Exploring the perspective of midwives involved in offering serum screening for Down's syndrome in Northern Ireland

Aims. To explore the perspective of midwives offering serum screening for Down’s syndrome.

Background. Previous literature has indicated that the offer and discussion of prenatal serum screening tests with women is complex, and health professionals may influence women’s decisions to accept or decline screening. Midwives are usually the key professional to offer serum screening for Down’s syndrome in the UK but their perspective is relatively neglected in the literature.

Design. An explorative qualitative interview study with 15 midwives employed in a maternity unit in Northern Ireland involved in offering prenatal screening to pregnant women. Data were collected from 1 July 2005–31 October 2005.

Methods. A focused ethnographic approach was used to explore the perspective of midwives.

Results. Midwives reported difficulty in explaining the test to women and felt unable to provide the necessary information to adequately inform women within their appointment time. The test offered (the triple test) and potential pathway of subsequent care, were identified as sources of professional and personal conflict by midwives. The expectation that midwives would provide a universal offer of Down’s syndrome serum screening but be unable to support women regarding termination of pregnancy also created dissonance.

Conclusions. The feasibility of proceeding with a universal serum screening programme for Down’s syndrome is questionable in countries which legally or culturally oppose termination of pregnancy. Professionals practising within environments such as this experience conflict in their role, which affects communication with women when discussing screening tests.

Relevance to clinical practice. As midwives are often, the primary health professional providing information to women, it is important that midwives are key participants in ongoing planning and discussions about screening policy to ensure programmes are implemented successfully.

Keeping a sense of proportion but losing all perspective: a critique of Gorard's notion of the 'Politician's Error'

In 1999 Stephen Gorard published an article in this journal in which he provided a trenchant critique of what he termed the `politician's error' in analysing differences in educational attainment. The main consequence of this error, he argued, has been the production of misleading findings in relation to trends in educational performance over time that have, in turn, led to misguided and potentially damaging policy interventions. By using gender differences in educational attainment as a case study, this article begins by showing how Gorard's notion of the politician's error has been largely embraced and adopted uncritically by those within the field. However, the article goes on to demonstrate how Gorard's own preferred way of analysing such differences – by calculating and comparing proportionate changes in performance between groups – is also inherently problematic and can lead to the production of equally misleading findings. The article will argue that there is a need to develop a more reliable and valid way of measuring trends in educational performance over time and will show that one of the simplest ways of doing this is to make use of existing, and widely accepted, measures of effect size.

Illicit Cycle of Narcotics from a Human Rights Perspective

The purpose of this article is to analyse the illicit cycle of narcotics within a human rights framework. It begins by illustrating the benefits of adopting a human rights framework, such as its ability to promote victim-centred and holistic approaches. The article then identifies key human rights issues such as poverty, forced labour, law enforcement practices and addiction to narcotics. It continues with an analysis of the nature and the extent of obligations imposed upon States. This article focuses on three categories of human rights obligations to address: 1) the supply of narcotics; 2) narcotics trafficking; and 3) the demand for narcotics. The main conclusion reached is that a human rights framework can strengthen the global action against the illicit cycle of narcotics.