Thursday, May 30, 2013

Dinner for Two

You are what you eat.


For pregnant women, the stakes are even higher: your baby is what you eat too.

As if women aren’t already constantly scrutinised about their physical appearance - and how it is related to the amount of their environment that they consume and burn as fuel for energy - what women eat while pregnant becomes a minefield that not only has the potential to affect them but also their babies. 

In addition to the usual body image anxiety, add to the list:
As if pregnancy wasn’t exhausting enough. Surely, you’d think if there’s any time in their lives when women get a ‘pass’ on the way they look and what they eat, it’s when they're pregnant, right?


Today, I was flicking through a women’s magazine at a cafe and spotted an article comparing the pregnancies of Kate Middleton and Kim Kardashian.  Ordinarily, I’m not particularly interested in  what either of them are up to. This particular article caught my eye, however, because it was about the amount of weight both women had gained during their pregnancy. Both are due around mid-2013, so are well into their third trimesters. 

Kate Middleton - whose natural build appears to be tall and slim - was being censured for being too skinny, not gaining enough weight, being too controlled in what she ate, and hiding her bump under tailored coats and dresses. By contrast, Kim Kardashian, who is shorter and more ‘curvaceous’ (bleurgh!) - was being censured for being too fat, gaining too much weight, eating whatever she wanted, and letting her fertile and full figure spill out of form-fitting clothes and flowy pants-suits. 

God forbid either woman could be just left alone to get on with it. 

Which begs the question that if these two women represented the too-little and too-much of the pregnant body, who is the woman who has the ideal shape? 

Could that be ... um ... nobody?

The article was couched in terms of concern for the food and body issues each woman must be experiencing. Clearly, Kate and Kim are well-off enough to look after themselves. The faux-concern expressed in this article was targeted less at them, and more at the readers of the magazine, who may well compare themselves to both Ks and find themselves wanting.

This is called the shaming and policing of gender.  

So what else would you expect from a women’s magazine, you might think. Fair enough.  But this policing of diet during pregnancy doesn’t begin and end with celebrity adulation.

I’ve blogged previously about  Annie Murphy Paul’s excellent book on fetal origins research. But she also had me fuming when it came to the topic of eating and pregnancy. In the ‘two months’ chapter, she focuses on the effects maternal nutrition has on the foetus. In the personal narrative part of the chapter, Paul acknowledged the anxiety she felt over her own food choices during pregnancy:

No activity of everyday life is so instantly changed by pregnancy as eating. New worries about food safety turn ordinary meals into minefields ... Is the cheese pasteurised? Is the fish cooked through? Is the egg still runny, the meat still pink? More daunting still is the notion that what you eat becomes the very stuff of which your child is made ... I did my best to eat healthily, but I continually second-guessed my choices, berated myself for my slip-ups, worried that I was missing some crucial nutrient ... Eating is no longer a simple bodily function, much less a pleasure to be savoured; it’s a series of fraught choices, an act with grave consequences, committed three times a day. (Origins, pp 12-3)

She then traces a brief history of (predominantly male) control of pregnant women’s appetites from Galen, to the Bible to modern medicine. Everyone, it seems, has had something to say about what women eat while pregnant. Again, it is couched in terms of concern: a 2009 study found that overweight women are more likely to have complications and require interventions during birth; further studies found that overweight women were significantly more likely to have overweight children than those of a ‘normal’ weight’. By comparison, such ‘natural experiments’ as tracing the birth outcomes of children born to mothers who were starved during the Dutch hunger winter, also showed that their children were at higher risk of future health problems.  It seems then, that are sound reasons for being concerned about extreme weight gain - or loss - in pregnancy.

So far, so fair enough.

