A study of the policy implications arising from a local survey of perinatal mortality

Abstract

In this study the policy implications arising from a locally commissioned survey of perinatal mortality are analysed at several levels, and are examined in relation to factors associated with the policy process.
Part I contextualises perinatal mortality as 'a problem' by tracing its development through official statistics, studies of birth cohorts, and other inquiries. Its emergence as a socio-medical indicator, and its relationship to prevailing forms of theoretical explanation for inequalities in health are described. Recurrent confusion is noted bet ween its association with adverse socio-economic factors and recommendations for its solution through improvements in medical care.
Part II describes a substantive local study using an ethnographic research strategy. The findings are presented as both process and product. Locally held a priori assumptions are examined using the National Perinatal Epidemiology Unit's guidelines for local surveys. Contradictory views of reality are identified between some parents and medical personnel, and between the research findings and official perceptions of causation and explanation. It is argued that status inequality is manifested through the disparate perceptions of reality, and that medical expertise assumes the power to provide sufficient explanations for a range of phenomena. This power includes the professional response to the research findings and serves to define the handling of the policy issues arising from them.
Part III explores the prot ect ed status of expert knowledge within the context of social constructionist theories. Socialist feminist theory appears best to explain several phenomena occurring in the empirical study which related to women. Social constructionism does not explain adequately, however, the reluctance of some professionals to approach the evidence according to the conventions of scientific inquiry.
It is concluded that attempts to change policy and professional practice in matters of this kind will be ineffective unless the complex fundamental issues raised by this study are addressed.