Stop messing with mothers-to-be

The mountain of scary ‘advice’ facing pregnant women is built on risk inflation and utterly junk science.

Ellie Lee

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Topics Politics

The adverse reaction which greeted the publication last week of the Royal College of Obstetricians and Gynaecologists’ (RCOG) report, Chemical Exposures During Pregnancy: Dealing with Potential, But Unproven, Risks to Child Health, was a welcome response to a new low in scaremongering. Unfortunately, though, the reaction goes nowhere near far enough to shield women from the barrage of junk science they are already expected to ingest during their pregnancy.

The RCOG report advises pregnant women to do as much as they can to avoid the chemicals found in day-to-day items. This included suggesting not eating processed food (shop-bought sandwiches and ready meals); avoiding food and drink in cans and plastic containers; minimising the use of moisturisers, cosmetics, shower gel and fragrances; and avoiding buying new furniture, fabrics, non-stick frying pans and cars when pregnant or breastfeeding.

The rationale for this advice openly draws on the precautionary principle. ‘The paper recommends that the best approach for pregnant women is a “safety first” approach, which is to assume there is risk present even when it may be minimal or eventually unfounded’, state the authors. Indeed, it seems that these ‘science experts’ draw on the further development of the now notorious idea proposed by the former US defence secretary Donald Rumsfeld: namely, that we should be concerned by the danger posed by ‘unknown unknowns’. The report’s subtitle says it all by explicitly suggesting that women need advice on risks that are ‘potential’ but ‘unproven’ – risks which we don’t know exist and about which we know nothing.

The authors claimed that in taking this approach they were seeking to ‘empower’ women and help them make ‘informed choices’ (that choice being to live life as a pregnant woman on the basis that it is always better to be ‘safe than sorry’). The response, thankfully, has been almost entirely critical. Scientists, the Royal College of Midwives, medical journalists and the organisation Sense About Science have all voiced their objections. The general view is that this report has gone too far in relation to what could plausibly be claimed about risks from chemicals, does not provide useful and sensible advice that has a real-life application, and causes unnecessary anxiety.

These criticisms are entirely true. The last thing pregnant women need is this sort of so-called information. It should be called out for what it is: junk science based on a fictional idea of what information should be all about. What is notable, however, is that almost all of the erstwhile critics seemed to find it impossible to voice this simple message. To them, it is apparently impossible simply to dismiss what is being said as nonsense that should be thrown in the bin. Instead, most felt obliged to respond in one of two ways.

The first was to say what women really need is even more information and advice about these matters. Thus the National Childbirth Trust (NCT) claimed that ‘it was unacceptable that pregnant women today were still having to make decisions without clear information on possible risks’. The problem, however, is that where the risks are ‘possible’ (that is, uncertain, speculative, potential and as such associated with anything and everything in life), there is actually only one sort of information that can be given, and it is the kind given in the RCOG report. The NCT cannot have it both ways. It is not reasonable to demand ‘clear information on possible risks’ other than that which says, ‘We don’t know what the risk is, so you are best off to try to avoid it all altogether’.

The only other real option is to take the position held by Joan Wolf, author of the excellent study about contemporary risk thinking, Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. Wolf has explored how, in the US, pregnant women are frequently told: everything is potentially risky; you have control over fetal development, but we do not know how; actions that you think are innocuous are probably harmful, but we cannot tell you which ones; things you do or do not do might be more problematic at certain times in pregnancy, but we do not know when; what you do or do not do can produce disastrous or moderately negative effects, but we cannot predict either one.

Wolf’s assessment is that the only rational response is not a call for more information of this kind; rather, it is to recognise that there is far too much of it already. While science can tell us important things, what we need to come to terms with is the inevitability of risk, the fact that people do risky things all day long (in that there are outcomes of actions over which we do not have total control), but this is just life. It is not a problem, and we do not need to be ‘informed’ or ‘empowered’ about it.

The other sort of argument made by the critics of the RCOG report was that instead of ‘raising awareness’ of the theoretical risks of everyday chemicals, more advice and information should be given to pregnant women about ‘real harm’. Hence, instead of just focusing on making it clear to the RCOG what they should do with their report, the critics have engaged in a sort of ‘my risk is bigger than your risk’ competition. In the discussion so far, the risks we apparently really understand and should be even more informed about have included all the old chestnuts: coffee, alcohol, cigarettes and stress.

Indeed, an interesting ‘my risk is bigger than your risk’ theme is developing when it comes to ‘stress’. Here, the entirely legitimate point that it is not reasonable to worry people and cause anxiety for no reason has morphed into a claim about the apparently overwhelming evidence that ‘stress’ endangers the developing fetus. In reality, as the US sociologist Betsy Armstrong has explained, the ‘science’ supporting the idea that stress in pregnancy is a problem is far more contentious than such objections assume. The wider public discourse about this issue demands robust criticism not endorsement because of its scaremongering qualities. In any case, given that a pregnant woman can no more avoid ‘stress’ in her life than a she can a pre-prepared ham sandwich, it is worth asking quite where this line of argument takes us.

In this way, one outcome of the efforts to criticise the RCOG report has been to further the idea that women are at risk; the idea that the things women are already told to worry about an awful lot (drinking, stress, coffee) should, in fact, be worried about even more. The problem with this approach is that to a greater or lesser degree, it simply reproduces the problem it purports to challenge: the inflation of risk.

This is most obviously the case when it comes to drinking and pregnancy. As has been explored on spiked before, the message now put out loud and clear by the Department of Health (DoH), and pretty much everyone else, is ‘don’t drink, not even a drop’, even when you are just thinking of becoming pregnant. This advice is no more based on evidence than that which tells women not to use a deodorant.

Indeed, when this advice was first formulated by the DoH in 2007, it was made absolutely clear that there ‘is no new evidence’ to justify it. On the contrary, the review of the evidence commissioned by the DoH itself found there to be no proof that drinking at the levels at which the vast majority of pregnant women do (that is, what are called ‘low to moderate levels’) is a cause for concern. The rationale was purely and absolutely precautionary, based on potential and unquantified risk.

As Pam Lowe and I have argued elsewhere, what was important about the alcohol and pregnancy advice issued in 2007 was that ‘advice’ and ‘evidence’ were formally redefined in a hugely important way. The logic of the policy shift ran something like this: ‘Because you are pregnant, we really think different rules apply to you. You should accept the mantra of “better safe than sorry” even if there is no evidence for doing this; after all, it’s a baby, right?’

Those who think that they can effectively take up the sort of garbage thinking put out by the RCOG by pointing to the ‘real problems’, be they drinking in pregnancy or getting stressed out, are on the wrong path altogether. The allegedly ‘real problems’ that tend to be counterposed to the scaremongering are always far less real’ than is claimed. Indeed, on proper examination, they turn out to be built out of the same precautionary prejudices and cultural tropes about the pregnant woman on the one hand, and the fetus on the other, as the RCOG’s more outlandish claims.

No doubt it feels more comfortable to criticise those who scaremonger about pregnancy by putting oneself forward as the ‘sensible person’ who never dismisses ‘real risks’. This will not make one jot of difference; taking on the latest excesses of the precautionary principle requires us to undermine the previous excesses upon which it is built.

Dr Ellie Lee is reader in social policy at the University of Kent, and director of the Centre for Parenting Culture Studies (CPCS), and co-author of the forthcoming Palgrave book, Parenting Culture Studies.

Picture by: Katie Collins/PA Wire/Press Association Images

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