After her gambol through the research, however, Paul then returned to the effect all of this new knowledge had on her own pregnancy diet.  That’s when it all got a little annoying. In narrating her attempts to find substitutes for un-fit food - like tuna salad (too much mercury) - Paul sounds somewhat like a woman’s magazine herself when she extolls the virtues of other fish:

Soon I’m finding all kinds of ways to eat fish: Sardines on buttered toast for breakfast (delicious with scrambled eggs). A snack of herring on crackers with a dab of Dijon mustard. For dinner, shrimp sauteed in butter with garlic and cayenne pepper. Catfish, breaded and broiled golden. Tilapia on the grill, with some mango salsa to perk up its admittedly anemic flavour. ... As I tuck into a snowy filet of flounder, squeezed with lemon and speckled with pepper, I think to myself: eating carefully can actually taste really good. (Origins, p 34)

I mean, really? And wtf is tilapia? (This, apparently)

Later we see her get advice from a nutritionist about eating a ‘colourful’ plate of food, who also dreams up a shopping list full of acceptable whole grains and suitable salad (that would be ‘arugula not romaine lettuce’).  Then we follow her to the whole food store while she fills her basket with all this stuff. Oh, and a ‘naughty’ bar of a dark chocolate at the end.

It wasn’t just the nausea I was experiencing at the time that made me feel sick while reading this chapter. 

Given that morning sickness was dominating my dietary choices, or lack of them, at the time, I was intrigued to note that not once in this chapter does she mention morning sickness.

For me, during this period, I found it easiest to keep down well-cooked fatty and salty food - like hot chips or a samosa - rather than salads or just about any kind of vegetable. Indeed, even the - not every strong - aroma of lettuce (iceberg, if you must know) made me gag. This being round two, my feeling was ‘just go with it, you can try and eat better once you’re feeling better’. The Pollyannish chirruping about ‘eating carefully can actually taste really good’ did not improve my mood much, however.

But that wasn’t all.

Even the teeny tiny iodine pills I was taking conspired against me. Not only did taking them during my first trimester continuously make me gag, the ‘helpful’ leaflet included in the packet said things like ‘eat a low fat healthy diet’, ‘eat slowly and chew throughly before swallowing’, and ‘eat lots of fresh fruit, vegetables, whole grain foods / bread’ but ‘eat less fried / processed food; pastry; takeaways, biscuits, cakes, fizzy drinks, sweets, sugar, white bread; chippies.’  In my pregnancy so far, I have to plead guilty to eating every single thing on the ‘eat less’ list - many more than once - and rather fewer on the ‘eat lots’ one.

Does this make me a bad mother-to-be?

Frankly, I doubt it.  The long-term nutritional advantages that I enjoy as a middle-class woman in good health living in a country with abundant fresh food, means that I have had enough to eat of a wide variety of foods - and the nutrients within them - just about every day of my life. This in turns means that my unborn child will be enjoying those benefits too. The odd plate of chips or some Whittaker’s creamy milk is not going to undo that.

There’s still the food safety angle of course.  But then who does set out to get food poisoning? Instead, I think it’s about seeing it in terms of risk: do you think it’s worth the risk to eat a particular ‘banned’ food during pregnancy or not? In my first pregnancy, I would’ve said emphatically not. I religiously avoided everything that was on the list of banned foods ... and even some that weren’t ‘just in case’.  My baby turned out fine.  This time round, I’m a bit more relaxed. I still steer clear of raw fish and runny yolks, but I have - gasp - eaten (pasteurized) soft cheese, hummus, vegetarian sushi and some deli food. And you know what? So far, so good (she says, touching every piece of wood available).   

For now, what I need to steer clear of as hazardous to my health is well-meaning concern and advice about what I should and shouldn’t be eating. As an adult woman, I’m perfectly able to navigate my own food choices ... and also to deal with whatever consequences might ensue. 

But I also dream of life post-birth when I can enjoy the simple pleasures of runny poached eggs and raw salmon sushi without a twinge of guilt or the need to second-guess myself.

Sunday, May 19, 2013

On failing to become a Pregnant Superwoman

About a month ago, when I was still feeling quite sick in the first trimester of my current pregnancy, I was walking towards the bus station around the time that school got out. It was the last day of term and there were hordes of over-excited teenagers streaming past me in the opposite direction. None of them paid me the slightest bit of attention, preoccupied as they were with their own lives. 

Walking past them, however, I suddenly felt extremely self-conscious. Covering my-not-quite-showing-yet tummy with my arm, I felt menaced, exposed and vulnerable. At the same time telling myself that I was being silly in the extreme, I felt like any moment one of these teenagers in their youthful high spirits might inadvertently cause me - or, more specifically, my less-than-12-week foetus - some harm.

