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 It wasn’t booze that was being withdrawn, it was a basic level of respect for the decision-making capabilities of anyone who was pregnant.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

Bureaucratic ability to hold corporate interest account will be more necessary now than ever.

Fireworks lit up the sky in rural North Dakota on Sunday night, as protestors celebrated at what is being widely hailed as a major victory for rights activism.

After months spent encamped in tee-pees and tents on the banks of the Canonball river, supporters of the Standing Rock Sioux Tribe finally received the news they’d been waiting for: the US Army Corps has not issued the Dakota Access pipeline with the permit it requires to drill under Lake Oahe.

“We […] commend with the utmost gratitude the courage it took on the part of President Obama, the Army Corps, the Department of Justice and the Department of the Interior to take steps to correct the course of history and to do the right thing" said a statement released by the Standing Rock Sioux tribe’s chairman, Dave Archambault II.

With the camp’s epic setting, social-media fame, and echoes of wider injustice towards Native Americans, the movement has already earned a place in the history books. You can almost hear the Hollywood scriptwriters tapping away.

But as the smoke settles and the snow thickens around the thinning campsite, what will be Standing Rock’s lasting legacy?

I’ve written before about the solidarity, social justice and environmental awareness that I think make this anti-pipeline movement such an important symbol for the world today.

But perhaps its most influential consequence may also be its least glamorous: an insistence on a fully-functioning and accountable bureaucratic process.

According to a statement from the US Army’s Assistant Secretary of Civil Words, the Dakota Access project must “explore alternate routes”, through the aid of “an Environmental Impact Statement with full public input and analysis”.

This emphasis on consultation and review is not big-statement politics from the Obama administration. In fact it is a far cry from his outright rejection of the Keystone Pipeline project in 2015. Yet it may set an even more enduring example.

The use of presidential power to reject Keystone, was justified on the grounds that America needed to maintain its reputation as a “global leader” on climate change. This certainly sent a clear message to the world that support from Canadian tar-sands oil deposits was environmentally unacceptable.

But it also failed to close the issue. TransCanada, the company behind Keystone, has remained “committed” to the project and has embroiled the government in a lengthy legal challenge. Unsurprisingly, they now hope to “convince” Donald Trump to overturn Obama’s position.

In contrast, the apparently modest nature of the government’s response to Dakota Access Pipeline may yet prove environmental justice’s biggest boon. It may even help Trump-proof the environment.

“Although we have had continuing discussion and exchanges of new information with the Standing Rock Sioux and Dakota Access, it’s clear that there’s more work to do”, said the Jo-Ellen Darcy, the Army’s Assistant Secretary for Civil Works.

Back in July, the same Army Corps of Engineers (which has jurisdiction over domestic pipelines crossing major waterways) waved through an environmental assessment prepared by the pipeline’s developer and approved the project. The Standing Rock Sioux Tribe subsequently complained that the threat to its water supply and cultural heritage had not been duly considered. This month’s about-turn is thus vital recognition of the importance of careful and extensive public consultation. And if ever such recognition was needed it is now.

Not only does Donald Trump have a financial tie to the Energy Transfer Partners but the wider oil and gas industry also invested millions into other Republican candidate nominees. On top of this, Trump has already announced that Myron Ebell, a well known climate sceptic, will be in charge of leading the transition team for the Environmental Protection Agency.

Maintaining the level of scrutiny finally granted for Standing Rock may not be easy under the new administration. Jennifer Baker, an attorney who has worked with tribes in South Dakota on pipeline issues for several years, fears that the ground gained may not last long. But while the camp at Standing Rock may be disbanding, the movement is not.

This Friday, the three tribes who have sued the Corps (the Yankont, Cheyenne River, and Standing Rock Sioux Tribes) will head to a hearing before the Inter-American Commission on Human Rights, seeking to increase pressure on the government to comply with both domestic and international law as it pertains to human rights and indigenous soveriegnty. 

What the anti-pipeline struggle has shown - and will continue to show - is that a fully accountable and transparent bureaucratic process could yet become the environment's best line of defence. That – and hope.

India Bourke is an environment writer and editorial assistant at the New Statesman.