Eubios Journal of Asian and International Bioethics 19 (July 2009)
DeGrazia, David. (2008) Single Payer Meets Managed
Competition: The Case for Public Funding and Private
Delivery, Hastings Center Report 38: 23-33.
Dunn, John. (1994) Democracy: the unfinished journey
508 B.C.-1993 AD, Oxford University Press.
Emanuel, Ezekiel J and Victor R. Fuchs, (2005) HealthCare Vouchers-A proposal for Universal Coverage,
New England Journal Medicine 352: 1255-1260.
Gottleib, S. (2000) Medical Bills Account for Forty
Percent of Bankruptcies, British Medical Journal 320:
1295.
Hollenbach, D. (1979) Claims in Conflict: Retrieving andRenewing the Catholic Human Rights Tradition. New
York: Paulist Press.
Iltis, Ana Smith and Mark J. Cherry (2008) First Do No
Harm: Critical Analyses of Roads to Health Care
Reform, Journal of Medicine and Philosophy, 33; 403415.
Jacobs, Lawrence (1994) All Over Again? Public
Opinion and Health Care, New England Journal
Medicine 358: 1881-1883.
Kunz, J.L. The United Nations Declaration of Human
Rights, American Journal International Law. 43: 316322.
Lebacqz, K. (1987).Justice in an Unjust World.
Minneapolis, Augsburg, Press.
………(1986) Six Theories of Justice: Perspectives
fromPhilosophicalandTheological
Ethics.
Minneapolis: Augsburg Press.
Lovin, R.W. (1995) Reinhold Niebuhr and ChristianRealism. Cambridge: Cambridge University Press.
Maritain, J. (1941) The Rights of Man and Natural Law.
Trans. D.C. Anson. New York: Charles Scribner‟s
Sons.
Menzel, Paul and Donald W. Light (2006). A
Conservative Case for Universal Access to HealthCare, Hastings Center Report 36: 36-45.
Morgan James J and Thomas H. Lee, (2005). Do weReally Want Broad Access to Health Care? New
England Journal Medicine 352: 120-1263.
National SCHIP Policy Overview, U.S. Department of
Health and Human Services 13 Dec 2007
http://www.cms.hhs.gov/nationalschippolicy.
Sade, Robert M., (2008) Foundational Ethics of the
Health Care System: The Moral and Practical
Superiority of Free Market Reforms, Journal of
Medicine and Philosophy 33: 461-497.
Taylor, James Stacey, (2008) Market Incentives and
Health Care Reform, Journal of Medicine andPhilosophy 33; 498-514.
UnitedNations Declaration of Human Rights,
http://www.un.org/en/documents/udhr/, accessed 17
May 2009.

103

Punishing Paternalism: An
Ethical Analysis of Japan's
Leprosy Control Policy
Michio Miyasaka, Ph.D.
School of Health Sciences, Niigata University
Asahimachi-dori 2-746, Niigata City 951-8518, Japan
Email: miyasaka@clg.niigata-u.ac.jp
Abstract
Leprosy (Hansen's disease) has been associated witha deep stigma that dates back to ancient history.
Japan‟s leprosy control policy exemplifies the ethicalquestions this disease evokes in the context of humanrights in modern medicine. This paper explores thehistory of Japanese leprosy control policy which started
during its rapid modernization in the late 19th century
and continued until 1996. I argue that the responsibilityof the medical profession for development of the overall
control policy which resulted a mass human rights
violation. Japanese leprosy control policy can beinterpreted as four powers given to the medical
profession: 1) forced isolation, 2) sterilization, 3) forcedlabor, and 4) arbitrary punishment. Japaneseleprologists considered forced isolation necessary,even after sulfone drugs became widely available andthe international medical community suggested thatforced isolation should be abolished. Male patients who
wished to marry had to undergo vasectomy, andpregnant female patients were forced to have abortions.
Patients with milder symptoms were assigned heavylabor, which may have exacerbated their condition.
Leprosarium directors were empowered to arrest andpunish disobedient patients without court order.
Records show that 22 of 92 persons imprisoned in
Jukambo, a special leprosarium facility for the most
severe punishments, died in confinement. In thelandmark Kumamoto judgment in 2001, the court ruledthat forced isolation was not justifiable after it became
medically unnecessary, since at least the 1960s.
However, the other three troubling aspects of thecontrol program were left unquestioned, even thoughthose would be much more difficult to justify.
Furthermore, the lawsuit was filed against the country,
and no individual responsible for the establishment andcontinuation of the policy was prosecuted.
1. Introduction
Leprosy, or Hansen's disease, has been associatedwith a deep stigma that dates back to ancient history. In
many parts of the world, patients were ostracized bytheir communities and families based on religious or
popular beliefs that often described leprosy as a resultof sins or wrongdoings. It was described as a divine
punishment for immorality in the Old Testament, andhundreds of leprosy patients were considered to be
killed because of rumors that some of them poisoned
1)wells and fountains in medieval Europe. In Japan,
there was a Buddhism-rooted belief that explained
leprosy as an outcome of wrongdoings in the patient's
previous lives. Japanese folklore tells of leprosy

