid drawing conclusions not supported by the data.
Subgroup Analysis: Be wary of subgroup analyses that appear to cherry-pick data to support a predetermined narrative.
Definitions: Clear and consistent definitions are essential for accurate research and avoid misinterpretations.

The concern is not merely about semantics or statistical interpretation; it extends to resource allocation and patient care. If resources are disproportionately directed towards a specific population group based on flawed premises, it could detract from other areas where the need may be greater. This raises ethical questions about equitable healthcare distribution and the potential for unintended consequences.

A Call for Evidence-Based Obstetrics

The debate sparked by Langer's letter underscores the critical need for evidence-based practice in obstetrics. While cultural sensitivity and patient autonomy are vital considerations, they should not eclipse the importance of rigorous scientific inquiry and objective data analysis. The ultimate goal must always be to provide the best possible care for women, grounded in sound evidence and free from ideological biases.

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Everything You Need To Know

What is the main concern raised by Susanne E.M. Langer in her critique of articles published in the ANZJOG?

Susanne E.M. Langer, a midwife and academic, raises concerns that preconceived notions and politically correct narratives may be influencing research findings in obstetrics, potentially compromising the validity and objectivity of these findings. Her critique focuses on articles in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), where she believes ideological biases might be overshadowing scientific evidence and impacting patient care.

Why does Langer criticize the article titled 'Poorer detection rates of severe fetal growth restriction in women of likely refugee background'?

Langer criticizes the article for several reasons, primarily due to misleading claims. She argues the title is unsupported by the data, as the study's findings suggest that 'refugee' women are doing well in terms of prenatal outcomes. She points out there is no significant difference in intrauterine growth retardation (IUGR) between the 'refugee' population and the general population and that the need for more services for 'refugee' women is a politically motivated claim.

What are the key areas where ideological influence can negatively affect obstetric practice, as highlighted by the concerns? Explain each.

Ideological influences can negatively affect obstetric practice in several key areas. First, misleading titles may not accurately reflect study findings. Second, data interpretation issues may lead to incorrect conclusions that aren't supported by the data. Third, subgroup analyses could be used to support a predetermined narrative by selectively picking data. Finally, unclear definitions could lead to misinterpretations. Langer emphasizes that such issues may have implications for resource allocation and patient care, raising ethical questions about equitable healthcare distribution.

How could flawed premises about patient populations lead to unintended consequences in healthcare, as mentioned in the context?

Flawed premises, such as those criticized by Langer, can lead to the disproportionate allocation of healthcare resources. If resources are directed towards a specific population group based on inaccurate or biased information, it could detract from other areas where the need may be greater. This could result in inequitable healthcare distribution and potentially lead to unintended consequences, such as some populations receiving less adequate care than they need.

What is the ultimate goal in obstetrics, according to the debate sparked by Langer's letter, and how should it be achieved?

The ultimate goal in obstetrics should always be to provide the best possible care for women. This can be achieved by prioritizing evidence-based practice, rigorous scientific inquiry, and objective data analysis. While cultural sensitivity and patient autonomy are important considerations, they should not overshadow the importance of sound evidence and freedom from ideological biases in making decisions about patient care, ultimately ensuring that women's health remains the central focus.