NEW ZEALAND COLLEGE OF MIDWIVES AGAINST NEW ZEALAND LISTENER
Case Number: 2557
Council Meeting: JANUARY 2017
Verdict: Upheld in Part
Publication: The Listener
Balance, Lack Of
Comment and Fact
Headlines and Captions
1. The College of Midwives’ complaint relates to an article that appeared as the cover story in TheNew Zealand Listener edition of October 8-14, 2016 (released on October 3).
2. The article, headlined Birth Control, centred on a research paper by Elle Wernham et al of the University of Otago, Wellington, looking at data on lead maternity carers (LMCs) that found some poorer outcomes for midwife-led maternity care than in medical-led care (MLC).
3. The college complains of breaches of the Council’s principles on accuracy, fairness and balance (1), headlines and captions (6) and comment and fact (4). The complaint is upheld in relation to principle 6.
4. The college’s president, Deb Pittam, on behalf of the college, complained that the article’s headlines and captions did not accurately and fairly convey either the substance of the report, the study the article was based upon, nor maternity care in this country.
5. She cites in particular headlines that read “Alarming Maternity Research”, “The dangers of midwives in charge” and “Where the revolution went wrong”. She also points to the cover picture of a “hippy genre” couple carrying a banner reading “deliver us from doctors”.
6. She said the research paper did not suggest there were dangers in choosing a midwife or that changes to maternity had gone wrong as the cover stated and it did not accurately reflect the substance or key elements of the story.
7. She says the reporting was inaccurate, in that it cited babies in the 2008-2012 study were at higher risk if they were delivered by midwives than doctors, when the data could not identify who delivered the baby, but only compared the outcomes for midwife-led and MLC-led care and the data only recorded who the woman first registered with, not who delivered the baby or was responsible at the time of birth - midwife or doctor. It also suggested there was greater danger to babies than there was, because the actual numbers were small.
8. She said a text box in the article which read “babies delivered by midwives are 55 per cent more likely to have oxygen deprivation during delivery” suggested over half of all babies were at risk and was highly inaccurate and misleading and suggested 55 per cent of all midwife-led births had birth-related asphyxia.
9. In a further alleged breach of principle 1 she said the article referred to minutes of a college meeting that were not written up at the time and had not been transcribed or circulated since, so could not be attributed to the college’s national meeting as having dismissed the research as “flawed” “poor” and based on wrong assumptions.
She implied the comments were made outside the meeting by individuals.
10. She said the reporter had used inflammatory language to portray the maternity care environment as “war torn” and a “hard fought battle” yet the experts cited had discussed the need to keep the results in context and agreed the integrated model of midwives and obstetricians was working well - and that undermined the claim of “midwives in charge”.
11. On the complaint of a breach of principle 4 (comment and fact), Ms Pittam said the right of reply was not evenly spread with the college and other leaders in the maternity sector were given little opportunity to respond to other interviewees’ opinions.
12. For instance, she said Lynda Exton’s view of increased mortality had been proven wrong in the past but she was able to voice that opinion “unhampered yet again” and there was not a clear distinction made between opinion and comment on the one hand and fact on the other.
13. She also asserted that comments by the chair of the DHB chief medical officers group Ken Clark in the article were untrue.
14. She said the reporter did nothing to discredit these “false claims” but reinforced them by quoting them.
15. Ms Pittam said coverage like The Listener article obstructed the evaluation process and only
succeeded in “terrifying pregnant women and demoralising the health workforce”
as well as increasing stress on midwives.
16. She also alleged the reporter’s other work on the topic was also inaccurate, unbalanced and unfair and demonstrated a predetermined agenda on her part and that ofThe Listener - and that she had not identified personal views as opinion.
17. Ms Pittam provided the Council with further references and material supporting midwives and/or taking issue with the research paper’s findings and methodology and broadly supporting her views - including questioning the existence on the evidence of a causal link between the different outcomes and whether the pregnancy oversight was midwife or MLC – led.
18. The editor of The Listener Pamela Stirling in her response - and in a subsequent rebuttal of the college’s reply to her first response - said in relation to principle 6 the headlines accurately reflected the concerns raised by the report.
19. Specifically the subheadline “the dangers of midwives in charge” addressed the disparity in outcomes in midwife-led births compared with obstetrician-led births and was an accurate way to describe a model where midwives were the lead carers.
20. “Where the revolution went wrong” fairly reflected a key element of the article - a political decision in the mid-1990s to transfer control of delivery from doctors to midwives and whether that had resulted in the optimum outcomes. Along with funding changes it had seen, she said, nearly all GPs abandoning obstetrics and it was estimated there were fewer than 15 nationwide.
21. The concerns of some of those interviewed in the article justified the use of the word “alarming” to describe the research findings.
22. Ms Stirling accepted that the end of the first paragraph of the article should have referred to babies whose mothers had a midwife as lead carer, not who delivered their babies. The mistake was acknowledged and a correction ran on the letters page on November 9.
23. She asserted that throughout the article it was acknowledged doctors were often involved in midwife-led care and vice versa and it was not known to what extent each may have been involved in each birth.
24. But she said the focus was on the lead carer, not who ultimately delivered the baby. This was mentioned in the article.
25. But the comparison of obstetricians and midwives as LMCs was fair and valid no matter who ultimately delivered the baby because the research study showed these had measurably different outcomes.
26. She rejected the assertion by Ms Pittam that the text box referred to in paragraph 8 above would be understood as referring to 55 per cent of all babies delivered by midwives, but rather that it was proportionately more likely.
27. In relations to the “minutes” of the college’s national meeting Ms Stirling provided a copy of a document identified as notes taken at the meeting. Ms Stirling said it was understood the document was widely circulated to college members as a record of the meeting. She argued it was accurate to describe them as minutes, even though they were described as “notes”.
