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 It wasn’t booze that was being withdrawn, it was a basic level of respect for the decision-making capabilities of anyone who was pregnant.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

The vitriol aimed at Hillary Clinton shows the fragility of women's half-won freedom

The more I understand about the way the world treats women, the more I feel the terror of it coming for me.

I’m worried about my age. I’m 36. There’s a line between my eyebrows that’s been making itself known for about the last six years. Every time I see a picture of myself, I automatically seek out the crease. One nick of Botox could probably get rid of it. Has my skin lost its smoothness and glow?

My bathroom shelf has gone from “busy” to “cluttered” lately with things designed to plump, purify and resurface. It’s all very pleasant, but there’s something desperate I know at the bottom of it: I don’t want to look my age.

You might think that being a feminist would help when it comes to doing battle with the beauty myth, but I don’t know if it has. The more I understand about the way the world treats women – and especially older women – the more I feel the terror of it coming for me. Look at the reaction to Hillary Clinton’s book. Too soon. Can’t she go quietly. Why won’t she own her mistakes.

Well Bernie Sanders put a book out the week after the presidential election – an election Clinton has said Sanders did not fully back her in –  and no one said “too soon” about that. (Side note: when it comes to not owning mistakes, Sanders’s Our Revolution deserves a category all to itself, being as how the entire thing was written under the erroneous impression that Clinton, not Trump, would be president.) Al Gore parlayed his loss into a ceaseless tour of activism with An Inconvenient Truth, and everyone seems fine with that. John McCain – Christ, everyone loves John McCain now.

But Hillary? Something about Hillary just makes people want to tell her to STFU. As Mrs Merton might have asked: “What is it that repulses you so much about the first female candidate for US president?” Too emotional, too robotic, too radical, too conservative, too feminist, too patriarchal – Hillary has been called all these things, and all it really means is she’s too female.

How many women can dance on the head of pin? None, that’s the point: give them a millimetre of space to stand in and shake your head sadly as one by one they fall off. Oh dear. Not this woman. Maybe the next one.

It’s in that last bit that that confidence racket being worked on women really tells: maybe the next one. And maybe the next one could be you! If you do everything right, condemn all the mistakes of the women before you (and condemn the women themselves too), then maybe you’ll be the one standing tippy-toe on the miniscule territory that women are permitted. I’m angry with the men who engage in Clinton-bashing. With the women, it’s something else. Sadness. Pity, maybe. You think they’ll let it be you. You think you’ve found the Right Kind of Feminism. But you haven’t and you never will, because it doesn’t exist.

Still, who wouldn’t want to be the Right Kind of Feminist when there are so many ready lessons on what happens to the Wrong Kind of Feminist. The wrong kind of feminist, now, is the kind of feminist who thinks men have no right to lease women by the fuck (the “sex worker exclusionary radical feminist”, or SWERF) or the kind of feminist who thinks gender is a repressive social construct (rechristened the “trans exclusionary radical feminist”, or TERF).

Hillary Clinton, who has said that prostitution is “demeaning to women” – because it absolutely is demeaning to treat sexual access to women as a tradeable commodity – got attacked from the left as a SWERF. Her pre-election promises suggest that she would probably have continued the Obama administration’s sloppy reinterpretation of sex discrimination protections as gender identity protections, so not a TERF. Even so, one of the charges against her from those who considered her not radical enough was that she was a “rich, white, cis lady.” Linger over that. Savour its absurdity. Because what it means is: I won’t be excited about a woman presidential candidate who was born female.

This year was the 50th anniversary of the partial decriminalisation of homosexuality, and of the Abortion Act. One of these was met with seasons of celebratory programming; one, barely mentioned at all. (I took part in a radio documentary about “men’s emotional experiences of abortion”, where I made the apparently radical point that abortion is actually something that principally affects women.) No surprise that the landmark benefiting women was the one that got ignored. Because women don’t get to have history.

That urge to shuffle women off the stage – troublesome women, complicated women, brilliant women – means that female achievements are wiped of all significance as soon as they’re made. The second wave was “problematic”, so better not to expose yourself to Dworkin, Raymond, Lorde, Millett, the Combahee River Collective, Firestone or de Beauvoir (except for that one line that everyone misquotes as if it means that sex is of no significance). Call them SWERFs and TERFs and leave the books unread. Hillary Clinton “wasn’t perfect”, so don’t listen to anything she has to say based on her vast and unique experience of government and politics: just deride, deride, deride.

Maybe, if you’re a woman, you’ll be able to deride her hard enough to show you deserve what she didn’t. But you’ll still have feminine obsolescence yawning in your future. Even if you can’t admit it – because, as Katrine Marçal has pointed out in Who Cooked Adam Smith’s Dinner?, our entire economy is predicated on discounting women’s work – you’ll need the politics of women who analysed and understood their situation as women. You’ll still be a woman, like the women who came before us, to whom we owe the impossible debt of our half-won freedom.

In the summer of 2016, a radio interviewer asked me whether women should be grateful to Clinton. At the time, I said no: we should be respectful, but what I wanted was a future where women could take their place in the world for granted. What nonsense. We should be laying down armfuls of flowers for our foremothers every day.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.