No doubt some of my (imagined) fear was due to my physically weakened state: at the time, I was only managing to keep down perhaps one small meal a day and some crackers. I find a full tummy does wonders for one’s sense of perspective. But perhaps my reaction went deeper: perhaps I was having some kind of primal maternal reaction to perceived external threat. 

My experience of threat that day got me thinking about how women negotiate their increased physical vulnerability during pregnancy - whether through sickness, increased girth, or any of its other fun physical changes. While I agree that ‘pregnancy is a state of health’, I can’t help but appreciate some of the special assistance I have received while pregnant, particularly flexible work hours negotiated with my managers so I could work around the worst parts of my morning sickness. The acknowledgement that I was neither a Pregnant Superwoman nor a slacker not only helped me continue to work effectively during that first trimester, but also helped my psychological well-being (i.e. it didn’t totally stress me out).

I also remembered how much it drove me up the wall the number of times I had to stand on the bus home from work while eight and nine months pregnant - very tired and swollen - last time round. On one particular ride, the only two people standing on the bus nearly the whole way home were myself at eight months' pregnant, and another woman who was clearly in a similar condition. Not one person offered either of us a seat (check out this pregnant woman’s graphic survey of the how often she was offered a seat on the subway). Noticeably, the seats designated for vulnerable people only specified that they should be given up for elderly and disabled people. Occasionally, they specify parents with small children - ones who are presumably managing buggies and other paraphenalia as well as children. I realised that it’s been a long time since I saw these seats designated for pregnant women as well.

There may be a perfectly good reason behind this ‘oversight’: namely, the establishment of a legal - and, to some extent, social - framework that discourages discrimination towards pregnant women. Gone are the days when pregnant women were forced to leave the work-place, or were routinely subject to patronising attempts to get them to rest at all times because they shouldn’t be attempting anything too strenuous in ‘their delicate condition.’

This is not by any means to suggest that women do not still experience discrimination while pregnant. The very useful Employers’ Guidelines for the Prevention of Pregnancy Discrimination states clearly that pregnancy discrimination as a form of sex discrimination, and that ‘it may be unlawful for an employer to discriminate against an employee or a job applicant because she is pregnant or because it is assumed she may become pregnant’ (p 3).  

While recognising that pregnant women shouldn’t be treated negatively because they are pregnant, however, the guidelines also recognise that there may be health and safety concerns connected with a woman’s pregnancy at work. These could relate, for example, to heavy lifting and handling, exposure to radiation or certain chemicals or a risk of infection. Early risk assessments are recommended to identify ways to mitigate these concerns. Any steps taken to do so - such as a temporary transfer to another kind of role within the same organisation - should not have a negative impact on a woman's pay, benefits or other work opportunities.

I was and am very clear that I don’t want to be discriminated against because I am pregnant: I did not lose any of my faculties along with my lunch during that first trimester.

And yet ...

My perception of my own physical vulnerability - whether walking through a crowd of excitable teenagers or feeling my ankles swell even more while standing on the bus home - made me want to demand special treatment: ‘look out world, pregnant woman in the area’!

Was I guilty of failing the Pregnant Superwoman test?  Was admitting vulnerability somehow un-feminist?

In her fascinating book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives (2010), science writer Annie Murphy Paul grapples with similar feelings. Pregnant while she wrote the book, which examines the insights of fetal origins research, Paul talks about experiencing ‘a new and acute sense of vulnerability.’ I felt an uncanny jolt of recognition as I read the following description:

Hurrying down Seventh Avenue toward the subway, crowds streaming past, I realize that I am scanning the faces of the strangers who walk by, and that I’ve put a protective arm across my belly, at three months just beginning to swell. Being pregnant has made me vigilant, on guard for threat; I feel alert and instinctive as an animal, ears perked and nose twitching. (Origins, p 41)

Paul speaks to researchers who confirm her sense that her instinctive protectiveness might indeed be an evolved behaviour with which pregnant women compensate for their decreased immunological response (Origins, pp 41-3).

