Global health indicators and maternal health futures: The case of Intrauterine Growth Restriction

Abstract

Public health indicators generally operate in the world as credible, apolitical and authoritative. But indicators are less stable than they appear. Clinical critiques of Intrauterine Growth Restriction (IUGR) criteria have been forthcoming for decades. This article, though, takes up the measuring and calculation gradients of IUGR in the ultrasound machine itself, including the software algorithms that identify IUGR. One hospital where research was conducted incorrectly predicted pathological birth outcomes 14 of 14 times. We are at a historical moment when the global use of prenatal diagnostic ultrasound for the express purpose of assessing IUGR is set to escalate. Medical imaging device corporations like Siemens, Toshiba, General Electric and Phillips are quite literally banking on it, and new forms of ultrasound technology and diagnostic software are increasingly available on smartphones, tablets and laptops. Clinical guidelines for IUGR--assumed to be authoritative and evidence-based--are evolving right along with the installation throughout the world of the technology capable of diagnosing it. Maternal malnutrition remains the single strongest predictive factor for IUGR, regardless of the technological investments currently amassing to identify the indicator, which is cause for a reassessment of priority spending and investment.

“Guilty until proven innocent”: the contested use of maternal mortality indicators in global health

“…Anthropologist Susan Erikson has argued that while indicators allegedly operate in the world as credible, apolitical and authoritative (Erikson, 2015, p. 1157), they are rarely neutral and are, instead, both value-laden and often, as Vincanne Adams puts it, quite ‘messy’ (Adams, 2016a, p. 59). Making numbers appear authoritative therefore requires hard work (Harper, 2006).…”

“…These actors’ institutional practices have introduced new forms of administrative oversight, audit and accountability, a clear manifestation of the incursion of corporate thinking and culture into broader social spheres (Merry, 2011). As Erikson (2015) has shown, today’s dominant global health actors tie market interests to health outcomes in ways that depend on numerical indicators. The growing power of private foundations in global health governance has also supported the proliferation of competing ‘advocacy coalitions’ and issue-specific global health networks (Shiffman et al, 2016), whose success is increasingly defined by their ability to reach concrete goals through management-style performance accountability measures that depend on health data .…”

Tricky Tools for Feminist Struggle

“…If "to classify is human" (Bowker & Star, 1999), then surely the prerequisite counting and measuring is also. Medical anthropologists and sociologists have recently scrutinized the pervasiveness of "metrics work" within the current regime of global health and governance (Adams, 2016;Adams et al, 2016;Sangaramoorthy & Benton, 2012;Erikson, 2015;Merry, 2011). Recognizing metrics as formations of power-knowledge, Vincanne Adams asserts, Such scholarly reflection on "numerical forms of truth-telling" is not new.…”

Prevalence and influence of maternal undernutrition on intra uterine growth restriction (IUGR) among beninese newborns

“…According to literature, chromosomal defects, primiparity, multiple births, maternal infections during pregnancy, maternal chronic pathologies like hypertension are well-known determinants of intrauterine growth restriction. 6 Moreover, in developed countries, some individual factors like maternal smoking and alcohol consumption are the main causes of IUGR, whereas, in LMICs, chronic maternal nutritional disorders play an important role. 4,[7][8][9][10][11] Maternal nutritional deficits can take various forms such as low weight gain during pregnancy, low body mass index before pregnancy, small maternal size or micronutrient deficiencies.…”