Too many C-sections? There oughtta be a law.
Reality-show winner Jean Wyllys rode his fame to a seat in the lower house of the National Congress of Brazil as a member of the far-left Socialism and Freedom Party, which holds 1 percent of the seats in Congress. There, he became a social media darling for his defense of LGBT causes. Now Jean Wyllys wants to tackle Caesarian sections.
Brazilian women have a lot of C-sections. A lot. Almost half of all births in Brazil are Caesarian sections, one and a half times the American rate, which is already double what the World Health Organization recommends. That rate jumps to 82 percent for private hospitals. It’s enough of a big deal that you could read about it in The Atlantic last year. It is an actual problem, a nine-figure problem, a legitimate women’s rights issue, a Bad Thing That Needs to Stop.
But Jean Wyllys’s bill, PL 7633/14, would make things even worse. Currently winding its way through Congress, the bill establishes committees to oversee the number of C-sections and reduce their rates. Going by the unwieldy acronym CMICBPO, the committees would establish inquiries to investigate institutions that went three consecutive periods above the WHO-recommended rate of 15 percent for C-sections. The actions of the CMICBPO could lead to defunding and forbidding C-sections both in public and private hospitals.
(That WHO recommendation is from 1985, by the way. Would you really want to enshrine in law a number the World Health Organization published around the time The Goonies came out?)
Now let’s think about what that rate means. If Brazil suddenly cut its C-section rate by two thirds and hit that target, about half of all hospitals and clinics would be above 15 percent in any given period. That’s how averages work. Chance alone means that one eighth of all statistically representative hospitals and clinics would be above that rate for three consecutive periods, triggering a CMICBPO inquiry despite acting in exactly the same way a the other seven eighths.
And not all institutions are representative, of course. Some specialize in C-sections, attracting patients who want or need the procedure. Some cater to older patients, who have had C-sections in the past and would prefer subsequent births to use the same method rather than a VBAC. Some are located in areas with older and wealthier mothers, who use more fertility treatments and therefore have higher rates of multiple births. At the very least, administrative costs would increase.
Consider how physicians and institutions would react to the new incentives. Caesarean sections would become a burden on hospitals. Mothers who requested it, and not too few of them do, would be pestered and cajoled and harassed like many of those seeking natural births are today. Instead of jumping the gun with unnecessary and expensive surgeries, doctors would hesitate before initiating urgent and absolutely necessary procedures. Institutions over the 15 percent threshold would turn away prospective mothers rather than risk being defunded, or even try to poach natural-birthers from each other.
And if you really wanted a C-section and couldn’t have one in your local hospital, well, all those illegal abortion clinics are already equipped and staffed for gynecological surgeries. I’m sure nothing would go wrong in those.
Thankfully, this bill will not become a law. Wyllys is a representative of the Brazilian bien–pensant, a pundit with a symbolic vote in Congress, not someone who can convince a majority of the other 512 Congresscritters to follow his lead. He’s a social taste-maker, not a lawmaker. And that right there might be much more consequential in the long run.