Like me, however, Paul seems to be a little reluctant to fully sign up to research insights that could be used to politically roll back decades of hard-won feminist gains. After outlining the legal battles against pregnancy discrimination in the US, Paul concludes:

I know I don’t want Supreme Court justices, or even psychologists and public health experts to tell me how hard I should be working while pregnant. I have no desire to return to the stifling prohibitions of the Victorian age, or the paternalistic protections of the Progressive Era. And yet it seems to me that, in our own time, pregnancy comes with a set of expectations that is oppressive in its own way. Women today are given to understand that pregnancy should not slow them down in the slightest; at the same time they’re barraged with warnings that too much stress could harm their fetuses. … That’s a lot of cultural baggage to bear, at a time when women have enough additional weight to carry. I find myself daydreaming about a pregnancy free of these burdens, concerned only with the optimal experience of woman and fetus.   (Origins, pp 69-70)

She briefly examines the work culture of the US, and looks to other countries where women are not only paid for parental leave but also for ante-natal leave. Wanting to debunk what she calls the ‘Pregnant Superwoman’ myth, Paul aims to take it easier on herself throughout the rest of her pregnancy: she signs up for a yoga class and has a mid-afternoon nap on the sofa instead of rushing to the computer while her son is asleep.

I think, however, that she is a little to quick to attribute the ‘Pregnant Superwoman’ myth solely to feminism, as, for example, when she says:

My guess is that the Pregnant Superwoman got her start when women entered the workplace in large numbers in the 1960s and 1970s. Getting ahead proved that nothing about being female -including the inconvenient tendency to get pregnant - would interfere with one’s performance or one’s commitment to the job. (Origins, p 59)

A historian might’ve pointed out to her, however, that in this time period many of the women entering the workforce were already mothers, ones who had their children at a very young age (often in their early 20s) and were looking to find fulfillment outside the home once their children were at school.

As Susan Douglas and Meredith Michaels have argued, the myth of the Superwoman in general is a media construction, rather than a feminist one:

The supermom - a media construction - was not what feminists had hoped for as a model. Feminists didn’t think mom should suddenly do everything - work outside the home, and clean the house and care for the children and make gourmet meals. Feminists thought maybe dad and the government should participate too. But we got the media’s version of the feminist ‘have it all’ mom anyway. Then when it turned out that real women could not and would not actually be supermom, the supermom was discredited as something we had allegedly aspired to but couldn’t achieve, and thus we were supposed to go back to the kitchen. (The Mommy Wars, p 206)

My guess is that ‘Pregnant Superwoman’ is probably cut from the same cloth. Thinking some more about my altered - and temporary - state, I realise that vulnerability is not the same as weakness. Recognising that different people have different limits - whether at different stages in their lives, or throughout their lives - means that societies need to re-organise themselves to accommodate and realise the potential of all their members. Flexible working practices and parental leave are just some examples of the ways in which treating pregnant women equally means treating them differently.

Saturday, May 11, 2013

Rethinking Mothers' Day

It’s that time of year again: the day when care, compromise, sacrifice and love are reduced to sentimentalism and cliched tokens of appreciation. It might not come as much of a surprise to learn that Mothers’ Day, as conventionally defined, kind of makes me cringe. 

Before I became a mother, I found the idea that families’ emotions were manipulated for commercial gain somewhat cynical (which is not to say that I neglected my mother on Mothers’ Day - I’m not totally heartless!). After becoming a mother myself, I’ve become even more troubled by it (although gifts and general spoiling will be appreciatively received). What troubles me now is less the tokens of gratitude and sweet home-made cards - there are, of course, many ways to show appreciation without lining the pockets of florists and confectioners - than what I see as the sentimental notions of motherhood being peddled to justify it all. 

I personally find these notions constricting because I don’t think having a baby made me less able to work and make a significant contribution in my chosen career (especially when compared with my imputed ability to do laundry and make apple pie). Nor do I think it made me less able to see that many of the systemic inequalities that women experience are closely linked to becoming mothers and raising children. Nor did it cause me to forget that becoming a mother nearly caused me to lose my life. While there are plenty of positive moments to offset this, motherhood is a also a serious business and, to me, luxury soaps don’t quite do justice to it.