104

Eubios Journal of Asian and International Bioethics 19 (July 2009)2)

patients cast away in valleys or on mountains.
However, the leprosy control policy in modernizedJapan exemplifies a situation that has evoked serious
ethical questions in the scientific period of modern
medicine and public health. In the second section ofthis paper, I will explore the history of Japanese leprosy
control policy from a paternalism point of view in whichfour powers were given to the medical profession. The
third section briefly sketches how the control policy
ended.
2. Leprosy Control Policy In Japan
Japan's leprosy control policy started during its rapid
modernization in the late 19th century when the country
opened its ports and started introducing Western sociolegal systems and medicine. Leprosy patients of the
day gathered and formed colonies around shrines,
temples, and hot springs. Some Westerners observed
them leading miserable lives on the streets as outcasts
3)
or beggars,
and some missionaries establishedprivate leprosaria. In 1889, the French Catholic
missionary Germain Léger Testevuide opened the firstprivate leprosarium, Koyama Fukusei Hospital in
Shizuoka Prefecture. The establishment of private
leprosaria by several other foreign missionaries
followed. Their activities were welcomed by patients,
but stimulated a rivalry from Japanese leaders who
wished to make Japan "a first-class nation" with a4)
modernized public health system.
From an ethical point of view, Japanese leprosy
control policy can be interpreted as four powers given
to the medical profession which resulted a mass humanrights violation: 1) forced isolation, 2) sterilization, 3)
forced labor, and 4) arbitrary punishment.
1) Forced isolation
The first International Leprosy Conference was held in
Berlin in 1897, in which two Japanese physiciansparticipated. The conference acknowledged leprosy as
a contagion caused by Mycobacterium leprae, as
described by a Norwegian physician, Armauer Hansen,
in 1873. There were differing views among theattendees regarding the containment of leprosy by
5)
isolation, but the conference eventually concluded thatpatient isolation was necessary as part of the disease
control strategy. This conclusion inspired Japanese
6)
leaders and physicians to support patient isolation In
1900, the Japanese Ministry of Home Affairs conducteda national survey and reported 30,359 leprosy
4)
patients. In 1907, the Leprosy Prevention Law (LPL)
was enacted, under which physicians were required toreport all leprosy patients they found, and political
officers were empowered to order these patients
admitted to leprosaria. In 1909, five public leprosaria
opened in Aomori, Tokyo, Osaka, Kagawa, andKumamoto. Additional leprosaria were added later tototal 13 national leprosaria that covered most of thecountry.
During the 20th century, international and Japanese
health care professionals gradually diverged in theirviews of forced isolation of leprosy patients. The
International Leprosy Association (ILA) increasingly
emphasized voluntary and limited isolation. After
sulfone drugs were found effective in the 1940s andtheir use increased in the 1950s and 1960s, the ILA

