How much of pregnancy health advice is plain old prejudice and fear?

Questions as to whether pregnant women should drink alcohol or coffee go beyond the restrictions of an over-cautious medical establishment. It’s to do with how we value people. In her book <em>Expecting Better</em>, Emily Oster has raised some issues that

In 2007, when I was midway through my first full-term pregnancy, government advice on alcohol consumption during pregnancy changed. Moderate drinking – one to two units a week – was reduced to no drinking at all. Crucially, there was no new clinical evidence to support this change. It was simply in order to be “on the safe side”.

I felt furious, so furious I wrote to the Department of Health. I’d given up alcohol anyhow – again, to be “on the safe side” – but that, it seemed to me, was a personal preference. Having someone else tell me to be over-cautious was another thing entirely. It wasn’t booze that was being withdrawn, it was a basic level of respect for the decision-making capabilities of anyone who was pregnant.

In Expecting Better, Emily Oster describes how in her experience, “being pregnant was a lot like being a child again. There was always someone telling you what to do”. You are patronised and ordered to restrict your realm of experience significantly, yet the reasons why can seem – and often are – terribly flimsy.

Exploring this in more detail (at first merely in order to gain “permission” to drink a cup of coffee) Oster found that the evidence used to back up many pregnancy recommendations is weak or based on poor research. She discovered that the decision-making processes she, as an economist, taught her students – collect data, but also weigh up personal costs and benefits – did not seem to apply. Oster’s book is the result of her own research, her key aim being to present data that will allow others to make their own cost and benefit calculations. “This book,” she writes, “is very specifically not about making recommendations; it’s about acknowledging that if you have the right information you can make the right decision for yourself.”

Expecting Better is a pregnancy guide, not a political tract, and as such it deserves much praise. It’s a book I would recommend to anyone expecting their first child. Nonetheless, I’d add the proviso that while you don’t have to be middle-class to read it, it helps. It’s always easier to challenge received wisdom when you’ve got a little unearned authority behind you to start with, as I discovered when the Department of Health responded to my letter (was the use of my Dr title the reason why the new rules drinking rules weren’t “aimed at women like you”?). Facts matter, sure, but so do social judgments and stereotypes. A lack of information is just one of many things which hold us back from making the choices that are best for us.

I don’t wish to criticise a book for all the things it doesn’t say, particularly if it never set out to say them in the first place. However, right now I’d like to see a different book on pregnancy, risk and choice, one that looks beyond merely presenting the facts and towards the social and cultural conditions that still militate against autonomous decision-making. Class is one factor, but I suspect sexism and ingrained anti-choice sentiment also play their part. It’s all very well for Oster to explain that “the value of having numbers – data – is that they aren’t subject to someone else’s interpretation. They are just the numbers. You can decide what they mean for you”. But in the real world, sadly, that’s just not true.

Clearly there’s no law (as yet) against a pregnant woman wanting the odd cappuccino. But what about the widespread belief that such a woman’s wants are irrelevant when set against anything that could, in one’s wildest imagination, harm the foetus? Such a woman will be told that coffee avoidance isn’t a personal matter but a moral absolute. So what if she’s read Oster’s book and knows for sure that one measly cup is absolutely fine? She also knows that “absolutely fine” doesn’t count for much when you’re reduced to a walking womb whose feelings and desires take second place. This is an issue that goes beyond the restrictions of an over-cautious medical establishment. It’s to do with how we value people. In the US we’re increasingly seeing those who are pregnant imprisoned for taking risks that everyone else is allowed to take with impunity. At this point what may have started out as merely flawed advice becomes a serious human rights issue.

It would be interesting to see how recommendations made to those who are pregnant compare with those made to people facing other medical conditions. Yes, we all get patronised and pressured into accepting treatments which benefit us more on paper than in real life, but are there subtle differences in priorities and value judgements when the wellbeing of the innocent unborn is at stake? Perhaps there’s a hierarchy in place. For instance, are there also links between the way in which the pregnant have to suck it up for the hypothetical good of others and ways in which some sufferers of mental illness endure treatments which destroy their quality of life but make others – yet more supposed “innocents” – feel “safer”? How much of a factor is plain old prejudice and fear? Who gets to own his or her own body?

I think these are questions worth answering, if not by Oster, then by someone willing to take her pure data and re-examine it alongside the powerful distortions wrought by social pressure and moral censure. In the meantime, however, I’d thank Oster for how far she’s brought this debate already. Even if the initial motivation for her research was her own dread of a caffeine withdrawal headache, she’s written something that should be of practical value to all those who are pregnant – providing the rest of society allows it to be. 

A pregnant woman drinks coffee at her desk. Photo: Getty

Glosswitch is a feminist mother of three who works in publishing.

Photo: Getty
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In focusing on the famous few, we risk doing a disservice to all victims of child sexual abuse

There is a danger that we make it harder, not easier, for victims to come forward in future. 