Last year, I wrote about the history of the Mothers Day celebrated in New Zealand and some other western countries as a day which began as rallying call for pacificism in the context of the US Civil War. It was soon transformed into a paean to the cult of domesticity (y’know like ‘I love you mum, because you wash my socks’).  I also wrote a little about an international campaign aimed at decreasing maternal mortality around the world. For some women, becoming a Mama is much less about booties and bassinets than life and death. In 2008, for example, Oxfam estimated that half a million women die in childbirth each year. This year, the Huffington Post similarly profiled a range of global issues affecting mothers and encouraged people to donate to charities that support families to survive and thrive. 

And then I came across a series of stories that caused me to re-think how I see Mothers Day.  

This week, while reading one of my favourite blogs, I came across this Mama’s Day campaign targeting immigration reform in the USA, a part of the Stronger Families initiative. As part of their campaign aimed at encouraging decision-makers to rethink discriminatory polices that cause immense hardship to women and their children, Stronger Families is running a blog carnival in which bloggers from a range of different viewpoints share what motherhood and mothers mean to them. The posts address mothering from many different subject positions, including gender and gender identity, sexual orientation, class, immigration status, (dis) ability, and age. They are well worth a read to not only counteract the sugary narratives often presented in the mainstream media, but also as a reminder that one’s own story and way of being is not the only one, that families do not always equally enjoy their human rights. I was particularly affected by this story, this one and this one. 

On a different website, this story from a lesbian parent reminded me that while I might cringe about Mothers' Day, others celebrate the hard-won privilege of being able to be included in the narrative of the day. In turn, it reminded me of the story which New Zealand MP Louisa Wall told during her speech for the third and final reading of the Marriage Equality Bill. Wall’s story told of a lesbian mother whose partner had to have her name struck off her daughter’s birth certificate when she died, because only one person in a gay couple could be recognised as a parent or guardian. The law change now allows for both people in a gay couple to be legally recognised as a parent of an adopted child (see Wall’s speech in full here). Elsewhere, Michelle Obama's self-description as a Mom-in-chief has been interpreted as a revolutionary act for African-American women.

These stories reminded me that some groups of women have been denied the privilege of sharing in the narrative of socially sanctioned - and sanctified - motherhood. What makes me cringe about Mothers’ Day are the constraints it imposes on women like me who occupy a position of relative privilege - e.g. white, middle class, in a heterosexual relationship socially- sanctioned by marriage - but that this position is one not universally shared by all mothers. Many of these mothers continue to fight for their recognition as mothers, and for the legitimacy of their ways of mothering, as these Indigenous women do. Hearing the stories of women who do not share the privileges I do reminds me that we still have a long way to go to see mothers as fully-rounded people managing different pressures, desires and needs, and to support them accordingly.

Perhaps, after all, Mothers’ Day is a good day to reflect on re-evaluating and re-valuing what motherhood means.

Saturday, May 4, 2013

review: Origins

It was with some trepidation that I picked up this book. 

Written by science journalist Annie Murphy Paul, Origins: How the nine months before birth shape the rest of our lives (2010) threatened to be another ‘blame the mother’ - even before she’s given birth! - tome, this time in the guise of a popular overview of the latest developments in the study of fetal origins of adult disease. ‘Fetal origins’ is a burgeoning field of scientific research, as more and more studies have produced suggestive - but not necessarily conclusive - findings that indicate that some diseases such as diabetes, heart disease, as well as mental health problems, may get their start in utero. Other research has suggested that other aspects of our lives may also be affected by our pre-natal life, including educational attainment and material wellbeing. These are novel - and potentially controversial - claims. 

Intrigued, but with spider senses heightened for anti-feminist or overly deterministic polemic, I decided to delve in and see what the boffins were saying.  I was relieved to discover that Paul shared some of my concerns, and gestured to them in various parts of the book. Moreover, her narrative style was personal and accessible. 