and otherinternational medical organizations
recommended that enforced isolation be avoided as
6)much as possible. In Japan, on the other hand,
leprologists continued to believe that patient isolation
was effective and necessary. Furthermore, they
repeatedly requested expansion of the capacity ofleprosaria and more intensive isolation. There was only
minor argument among Japanese leprologists thatforced isolation may not be necessary. In 1931,
leprologist Noboru Ogasawara of Kyoto University
insisted that the disease was not incurable, not7)
heritable, and not highly contagious, but his claim was
ignored and attacked by other leprologists. In 1935, thegovernment adopted a program to eradicate leprosy
within 20 years, and local governments launched anationwide campaign in 1938 named Muraiken Undo
(literally, "campaign to clean up leprosy in every
prefecture") through which they encouraged local
residents to identify leprosy patients in theirneighborhood and inform officials in order to send themto leprosaria.
After WWII, Japanese society was drastically
democratized under US occupation; however, the policy
of forced isolation of leprosy patients survived. The newConstitution proclaimed fundamental human rights for
all nationals, including freedom of political activity. In
1951, the National Leprosaria Patients' Association wasestablished. Although this association demanded theabolition of forced isolation, leprologists weresuccessful in maintaining it. In the same year, three
leprosarium directors, Kensuke Mitsuda, Yoshinobu
Hayashi, and Matsuki Miyazaki, recommended that theDiet maintain and reinforce the isolation policy. The LPL
was revised in 1953 in accordance with the leprologists'
opinions: it upheld compulsory isolation, prohibition ofleave without permission, and punishment of
disobedient patients. As the law defined no discharge
codes, patients had to be isolated for life. Meanwhile,the nationwide campaign Muraiken Undo had resulted
in almost complete isolation of patients. The number of
those hospitalized in leprosaria reached 11,057 in
1955, which was estimated to be 91% of all leprosy
8)
patients in the country. Therefore, in the 1950s,
almost all leprosy patients in Japan had been isolated
in leprosaria and were destined to live out their lives
there, even after they were treated with sulfone drugs
and proven not to have bacilli.
2) Sterilization
The notion that leprosy patients should be prevented
from having children had been accepted, not only by
Japanese leprologists, but also by foreign missionaries
involved in the care of leprosy patients. However, they
adopted very different approaches. Hanna Riddell, an
English missionary who opened a private leprosarium,
Kaishun Hospital in Kumamoto, insisted on sex
segregation, the idea of hospitalizing female and malepatients separately. However, Kensuke Mitsuda, aleading leprologist, argued against her approach,pointing out that sex segregation was unrealistic. He
wrote, "It will be natural for desperate persons to live
only for the pleasure of the moment. But the only
pleasures they can obtain in leprosaria are gambling or
adultery. ... Here, a moral anarchy has emerged that
resulted in more than a dozen babies that should notEubios Journal of Asian and International Bioethics 19 (July 2009)9)

