A Rumsfeldian attack on mothers-to-be
The new warning that pregnant women should avoid booze is not evidence-based – rather it springs from the relentless moralisation of pregnancy.
The UK’s National Institute for Health and Clinical Excellence (NICE) has issued new guidelines on how much alcohol women should drink while pregnant: none.
The guidelines seem to be based on the approach taken by that famous American philosopher, Donald Rumsfeld. You may recall that a few years ago Rumsfeld responded to a question about whether he had any evidence that Iraq had supplied weapons of mass destruction to terrorists by stating: ‘The absence of evidence is not an evidence of absence.’
NICE, too, is not worried about the absence of evidence that consuming the odd glass of wine is harmful to fetuses. It accepts that its guidelines are not supported by research. Yet it believes that ‘absence of evidence’ should not deter it from preaching to women about the alleged dangers of drinking alcohol during pregnancy.
The moral policing of pregnancy
Back in May 1977, American TV viewers were horrified by images of Melissa – the first child suffering from Fetal Alcohol Syndrome (FAS) to appear on network television news.
The aim of the news report was to warn the public of the terrifying consequences of alcohol consumption during pregnancy. The message communicated by the images on the news was that Melissa was a casualty of a horrific condition that could have been avoided if her mum had just said no to alcohol. Melissa was described in the following terms: ‘She is very, very small; she has microcephaly, which means that her head is very small. She also has short palperable fissures or small eye slits, and she is mentally deficient.’ (1)
Melissa came to personify the dreadful consequences of reckless behaviour by selfish expectant mothers. This was a cautionary tale, which, since the 1970s, has been repeated time and again by campaigners who wish to police the conduct of pregnant women. A day after the Melissa news report in May 1977, a leading crusading organisation issued a dire warning: it said that those who consumed more than two drinks a day during pregnancy had a very high chance of giving birth to a mentally or physically impaired baby.
In the years that followed, alcohol consumption during pregnancy came to be portrayed as a moral failing, and as a grave risk to the wellbeing of the newborn. FAS awareness activists argued that any amount of alcohol during pregnancy posed a threat to the fetus. This unproven claim was soon given legitimacy by officialdom. In 1981, the Surgeon General of the US advised ‘women who are pregnant (or considering pregnancy) not to drink alcoholic beverages and to be aware of the alcoholic content of foods and drugs’.
It is not so much medical research that motivates health campaigns on this issue, but rather the belief that it is morally wrong for pregnant women to drink. Many moral entrepreneurs were disappointed when, in November 2007, a study by researchers at Oxford University failed to find a link between binge drinking and birth defects. Even the researchers themselves seemed taken aback by their findings. The absence of evidence that there is a link between consuming alcohol and birth defects did not deter the head of the Oxford research group from warning mothers-to-be to avoid booze… just in case! Dr Ron Gray said his research ‘did not give women a licence to drink during pregnancy’, and claimed that ‘future research could uncover evidence of harm’ (2).
This refusal to ‘give permission’ for wayward behaviour, despite the outcome of the research, shows that the diseasing of pregnancy is fraught with moral implications. Some public health officials were clearly aggrieved that the research offered no evidence to support their moral crusade. Indeed, they were explicitly concerned that the Oxford study might undermine arguments for the prohibition of alcohol consumption during pregnancy.
An official at the Royal College of Midwives (RCM) said she was ‘deeply concerned that this study could imply that there is little substantive evidence that binge drinking while pregnant seriously harms a developing fetus and gives the impression that drinking during pregnancy is safe’. From this perspective, any evidence that suggests pregnant women can safely have an occasional glass of wine is perceived as an outrage. This kind of response is not surprising, however, since the cultivation of anxieties about drinking during pregnancy is underpinned by the idea that it is a morally dangerous act.
Those who are convinced that drinking while pregnant is immoral can always count on ‘new research’ to provide fresh arguments. A few months after the Oxford study, it was claimed that new research, for the ‘first time’, suggested that ‘autism may be triggered by the child’s mother drinking alcohol during pregnancy’. Although the author of the study qualified his claim by stating that prenatal alcohol was ‘possibly’ the cause of autism, the headline of one newspaper article about the research baldly stated: ‘Drinking during pregnancy risks autism in babies.’ (3)
Sadly, when it comes to moralising about the conduct of pregnant women, the status of research and evidence is irrelevant. A few days after the publication of the Oxford study last year, NICE abandoned its previous guidelines and warned women not to drink any alcohol during the first three months of pregnancy. It suggested that from the fourth month onwards, women could drink a very small amount but never more than on one or two days a week.