Pregnant with her second child at the time of writing the book, Paul, preoccupied with the usual pregnancy concerns (‘what should I eat?’ ‘will this affect the baby?’) decided to explore further into what really happens in the those first nine months. The book, structured into nine month chapters each exploring a different field of research, also traces her own altered feelings and perceptions as she passes through the stages of her pregnancy: how she (secretly) wishes for another boy; how she starts to see everyone around her in a doubled way as both person and fetus simultaneously; how she experiences ‘Mommy Despair’ (not quite ante-natal depression but in the same spectrum). We also follow her to obstetric appointments, and hear her try and explain to her three-year old son about the new baby inside her tummy (his reaction: ‘that’s silly, mummy’). 

Going through the experience of pregnancy herself as she researches and writes this book enables Paul to steer a middle ground between interest in the research and a slightly distancing skepticism (does fetal origins research equal determinism?). She writes:

But science can’t tell us everything we need to know about this new perspective; there’s always a gap where the hard evidence of the laboratory meets the soft flesh of our bodies. So I’ll also embark on this exploration as a pregnant woman, someone who is living what she’s learning about. (pp 9-10)

Among the topics she covers are: the effects of both traumatic and everyday stress (three months); the effect of chemicals and pollution in the environment on a developing fetus (four months) the impact of environment on sex preference (five months); and the impact of diet and lifestyle in the context of concerns about determinism (seven months).  

In the course of exploring the latest research in these areas she muses that the difference between nature and nurture is not as simple nor as binary as people think: poor health may not only be a result of genes and/or environment, but also a result of the complex interplay of developing fetal biology and the intra-uterine environment (also biological). For example, some researchers have studied data from such ‘natural experiments’ as the Dutch Hunger Winter of 1944-45 or the famines caused by the Great Leap Forward in China to explore the impact of maternal malnutrition on babies born after the time period. In each case, researchers found evidence that infants born after these events had higher rates of still births, birth defects, low birth weights, and infant mortality. Furthermore, these infants grew up to have higher rates of obesity and heart disease than those born under ‘normal conditions’ (pp 23-4). These findings seem a little counter-intuitive to the lay reader: why would the effects of malnutrition - caused by deprivation - lead to poorer health outcomes that are more commonly thought to be the result of affluence?

This was a question that bothered British doctor David Barker, one of the earliest of the current wave of fetal origins researchers. In his own research into birth records in the UK, and the subsequent lives of these infants, he found similar patterns in some of the poorest areas of the country, and was led to the inescapable conclusion that low birth weights meant a higher risk of heart disease in middle age (p 25). Barker explained what he thinks these findings mean:  ‘I think the fetuses are actually taking cues from the intrauterine environment and tailoring their physiology accordingly. They’re preparing themselves for the kind of life they will encounter on the other side of the womb.’ (p 27)

When Barker’s findings were first published in 1989, they were not well-received - even ridiculed - as researchers at the time were focussed on the environmental and lifestyle factors in disease. Since then, however, fetal origins research has taken off in a number of different fields, including the medical, psychological, and economic. 

The results of the research Paul summarises are very interesting, but also alarming, particularly given that I am also pregnant with a second child. I’m already conscious of the slightly sanctimonious lists of things I should and shouldn’t be doing, and still can’t quite over the feeling that the aggregate of all this fetal origins research may be to position the rights of a fetus over the rights of a pregnant woman in a more coercive way. Some medical researchers have also sounded a similar note of caution. Physician Darshak Sanghavi, for example, is concerned that if people become convinced that destiny is determined in the womb, societies will no longer invest in the welfare of individuals: ‘why bother funding children’s health initiatives or universal preschool, if physical and cognitive functioning have been set in utero?’ (p 195). 

Nowhere is this concern about the possible ends to which fetal origins research could be put more palpable than in the contentious area of abortion. In one chapter, Paul cites evidence of the impact of ‘wantedness’ on a baby’s post-natal life: one study found that an ‘unwanted’ child born due to abortion restrictions was as much as 50 per cent less likely to survive into old age than the average child born in the same era (p 219).