have been born."
Mitsuda concluded that sex
segregation was impracticable in national leprosaria,
and that sterilization of patients was more realistic andwould contribute to patient welfare by permitting themto marry. Furthermore, he believed that sterilization
would contribute to a peaceful atmosphere in
leprosaria, because physicians could allow patients tomarry without letting them have children.
In 1915, Mitsuda began to vasectomize male patients
who wished to cohabit with female patients. In the bookhe published in 1950, Mitsuda wrote that the first10)
vasectomy was performed on a voluntary patient, butmany patients later claimed that sterilization was
conducted against their wishes and that it severely
impaired their dignity. Furthermore, pregnant female
patients were often forced to have abortions. Former
patient Shige Tamashiro regretfully described an
enforced abortion, or rather, the infanticide. She clearly
remembers the infant waving its hands and legs on asurgical plate, before a nurse covered the nose and themouth of the infant with a piece of gauze to terminate
its breathing, saying to Tamashiro, "It is a cute girl, and11)
looks very much like you."
During Japanese colonization of the Korean
peninsula, officials of Shorokuto Kousei-en, aJapanese-run leprosarium on Sorokdo Island near thesouthwestern tip of the peninsula, performed patient
sterilization as a punishment. A former Korean patient
testified in a lawsuit against the Japanese government
in 2004 that he was vasectomized when he refused toworship at a Japanese Shinto shrine in the leprosarium.
He was placed in the confinement room, and forced toundergo sterilization without being given any
explanation. Vasectomies and abortions had been
conducted on leprosy patients without legal basis, butboth were legalized by the Eugenic Law (Yusei Hogo
Hou) enacted in 1948.
3) Forced labor
Former patients have claimed that living conditions in
national leprosaria were far from appropriate. They
were assigned many types of labour, because doctors
in leprosaria "encouraged patients towards mutual
12)aid." Patients with milder conditions were assigned tonurse invalid patients, bury dead patients, wash
bandages and gauze for reuse, collect night soil, andrepair buildings and roads. For example, During WWII,
patients of Kuryu Rakusen-en, a national leprosarium in
Gumma located on a hillside at an altitude of 1200
meters, were ordered to walk down to markets about 10
kilometers (6.3 miles) away to buy charcoal andfirewood in order to save gasoline. They had to walk on
mountain trails back to the leprosarium carrying heavy
13)
loads of charcoal and firewood. It is presumed thatheavy labour exacerbated their condition, because thedisease renders victims insensitive to wounds and pain.
Former patient Yuji Kodama of Kuryu Rakusen-en
related that when he and other patients were gathering
firewood in a steep valley, he noticed that bunches offirewood passed from one patient to another were
stained with blood.

1054) Arbitrary punishment
Leprologist Mitsuda wrote that some patients inleprosaria committed assault and battery, theft,adultery, and incited riots, but "there was no way to
14)control disorderliness." He also pointed out that if aleprosy patient who was not institutionalized committeda crime and was arrested, he or she would be sent to aleprosarium instead of a prison because prisons would
not accept leprosy patients. In 1916, the government
accepted their request for police power by revising the
LPL so that leprosarium directors were empowered toarrest and punish disobedient patients. Accordingly,
confinement facilities were built in all national
leprosaria. The director could imprison patients for up to
one month and reduce their meals to twice a day
without a court order. However, leprologists of the day
regarded confinement as nothing but a mild "housearrest" which "seldom had any effect on the brutal ones15)
who could repeat their crimes." Directors of national
leprosaria decided to build a special facility in which
they could give more severe punishments. The special
facility was constructed in Kuryu Rakusen-en in 1938
and officially named Tokubetsu Byoshitsu ("special
sickroom"), but was called Jukambo ("maximum
confinement facility") by patients. In fact, it was a placeof deadly confinement composed of eight cells. A postWWII investigation of Jukambo unveiled one of thedarkest aspects of Japanese leprosy control policy.
Records showed that 22 of 92 persons imprisoned diedduring their imprisonment or within a few months after
their release. The dates of their deaths in Jukambo
were concentrated between November and March,when the air temperature of the region dropped to 16°C (-3.2°F) or below. Jukambo cells had no heating
apparatus, and the building was on a low foundation,
probably to prevent patients from escaping through thefloor. Furthermore, patients were usually imprisoned
much longer than the ordained period. The average
length of confinement was more than 130 days. The
longest imprisonment was over 500 days.
In 1947, media coverage made Jukambo a scandal
and officials of the Ministry of Health and Welfare(MHW) commented at the Diet that they would abolishit. However, the power given to leprosarium directors toarrest and punish patients remained in effect, and a"leper's prison" was established in Kikuchi Keifu-en, anational leprosarium in Kumamoto, in 1953.
3. End of The Policy
The Japanese leprosy control policy remained
unchanged for a long time. It survived the 1950s whenpost-WWII reform democratized Japanese socio-legal
systems, the 1960s when sulfone drugs became widely
available and studies showed that leprosy was rarely
16)
contagious,and the 1970s and 1980s when
Japanese scholars introduced bioethics and its
concepts (i.e., patients' rights and informed consent).
Its crucial last moments came as late as the 1990s,
when all residents in leprosaria had become "former
patients" who were bacteriologically negative and had
spent most of their lives there.