So what has motivated NICE’s new guidelines, published today, which state that women should ideally not drink any alcohol throughout their pregnancies? Dr Rhona Hughes, who chaired the committee that developed the guidelines, says the new recommendations are not based on scientific evidence. Rather, what motivated this latest move was a desire to protect women from their own feckless behaviour. It seems that NICE takes the view that since every pregnant women is a potential binge drinker, it is better to insist on ‘just saying no’.
As in the case of FAS, most health advice targeting pregnant women tends to expand, escalate and exaggerate the threats they face. In recent years, the advice to pregnant women to cut down on caffeine has given way to the recommendation that they should cut it our altogether during the first three months of pregnancy. One study claimed that pregnant women who consumed two or more cups of coffee a day were twice as likely to miscarry as those who abstained altogether (4).
The relentless medicalisation of pregnancy encourages a proliferation of health warnings about every aspect of an expectant mother’s experience. It’s as if scaremongers simply cannot resist the temptation to prey upon the anxieties of pregnant women, who are understandably nervous about the novel and uncertain experience of carrying a child and giving birth. So the New Labour government issued a warning in January 2007 suggesting that pregnant women should avoid close contact with sheep during lambing season. Apparently, such contact could damage their own and their fetus’s health because some ewes carry dangerous infections.
Pregnant women have also been warned not to take Vitamin E supplements because they might harm their unborn child. That came as a shock to some mothers-to-be – previous research had claimed that Vitamin E, an antioxidant, had a useful protective effect against miscarriage and pre-eclampsia. In May 2007, pregnant women were warned by the Food Standards Authority not to take iron supplements unless they were anaemic. This advice was based on a study that claimed that consuming iron supplements during pregnancy might increase the risk of women suffering from high blood pressure and delivering small babies.
A month later, British newspapers carried a series of stories based on a press release from the Royal College of Obstetricians and Gynaecologists, reporting a new ‘heatwave warning for pregnant women’. Articles headlined ‘Sun can damage unborn babies’ (The Times) and ‘Pregnant women should avoid the sun’ (Metro and Daily Mail) highlighted the scale of the alleged threat posed by sunshine to pregnant women. Some articles speculated that exposure to high temperatures in the first three months of pregnancy could lead to babies being born with a slightly lower birth weight; other scare stories linked exposure to sunlight during pregnancy with babies having low IQ levels and learning disabilities.
The moralisation of pregnancy has an inexorable tendency to become a caricature of itself. In recent times, pregnancy itself has been transformed into a disease-like condition. Pregnancy is now frequently depicted as a marker for mental illness. In August 2007, a survey claimed that nearly 90 per cent of women felt stress during pregnancy. If that wasn’t bad enough, apparently their stress levels increased the risk of miscarriages and other complications (5). Other researchers claim that the children of women who suffered stress early in their pregnancy have a higher risk of developing schizophrenia. Warnings about the impact of pregnant women’s psychological state on their babies’ health are a particularly insidious form of scaremongering. Such medicalisation of pregnant women’s natural anxieties is guaranteed to make them even more concerned. Pregnant women are also instructed to watch their weight… experts claim that women who put on ‘too much’ weight in pregnancy risk becoming obese later in life (6).
The constant hectoring of pregnant women fosters a sense of insecurity, which leads many pregnant women to become neurotic about their conduct lest they inadvertently place the lives of their children at risk. According to a recent survey carried out by the National Childbirth Trust, two out of five pregnant women and 56 per cent of expectant fathers are ‘very worried’ that something will turn out to be wrong with their baby.[vii] With the relentless campaign of diseasing pregnancy, it is surprising that these figures were not higher.
Advice to pregnant and pre-pregnant women stretches far beyond the boundaries of what has been found by research-based evidence. But it is difficult for women to resist such advice during pregnancy. Being with child is a unique time, when parents feel singularly dependent on professional support – which is probably why the pregnant woman has become such an important focus for the activities of self-righteous moral entrepreneurs. Women would be best advised to ignore the moralists, and get on with living – whether they are pregnant or not.
Jennie Bristow showed how the government was concerned that pregnant women act responsibly and condemned the fertility police. Emily Hill called claims about drinking during pregnancy an attack on working-class mums. Jamie Douglass called into question the government’s legless stats. Or read more at spiked issue Drink and drugs.
(1) Cited in An Argument That Goes Back to the Womb: The Demedicalization of Fetal Alcohol Syndrome, by Janet Golden, Journal of Social History, 30 (2) Winter 1999
(2) Binge drink baby damage ‘unclear’, BBC News 14 November 2007
(3) Drinking while pregnant risks autism in babies, The Times, 23 March 2008
(4) Two coffees a day doubles risk of miscarriage, says US study, Guardian, 21 January 2008.
(5) Warning to pregnant women over stress levels, Scotsman 30 August 2007.
(6) Confused, guilty and pregnant, BBC News, 2 October 2006
(7) Confused, guilty and pregnant, BBC News, 2 October 2006