28. The notes did contain the language objected to by the college in its complaint - that the research report was flawed research, poor research and based on wrong assumptions.
29. In relation to the allegation of inflammatory language Ms Stirling said the language - “war torn” and “hard fought battles” - was metaphorical and did not denigrate midwives but drew attention to the hard-fought effort to overturn the presumption in favour of doctor-led maternity care in the 1990s.
30. She said the article did not contain the author’s comment or opinion, but “only factual information and the opinion of people interviewed”. Dr Exton’s views were presented as opinions not facts, and the college’s counter view represented by Lesley Dixon was set out directly below it.
31. Rights of reply were provided at the editor’s discretion where balance was needed.
The article was largely supportive of midwifery and extensive comment was included from representatives of the college. A letter from the college was published on October 22.
Balance, not the right of reply, was required by the Council’s principles, Ms Stirling said.
32. She said The Listener had published articles, including one on October 26 commissioned before the college’s complaint was received, that were positive towards midwifery. The reporter had written only one of the other articles depicted by the previous Listener covers at the bottom of its opening page.
33. The magazine had taken a fair, balanced and accurate approach to the issue over a number of years.
34. Ms Stirling provided other documents including copies of reports of the research by other media, taking a similar approach to that ofThe Listener, the letters to the editor it published and a number of articles covering errors by individual midwives.
35. They included a letter from Professor Peter Crampton, the Pro-Vice-Chancellor of health studies at Otago University that stated that overall the article fairly and accurately represented the study - apart from the error acknowledged byThe Listener that the article did not use the term LMC in some cases.
36. As the Council has noted in the past it does not have the mandate or the resources to investigate the underlying research used as the basis for articles and cannot adjudicate or arbitrate between competing scientific papers or views or methodology or judge the merits of the research
37. If the college takes issue with the research and its conclusions -as opposed to the fairness of the reporting of them - it should take those up with the researchers and the institution, in this case Otago University.
38. The Council does, however, note the poor treatment of statistics in the article and that this appears to be the work of the writer rather than of the researchers whose work was reported. It was noted that the research covered a large number of births (over 240,000), that fewer than 10% of those births had been from pregnancies registered with a medical lead maternity carer, with over 90% midwife-led, but at no point is there any mention either of the total number of births in which there was a sub-optimal outcome or of the number of such births in either category. This omission makes it difficult to assess the significance of the percentage figures for outcomes – and those percentage figures are a key basis for some of the later discussion.
39. In the matter of the complaint on principle 4 - opinion and fact - the principle does not relate to examples where the reader takes issue with the accuracy of a view expressed by one of the people quoted in an article or where there are differing views on an issue. In such cases there may be an issue of balance, but it does not constitute a breach of the principle to accurately report a contested view or an opinion where it is is clearly marked as such.
40. The thrust of the principle is that it should be clear what is opinion and what is fact. A person’s view being quoted accurately - and clearly marked as their view - does not blur the distinction between opinion and fact. We do not find that in this case the reporter inappropriately confuses opinion and fact by analysing, summarising and drawing conclusions from the evidence.
41. In relation to principle 1 (accuracy, fairness and balance) the Council’s view is that the article canvasses a wide range of views and is balanced and accurate (with the reservation outlined below). The views of the college and others both supportive and critical of the current environment are included.
42. Moving to some specifics of the complaint.
43. In the case of paragraph 8 above, the Council (while noting the error of the reference to midwife deliveries not midwife-led care) accepts Ms Stirling’s view that it did not, as the college asserts, suggest 55 per cent of all births involving midwife births had a greater chance of oxygen deprivation as the college complains. It clearly refers to it that being 55 per cent “more likely” so is a relative not absolute measure.
44. On the question of whether the information came from “minutes” or not. Ms Stirling provides one dictionary definition but there are others that stress their more formal status. (e.g from BusinessDictionary.com: “The Permanent, formal, and detailed (although not verbatim) record of business transacted, and resolutions adopted, at a firm's official meetings such as board of directors, manager's, and annual general meeting,”)
45. It would have been preferable to call them notes, rather than minutes, in the article but they were clearly more than just the view of an individual. The document presented byThe Listener in support of its argument is a detailed account of the meeting. Clearly the evidence the magazine relied on in this instance was more than just the views of an individual after the meeting as the college implies.
46. The Council believes readers were not materially misled by the record of the meeting being described as “minutes”.
47. It is regrettable that early in the article the magazine in error referred to the paper’s findings as highlighting the risks to babies delivered by midwives, and that may have coloured readers’ perceptions of the rest of the article and the research.
48. However, the magazine has acknowledged the error and printed a correction, albeit not in terms wholly accepted by the complainant. The article read as a whole provides an accurate account of the research in that regard.
49. In relation to principle 6 (headlines and captions)the Council upholds the complaint.
50. It is acknowledged that magazine covers and the cover lines that appear on them are normally striking and more attention-grabbing compared to headlines on articles.
As such they may, for instance, stress one controversial or compelling aspect of the article they seek to promote and may be granted some leeway under Principle 6.
51. But in this case the Council believes The Listener went too far. While each of the coverlines and subheadlines in isolation referred to key elements of the article, taken as whole the front page in particular conveys a much more negative view of midwifes, the level of risks posed by midwife-led care and the changes to maternity care in the 1990s - further exacerbated by the "hippy" couple and their placard - than the substance of the article, the range of views it canvassed or the research on which it was based.
Press Council members considering the complaint were Sir John Hansen, Liz Brown, Peter Fa’afiu, John Roughan, Marie Shroff, Vernon Small, and Tim Watkin.
Ruth Buddicom and Sandy Gill took no part in the consideration of this complaint
Jenny Farrell and Mark Stevens stood down to ensure public member majority.