106

Eubios Journal of Asian and International Bioethics 19 (July 2009)

1) Patients’ rights movement
It should be noted that patients' activities to abolishthe control policy started early. Since the 1920s,
patients' associations were organized in each
leprosarium to improve living conditions. Their activities
were suppressed during wartime, and they wereterrorized by arbitrary punishment, especiallyconfinement in Jukambo. However, the suppressedenergy burst out once the Constitution of Japanguaranteed fundamental human rights, including
freedom of assembly and speech, and the Jukambo
was abolished. As mentioned above, the National
Leprosaria Patients' Association was established in
1951, and demanded abolition of the above-mentioned
questionable powers. Some patients went on hunger
strikes at their leprosaria, and a few hundred went on a
sit-down strike in front of the MHW and Diet Building.
However, their movement came up against public
ignorance. There had seldom been media coverage
about the patients' movement, and Japanese media
generally approved of the isolation policies until aroundthe 1980s.
2) Abolishment of LPL
Admittedly, at least in the 1980s, patients' unions andmedical professionals began to cooperate to change
the situation. Fujio Otani, a medical official of MHW, isregarded as a key player in the partnership between
medical professionals and former patients who were
now old and afraid of being discharged from leprosaria
by force. Furthermore, due to sterilization, they had nochildren who could support them when they went backinto society. The powers given to medical professionals
over patients were now applied mildly. Former patientswere almost free to leave their leprosaria and werereleased from heavy labor (which had gradually been
17)
assigned to the leprosarium staff).
Otani expressed
his opinion that the LPL should be repealed andreplaced by a new law to guarantee their livelihood andwelfare at the 1994 meeting of the Japanese Leprosy
Association and at the 1995 Government-organized
LPL Review Committee. In accordance with theCommittee‟s report, the Diet passed the Act to Abolishthe Leprosy Prevention Law in 1996.
3) Lawsuit against the country
On May 11, 2001, the Kumamoto District Court
declared that the isolation policy had violated thefundamental human rights guaranteed in theConstitution of Japan. The court associated theisolation policy with an "absolute isolation" and"extinction" of leprosy patients. It held the MHW
responsible for failing to seek an early reversal of the
LPL, and the Diet responsible for inaction in repealingit, ordering compensation and an apology from the18)
government.
The point at issue in the Kumamoto
judgment was the forced isolation of leprosy patients,
which the court ruled to be unjustifiable after it became
medically unnecessary, since at least the 1960s.
However, the other three questionable aspects of theleprosy control policy that I have considered here wereleft unexamined, even though those would be evenmore difficult to justify. Furthermore, the lawsuit was
filed against the country, and no individual responsible