Back in the 1970s when relations between journalists and police were somewhat different to today a simple ritual would be carried out around the country at various times throughout the week.

Reporters, eager for information for their regional newspaper, would take a trip to the local station and there would be met by a desk sergeant who would helpfully skim through details in the crime Incident Book.

Among the entries about petty thefts, burglaries and road accidents there would occasionally be a reference to an allegation of incest. And at this point the sergeant and journalist might well screw-up their faces, shake their heads and swiftly move on to the next log. The subject was basically taboo, seen as something ‘a bit mucky,’ not what was wanted in a family newspaper.

And that’s really the way things stayed until 1986 when ChildLine was set up by Dame Esther Rantzen in the wake of a BBC programme about child abuse. For the first time children felt able to speak out about being sexually assaulted by the very adults whose role in life was to protect them.

And for the first time the picture became clear about what incest really meant in many cases. It wasn’t simply a low level crime to be swept under the carpet in case it scratched people’s sensitivities. It frequently involved children being abused by members of their close family, repeatedly, over many years.

Slowly but surely as the years rolled on the NSPCC continued to press the message about the prevalence of child sexual abuse, while encouraging victims to come forward. During this time the corrosive effects of this most insidious crime have been painfully detailed by many of those whose lives have been derailed by it. And of course the details of the hundreds of opportunistic sexual assaults committed by Jimmy Savile have been indelibly branded onto the nation’s consciousness.

It’s been a long road - particularly for those who were raped or otherwise abused as children and are now well into their later years - to bring society around to accepting that this is not to be treated as a dark secret that we really don’t want to expose to daylight. Many of those who called our helpline during the early days of the Savile investigation had never told anyone about the traumatic events of their childhoods despite the fact they had reached retirement age.

So, having buried the taboo, we seem to be in danger of giving it the kiss of life with the way some cases of alleged abuse are now being perceived.

It’s quite right that all claims of sexual assault should be investigated, tested and, where there is a case, pursued through the judicial system. No one is above the law, whether a ‘celebrity’ or a lord.

But we seem to have lost a sense of perspective when it comes to these crimes with vast resources being allocated to a handful of cases while many thousands of reported incidents are virtually on hold.

The police should never have to apologise for investigating crimes and following leads. However, if allegations are false or cannot be substantiated they should say so. This would be a strength not a weakness.

It is, of course, difficult that in many of the high-profile cases of recent times the identities of those under investigation have not been officially released by the police but have come to light through other means. Yet we have to deal with the world as it is not as we wish it would be and once names are common knowledge the results of the investigations centring on them should be made public.

When it emerges that someone in the public eye is being investigated for historical child abuse it obviously stirs the interest of the media whose appetite can be insatiable. This puts pressure on the police who don’t want to repeat the mistakes of the past by allowing offenders to slip through their hands.  And so there is a danger, as has been seen in recent cases, that officers lack confidence in declaring there is a lack of evidence or the allegations are not true. 

The disproportionate weight of media attention given to say, Sir Edward Heath, as opposed to the Bradford grooming gang sentenced this week, shows there is a danger the pendulum is swinging too far the other way. This threatens the painstaking work invested in ensuring the public and our institutions recognise child abuse as a very real danger. 

Whilst high profile cases have helped the cause there is now a real risk that the all-encompassing focus on them does both victims of abuse and those advocating on their behalf a fundamental disservice.

As the public watches high -profile cases collapsing amidst a media fanfare genuine convictions made across the country week in week out go virtually unannounced. If this trend continues they may start to believe that child sexual abuse isn’t the prolific problem we know it to be.

So, while detectives peer into the mists of time, searching for long lost clues, we have to face the unpalatable possibility that offences being committed today will in turn become historical investigations because there is not the manpower to deal with them right now.

Operation Midland, which was set-up to check claims that boys were abused in the 1970s and 80s by a high-level group of paedophiles including politicians, military figures and members of law enforcement agencies, has had up to 40 detectives assigned to it and a similar investigation. Admittedly some of these were murder and major crimes officers but that’s still a large contingent.

In fact if such squads were formed for every historical case the Metropolitan Police would be overwhelmed as last year alone it received reports from nearly 1100 adults – many of them well past retirement age –that they were sexually assaulted when children.

So, now the Goddard Inquiry is in full swing, taking evidence about allegations of child sex crimes involving ‘well known people’ as well as institutional abuse, how do we ensure we don’t fail today’s victims?

If they start to think their stories are going to be diminished by the continuing furore over how some senior public figures have been treated by the police they will stay silent. Therefore we have to continue to encourage them to come forward, to give them the confidence of knowing they will be listened to.

If we don’t we will find ourselves back in those incestuous days where people conspired to say and do nothing to prevent child abuse.

Peter Wanless is Chief Executive of the NSPCC.