Paul, to her credit, does address the minefield of abortion,  She asks all the researchers she interviews about the impact of their research on debates over the legality and morality of abortion, and notes that virtually all of them are uneasy about this topic:

They grow uneasy, shifting in their chairs and hesitating over their words. Fetal origins is concerned with the relationship between prenatal experience and postnatal life, they say at last, leaving me to complete the thought. For the aborted fetus, there is no postnatal life, so the matter of fetal origins is moot. (p 217)

Paul, rightly I think, believes this response side-steps the issue of the political ends to which fetal origins research could be put, not least in the United States where there have been some high-profile court-cases that have upheld the right to life of the fetus over the wishes of the mother.  In societies still dominated by patriarchal values, fetal origins research could well be pressed into service in future court proceedings of this nature. 

As a result, I’m not so convinced by Paul’s assertion that fetal origins research discomfits both sides of the abortion debate:

Advocates of the right to abortion, for example, have at times portrayed the fetus as no more than an inert blob of tissue. Fetal origins research, with its emerging picture of a learning, adapting, responding fetus, makes that evasion less tenable. For their part, opponents of abortion have sometimes preferred to consider the fetus in splendid isolation, relegating the pregnant woman to the role of human incubator. Fetal origins research, with its elaboration of the intimate interplay between pregnant woman and fetus, does away with the imaginary separation (218).

In this effort to strike a middle path between two extremes, I think Paul creates a false dichotomy. While some advocates for a woman’s right to bodily autonomy and control of her own fertility (whether that means access to legal and safe abortion, or the ability to have children without being coerced into an unwanted abortion or sterilisation) may have represented the fetus in this way, I think the larger issues in feminist discourse on abortion have been both ‘choice’ (in the sense of self-determination, a fundamental human right) and the notion that ‘every child be a wanted child.’ I do not see how learning more about fetal origins undermines those basic principles. Far from it, the importance of fetal origins could be held up as further underscoring the importance of women being able to fully control their own fertility, of ensuring that every child they have is wanted, and will receive the best care - both pre- and post-natally - they can provide.

In framing the issue this way, I think Paul inadvertently reproduces (pardon the pun) the notion that abortion is an easy and frivolous ‘lifestyle’ choice for promiscuous women. By contrast, I can easily see how fetal origins research could be high-jacked by conservative opponents of women’s rights: already, the ability to detect fetal heartbeats at just seven week’s gestation has led to emotive anti-abortion slogans like ‘abortion stops a beating heart’. When there have not only been cases of women forced by court order to have children against their will - and what will the health outcomes of those children be like? - and, recently, a woman left to die because her rights were seen as secondary to that of her dying fetus, I think there are some serious ethical and political questions that need to be asked about the implications of this research. To be clear, I am not at all suggesting an anti-science approach and the abandoning of these research lines. Rather, I am suggesting that such research take place in the context of enhanced and protected women’s rights.

Paul may say all the right things about avoiding fetal determinism by ensuring programmes to address pre-natal risk indicators (like low birth-weight) are meant to support women and their children, rather than co-erce or label them. I’m a little more cynical, however, about the ways such programmes might be targeted and deployed in societies still dominated by patriarchal values. 

And, of course, much of the fetal origins research Paul highlights could lead to policy changes that would benefit everyone, not just pregnant women: in these cases, fetal origins research could lead to greater regulation of pollutants, toxic environments, food additives and so on. Paul also looks at the most recent work of economist Amartya Sen (already famous for his work on global poverty and the positive impact women’s empowerment has on children, families and communities). Sen’s latest work has focussed on the ‘hidden penalties of gender inequality’: the effects of pregnant women’s disadvantage on their fetuses. Sen argues that ‘women’s deprivation in terms of nutrition and healthcare rebounds on the society in the form of ill-health of their offspring - males and females alike.’  He comments further on the ironic implications of this: ‘We in India treat ... women so badly that most are undernourished and give birth to underweight babies. It is known that cardiovascular diseases hit men much more than women. So when you mistreat ... women, the men eventually suffer.’ (p 222)

So what I am left with at the end of this by turns fascinating and frustrating, but always compelling, book, is that motherhood is crucially important right from the moment of conception, whether one is a man or a woman; a mother or a child-free woman; a fetus, child or adult. This means that everyone has a stake in better supporting mothers and families: protecting women’s rights only threatens ideology not people.