for the establishment and continuation of the policy wasprosecuted.
Conclusion
The history of Japanese leprosy control policy
described here suggests that the responsibility of
medical professionals for development of the overall
control policy was significant. Most aspects of thecontrol policy were proposed by leading leprologists,
and the policy can be considered as their strong
paternalism being realized as extreme powers toaccomplish 1) forced isolation, 2) sterilization, 3) forcedlabor, and 4) arbitrary punishment. On the other hand,
the history also shows that there was a patients‟ rights
movement in its own right - a half century before
academic bioethics introduced Western concept of
patients' rights to the country. However, the movementfound the society less supportive in pre-bioethics Japanin which overwhelming power was given to thephysician. The patient's only choices were to obey or tooffer a hopeless resistance at the risk of punishment.
Acknowledgment
This manuscript was supported by a grant-in-aid for
Scientific Research (project number: 15652001) fromthe Japan Society for the Promotion of Science.
References
1)
Boiteau, P. et al. Rôle éventuel de la malnutrition
dans l'épidémiologie de la lépre. Exemple de laFrance du moyen âge et de la Renaissance.
Bulletin de Philologie et d'Histoire, année 1968,
1971;1:9-18.
2)
Yamamoto, Y. and Kato, S. Goza no yugichi-hi.
Gumma. Goza no yukuchi-hi kanko kyoryoku iinkai,
1972. (in Japanese)
3)
Ashmead, A.S. Suppression and Prevention of
Leprosy, Norristown, PA: Herald Printing andBinding Rooms, 1897, 80-85.
4)Fujino, Y. Inochi no kindaishi, Kyoto. Kamogawa
Shuppan, 2001. (in Japanese)5)
Pandya, S.S. The First International Leprosy
Conference, Berlin, 1897: The Politics ofSegregation.
História,Ciências,
Saúde–
Manguinhos. 2003;10 (supplement 1):161-177.
6)
Balina, L.M. and Valdez, R.P. Reflections on theInternational Leprosy Congress and Other Events in
Research, Epidemiology, and Elimination of
Leprosy.
International
Journalof
Leprosy
1994;62:412-27.
7)
Ogasawara, N. (1931) Rai ni kansuru mittsu no
meishin. Shindan to chiryo 1931;18. (in Japanese)8)
Tofu Kyokai. Mitsuda Kensuke and leprosy
prevention in Japan. Tokyo. Tofu Kyokai, 1958. (inJapanese)
9)
Mitsuda, K. Kaishun byoshitsu. Tokyo, Asahi
Shimbun, 1950, 204-205. (in Japanese)
10)
Ibid., 54.
11)
Chugoku Shimbun. Yatto taiyo gatetta. Anonymous
article on May 12, 2001. (in Japanese)
12)
Mitsuda, op. cit., 210-211.
13)
Kuryu Rakusen-en Kanja Jichikai (ed). Fusetsu nomon (Fifty-year History of Patients of Kuryu
Rakusen-en). Gumma. Kuryu Rakusen-en Kanja
Jichikai, 1982, 205-214.

Eubios Journal of Asian and International Bioethics 19 (July 2009)14)

Mitsuda, op. cit., 204.
Mitsuda, op. cit., 204-205.
16)
Sato, H. and Narita, M. Politics of Leprosy
SegregationinJapan:The
Emergence,
Transformation and Abolition of the Patient
Segregation Policy. Social Science & Medicine.
2003;56:2529-2539.
17)
Narita, M. "Rai yobo-ho" 44nen no michinori.
Tokyo, Koseisha, 1996.
18)
Watts, J. Japan's government compensates leprosy
patients for isolation policy. Lancet 2001;357:1599.
15)

Caesarian Sections inAustralia: Medical andEthical Issues- Arthur Saniotis
Discipline of Anthropology, School of Social Sciences,
University of Adelaide, South Australia 5005
[Also affiliated with Discipline of Public Health, Schoolof Population Health and Clinical Practice]
Email: saniotis@yahoo.co.uk
Abstract
Caesarian Sections in Australia have risen
exponentially in the last fifteen years. Reasons for therise of caesarian sections are both broad and complex
and highlight the increasing medicalization andintervention of the western bio-medical model. This
article gives an overview of caesarian sections inAustralia and discusses some of the main medical andethical issues regarding this practice.
Keywords:
Caesariansection,intervention,
medicalisation, ethics
Introduction
Until recently, caesarian section (CS) has been
complementary to vaginal birth deliveries among
Australian women. However, during the last 10-15
years there has been an exponential rise in CS among
Australian women. Consequently, the steep rise in CS
has brought up various medical, social and ethicalissues which have not been adequately addressed.
This paper gives an overview of CS in Australia andpurports some of the medical and ethical issues which
are located in this practice.
Prevalence in CS among Australian Women
CS has increased in Australia as a preferred form ofgiving birth, from a base of 19.4% in 1994 to 28.5% in
12003. Australia‟s rates of CS are high when comparedwith other countries. For example, CS rates in the2
United Kingdom during 2003-2004 were 22.7%, 22.7%
1

