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 It wasn’t booze that was being withdrawn, it was a basic level of respect for the decision-making capabilities of anyone who was pregnant.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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Why relations between Theresa May and Philip Hammond became tense so quickly

The political imperative of controlling immigration is clashing with the economic imperative of maintaining growth. 

There is no relationship in government more important than that between the prime minister and the chancellor. When Theresa May entered No.10, she chose Philip Hammond, a dependable technocrat and long-standing ally who she had known since Oxford University. 

But relations between the pair have proved far tenser than anticipated. On Wednesday, Hammond suggested that students could be excluded from the net migration target. "We are having conversations within government about the most appropriate way to record and address net migration," he told the Treasury select committee. The Chancellor, in common with many others, has long regarded the inclusion of students as an obstacle to growth. 

The following day Hammond was publicly rebuked by No.10. "Our position on who is included in the figures has not changed, and we are categorically not reviewing whether or not students are included," a spokesman said (as I reported in advance, May believes that the public would see this move as "a fix"). 

This is not the only clash in May's first 100 days. Hammond was aggrieved by the Prime Minister's criticisms of loose monetary policy (which forced No.10 to state that it "respects the independence of the Bank of England") and is resisting tougher controls on foreign takeovers. The Chancellor has also struck a more sceptical tone on the UK's economic prospects. "It is clear to me that the British people did not vote on June 23 to become poorer," he declared in his conference speech, a signal that national prosperity must come before control of immigration. 

May and Hammond's relationship was never going to match the remarkable bond between David Cameron and George Osborne. But should relations worsen it risks becoming closer to that beween Gordon Brown and Alistair Darling. Like Hammond, Darling entered the Treasury as a calm technocrat and an ally of the PM. But the extraordinary circumstances of the financial crisis transformed him into a far more assertive figure.

In times of turmoil, there is an inevitable clash between political and economic priorities. As prime minister, Brown resisted talk of cuts for fear of the electoral consequences. But as chancellor, Darling was more concerned with the bottom line (backing a rise in VAT). By analogy, May is focused on the political imperative of controlling immigration, while Hammond is focused on the economic imperative of maintaining growth. If their relationship is to endure far tougher times they will soon need to find a middle way. 

George Eaton is political editor of the New Statesman.