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.