Australian Institute of Health and Welfare. (2007)“Australia‟s Mothers and Babies 2003.” AIHW (online)
6
October
2007,athttp://www.ranzcog.edu.au/womenshealth/index.shtml
2
Department of Health (2005) NHS Maternity Statistics,
England: 2003–04 Bulletin 2005/10. Department of Health, 3
March 2006, at http://www.dh.gov.uk/Home/fs/en

107
3

4

in New Zealand, and 9.2% in the Netherlands. In
relation to CS “in 2003, 57.9% were without labour
5
while 41.9% were with labour.”In addition, CS
deliveries from Aboriginal and Torres Strait mothers
were less frequent at 23.3% compared to 28.8% for
5
non-indigenous mothers. From 1983-2003 emergency
6
CS have increased in Australia by 70%.
In Western Australia there were more than 430,000
6
CS deliveries for the period between 1984-2003.
Statistics reveal that planned or elective CS have risenamong females in Western Australia from 6% to 13%
over a twenty year period, while there has been a 70%
6
increase in emergency CS for the same period. In
New South Wales 20% of 131,101 women had a CS for7
the period 1998-2002. Research has also found that
Australian women with private medical cover are threetimes as likely to have elective CS than women who are6
not insured.
This trend is further illustrated withwomen having CS at 37. 4% in Australian private
hospitals while women in Australian public hospitals
5
having CS at 25.7%.
Medical Risks of Caesarian Section
The popularity of CS among Australian women should
not downplay its inherent risks. A 2005 study of
136,000 “second pregnancies” in New South Wales that
had CS performed during their first delivery were foundto be at greater risk of uterine rupture, hysterectomy
and infection.
Moreover, babies that were born
8
prematurely needed intensive care.
In addition,
women who had CS in their first delivery had increasing
complications if the second birth was also delivered by
7
CS. Despite medical improvement, CS delivery has
increasing health complications for the mother and6child.
According to Fenwick et al, CS “poses greater9physical and emotional risk to both mother and baby.”
10 11 12 13 14
A study conducted in the United States

3

New Zealand Health Information Service (2004) Report onMaternity: Maternal and Newborn Information, 12 November
2005,athttp://www.nzhis.govt.nz/publications/maternityreport.html
4
G. Bernard. “Summary of Vital Statistics 1995,” Pediatrics
98, no. 6 (1996): 115–120.
5“Caesarian Sections and Births on the Rise in Australia.”
News-Medical.Net 15 December 2005. 17 October 2007, at
http://www.news-medical.net/?id=15000
6“Dramatic Rise in Caesarian Section in Australia,”
ScienceDaily.com 21 May 2007. 17 October 2007, at
http://www.sciencedaily.com/release/2007/05/070516091842.
htm
7
Effects of Caesarian Sections on Future Pregnancies. 17
October,at
http://www.pregnancyinfo.net/csections_future.html
8
J. Robotham. “Tough New Rules for Caesarian: Growth
Spurt Caesarians in NSW.” Sydney Morning Herald. 7 April
2007.
9
J. Fenwick., J. Gamble., & Y. Hauk. “Reframing Birth: AConsequence of Caesarian Section,” Journal of Advanced
Nursing 56, issue 2 (2006):121-130.
10E. L. Ryding., K. Wijma., &B. WijmaB. “Predisposing
Psychological Factors for Posttraumatic Stress Reactions
After Emergency Caesarean Section,” Acta Obstetrica et
Gynecolgica Scandinavica 77 (1998): 351–352.