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 It wasn’t booze that was being withdrawn, it was a basic level of respect for the decision-making capabilities of anyone who was pregnant.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.

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The NS leader: Cold Britannia

Twenty years after the election of New Labour, for the left, it seems, things can only get worse. 

Twenty years after the election of New Labour, for the left, it seems, things can only get worse. The polls suggest a series of grim election defeats across Britain: Labour is 10 points behind the Conservatives even in Wales, putting Theresa May’s party on course to win a majority of seats there for the first time in a century. Meanwhile, in Scotland, the psephologist John Curtice expects the resurgent Tories, under the “centrist” leadership of Ruth Davidson, to gain seats while Labour struggles to cling on to its single MP.

Where did it all go wrong? In this week’s cover essay, beginning on page 26, John Harris traces the roots of Labour’s present troubles back to the scene of one of its greatest triumphs, on 1 May 1997, when it returned 418 MPs to the Commons and ended 18 years of Conservative rule. “Most pop-culture waves turn out to have been the advance party for a new mutation of capitalism, and so it proved with this one,” Mr Harris, one of the contributors to our New Times series, writes. “If Cool Britannia boiled down to anything, it was the birth of a London that by the early Noughties was becoming stupidly expensive and far too full of itself.”

Jump forward two decades and London is indeed now far too dominant in the British economy, sucking in a disproportionate number of graduates and immigrants and then expecting them to pay £4 for a milky coffee and £636,777 for an average house. Tackling the resentment caused by London’s dominance must be an urgent project for the Labour Party. It is one that Mr Corbyn and his key allies, John McDonnell, Emily Thornberry and Diane Abbott, are not well placed to do (all four are ultra-liberals who represent
London constituencies).

Labour must also find a happy relationship with patriotism, which lies beneath many of the other gripes made against Mr Corbyn: his discomfort with the institutions of the British state, his peacenik tendencies, his dislike of Nato and military alliances, his natural inclination towards transnational or foreign liberation movements, rather than seeking to evolve a popular national politics.

New Labour certainly knew how to wave the flag, even if the results made many on the left uncomfortable: on page 33, we republish our Leader from 2 May 1997, which complained about the “bulldog imagery” of Labour’s election campaign. Yet those heady weeks that followed Labour’s landslide victory were a time of optimism and renewal, when it was possible for people on the left to feel proud of their country and to celebrate its achievements, rather than just apologise for its mistakes. Today, Labour has become too reliant on misty invocations of the NHS to demonstrate that it likes or even understands the country it seeks to govern. A new patriotism, distinct from nationalism, is vital to any Labour revival.

That Tony Blair and his government have many detractors hardly needs to be said. The mistakes were grave: the catastrophic invasion of Iraq, a lax attitude to regulating the financial sector, a too-eager embrace of free-market globalisation, and the failure to impose transitional controls on immigration when eastern European states joined the EU. All contributed to the anger and disillusionment that led to the election as Labour leader of first the hapless Ed Miliband and then Jeremy Corbyn, a long-time rebel backbencher.

However, 20 years after the victory of the New Labour government, we should also acknowledge its successes, not least the minimum wage, education reform, Sure Start, a huge fall in pensioner poverty and investment in public services. Things did get better. They can do so again.

The far right halted

For once, the polls were correct. On 23 April, the centrist Emmanuel Macron triumphed in the first round of the French election with 24 per cent of the vote. The Front National’s Marine Le Pen came second with 21.3 per cent in an election in which the two main parties were routed. The two candidates will now face off on 7 May, and with the mainstream candidates of both left and right falling in behind Mr Macron, he will surely be France’s next president.

“There’s a clear distinction to be made between a political adversary and an enemy of the republic,” said Benoît Hamon, the candidate of the governing Parti Socialiste, who had strongly criticised Mr Macron during the campaign. “This is deadly serious now.” He is correct. Mr Macron may be a centrist rather than of the left but he is a democratic politician. Ms Le Pen is a borderline fascist and a victory for her would herald a dark future not just for France but for all of Europe. It is to Donald Trump’s deep shame that he appeared to endorse her on the eve of the vote.

This article first appeared in the 27 April 2017 issue of the New Statesman, Cool Britannia 20 Years On

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