A recent large-scale study from Bristol University found that the number of pregnant women suffering from anxiety and depression during pregnancy has risen by half within a generation. The reasons for this dramatic increase will be complex, and the authors of this paper speculate that an increasing prevalence of depression in the wider population may be amplified when a woman becomes pregnant.
Some of the individual fallout of this is gathered in this moving collection of stories here. One woman, so convinced she had poisoned her unborn baby while de-fleaing the cat – describes lying on the floor while pregnant, crying through the night.
We might not know the causes, but we too can speculate that the constant stream of reports on research findings which hold women’s behaviour in pregnancy responsible for all manner of negative outcomes in their children play their part in creating a climate of fear and anxiety.
At bpas, we see women so concerned about how an episode of binge drinking before they knew they were pregnant, they consider ending what would otherwise be a much-wanted baby. It may sound extreme, but when official public health campaigns warn women that any alcohol in pregnancy can cause their baby lifelong harm (a message which simply isn’t backed up by the evidence) it is unsurprising that this level of anxiety is caused.
But it doesn’t stop with alcohol. From the use of anti-depressants to women’s weight in pregnancy – whatever pregnant (or indeed increasingly “pre-pregnant”) women do - is seen as potentially problematic to their future children, regardless of the evidence base or the fact that risks need to be calibrated. So there may be risks from medications, but there are risks to the mother of coming off those medications or being denied those medications. A good example is the treatment of women with Hyperemesis Gravidarum, or severe morning sickness – despite the fact there are safe medicines to alleviate the symptoms, women are frequently refused these, sometimes leaving them with no choice but to end what was a much-wanted pregnancy as they simply cannot continue.
An article was published this week in the journal Social Science and Medicine exploring the problems with the growing trend for research into the origins of health and disease, to focus narrowly on the characteristics and behaviours of women during pregnancy, and how it affects long-term outcomes for their children. The characteristics of fathers, the social environment, exposures after birth, and the fact that health behaviours are so often influenced by the circumstances in which we live often get neglected in this drive to find simple answers to the complex causes which may underpin our physical and mental difficulties in childhood and later life.
The authors caution that complex research findings are being rushed into simplified, direct advice to pregnant women and public health policy, and they call for greater attention to be paid to how public health advice is constructed and conveyed. Such advice, they argue, should communicate the level of risk in a way that empowers individuals to assess the evidence and form their own opinion. We could not agree more.
It should worry us that women are increasingly being blamed for physical and mental outcomes in their children on the basis of very little evidence at all - because they are “too old, too fat” - and told to adjust their behaviour accordingly – sometimes in dramatic ways.
Women need good, evidence-based information on which to make their own choices in and about pregnancy. At a time when there is increased focus on women’s mental health in pregnancy and concerns about the high levels of anxiety experienced by some women, it is all the more important we make sure the advice women receive is solid – not scare-mongering.