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Banning pregnant netballers—is this the answer?
  1. S White
  1. Olympic Park Sports Medicine Centre, Swan Street, Melbourne 3000, Australia
  1. Correspondence to:
 Dr White; 
 susanwhite{at}optusnet.com.au

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A forum on a ban of pregnant netballers considered that the ban was discriminatory and that pregnant women should have the right to make decisions about competing in sporting activities

A recent move by Netball Australia to ban all pregnant netballers at all levels from participating in their sport has been met with a mixture of outrage and sympathy. Those who advocate a woman's right to make decisions about her own pregnancy, including sports participation, have been vocal in their disagreement with this ban. Sporting administrators in fear of litigation and some sporting competitors concerned about playing against a pregnant opponent have welcomed the ban.

The introduction of the ban had an immediate effect, with a national level netballer announcing her pregnancy (first trimester) and applying to the Human Rights and Equal Opportunity Commission for a lifting of the ban on the basis of discrimination. The case is pending.

Such a controversial situation prompted the Australian Sports Commission to hold a national forum with a range of experts and interested parties invited to contribute. Firstly, the available medical evidence was discussed. Associate Professor Caroline Finch, Chair of the National SportSafe Committee and a leading epidemiologist in the area of sports injury, reported that there is not a single case of an adverse outcome in pregnancy related to sports participation in the world literature. Admittedly there are no specific studies on pregnancy and contact sports, but numerous studies have looked at aerobic activities and fetal outcome.

A number of papers now concur that women who take moderate exercise (less than four times a week) in fact have larger babies than non-exercisers or more extreme exercisers.1 None of these studies recorded any problems in terms of labour, delivery, or Apgar scores in any of the groups. There are now even a few studies of cognitive behaviour in newborns and 1 year old and 5 year old children all showing that those whose mothers exercised during pregnancy functioned as well as, or better than, those whose mothers did not.2

Current available evidence suggests that sport and exercise, if anything, has a beneficial effect on the fetus/child.

In terms of contact in sport, the only large body of literature that considers fetal injury in relation to contact is in motor vehicle accidents and domestic violence, neither of which could be considered comparable to a game of netball. To further attempt to quantify a possible risk from sporting contact, Finch used data from two large epidemiological studies on the incidence of types of sporting injuries. In both studies, less than 2% of all injuries, in a range of sports, involved the chest or abdomen and in both studies all contacts were considered minor.

Finch conceded that there is room for more research in this area, but the current available evidence suggests that sport and exercise, if anything, has a beneficial effect on the fetus/child.

Professor Wendy Brown discussed public health issues, in particular female participation rates in sport. Professor Brown is the principal investigator with the Australian Longitudinal Study of Women's Health, involving 40 000 participants. Part of the study focused on sports participation and showed that the biggest fall in participation rates in women is during their 20s and 30s (child bearing years) when there are a number of practical barriers to regular exercise. Couple this with the fact that physical inactivity is one of the largest contributors to ill health,3 more so in women, then there is an overwhelming argument to encourage women to exercise during this time rather than send the wrong message by banning participation in netball (the single largest participation sport for women in Australia).

Dr Michael Sedgley, obstetrician and past chairman of the medicolegal committee of the Royal Australian and New Zealand College Of Obstetricians and Gynecologists, argued that there is no evidence to suggest that exercise during pregnancy is in anyway harmful to the fetus. He also cited research showing that exercise during pregnancy can decrease the incidence of nausea and depression and increase feelings of wellbeing in the mother. Unfortunately there is no evidence that active women have shorter or easier labours, but it is possible that they may recover more quickly in the post partum period. He advocated the right of the woman to make a choice about sports participation during pregnancy, in conjunction with her medical practitioner.

Exercise during pregnancy can decrease the incidence of nausea and depression and increase feelings of wellbeing in the mother.

A legal session involved discussion on the current Australian legislation with regard to anti-discrimination, occupational health and safety, and negligence law. Banning a person from participating in an activity because of their sex, religion, or pregnant state is against the provisions of the Anti-discrimination Act. To do so, a group must either apply for an exemption (which Netball Australia did not do) or show exceptional circumstances (the test case awaits).

In terms of the risks of negligence for sporting organisations, including its administrators, umpires, and opposing players, it has never been tested. The legal expert present stated that “causation” must be shown, and he felt that there was insufficient evidence in the current literature to support this. This point of view was disputed by some who were concerned that in a trial in which a jury may decide the matter, such an emotive case as (potential) injury to a child may affect the judgment.

A representative of the insurance industry acknowledged that one of the biggest issues facing sporting organisations in Australia is the rising cost and inaccessibility of public liability insurance, without which an organisation cannot operate. He felt that the current wording of the general policies would cover injuries to a pregnant woman and her fetus but that it had never been tested. If a case was to occur, this may significantly increase the premiumsrequired to cover future risk, making such cover beyond the reach of most sporting organisations and putting their existence in doubt.

Finally ethicists discussed the issues involving the ban, as well as confidentiality issues in relation to team medical officials in the case of a pregnant athlete involved in a sport that bans participation.

The resultant informal consensus of the forum was that the ban was discriminatory, that women should have the right to make decisions about competing in sporting activities (in conjunction with their medical practitioners), and that it is mandatory to better educate players, officials, and medical practitioners about the current state of knowledge on exercise during pregnancy. Litigation for negligence was considered unlikely from the current evidence in the literature.

Meanwhile Netball Australia continues its ban. This ban has generated much discussion and hopefully inspired researchers and the government to investigate and fund relevant research in this area.

The outcome of the case before the anti-discrimination board will certainly affect future policy, but it is hoped that sensible discussion of the issues, education of all parties involved, and the results of future research will contribute more to the development of participation guidelines than the fear of litigation.

A forum on a ban of pregnant netballers considered that the ban was discriminatory and that pregnant women should have the right to make decisions about competing in sporting activities

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