Pre-Eclampsia: Is Pregnancy Advice Unfair and/or Sexist?
There’s an article out through ProPublica, the public service investigative journalism website, on the ways in which pre-eclampsia is described in a number of the biggest US-based health websites. ProPublica reports that sites like the Mayo Clinic and MedlinePlus have been describing childbirth as a ‘cure’ for pre-eclampsia, overlooking the fact that serious complications can still occur after childbirth with consequences including maternal mortality. ProPublica point out that this is especially important to remedy as new mothers may not have time to get their own health checked out, especially if trusted medical websites are advising them that the danger has passed – a situation exacerbated in a country where medical bills will be a consideration for many. Out of interest I had a look at the NHS website to see what advice they give on pre-eclampsia. The opening of the article on pre-eclampsia does say that the condition can occur after the baby is delivered, but in the treatment section we once again find the problematic language that ‘the only way to cure pre-eclampsia is to deliver the baby’.
We might ask why such an issue has happened on not just one website but many, and one of the suggested reasons from the ProPublica article was of particular interest to me:
The language may… reflect the concern among some medical professionals that if women don’t believe their condition is serious, they will resist delivering before their due date or by cesarean section — and put themselves and their babies at risk.
If this concern has indeed been a factor behind the decision to describe birth as a ‘cure’ for pre-eclampsia then it can be added to a list of advice given in pregnancy that gives incorrect or non-evidence-based information to pregnant women: sometimes in order to keep more control of the pregnancy in medical hands and less of the responsibility for decision-making with the mother, sometimes in an effort to shift blame to the mother for forces outside of her control. And, in this case, a serious example that could put some mothers at risk because of medical fears about patient resistance to prescribed treatments.
Other, less serious examples include the NHS advice that pregnant women completely avoid alcohol, despite the fact that there is no evidence that one or two drinks have any adverse effects on the unborn. While completely avoiding alcohol might not be actively harmful to the foetus or to the mother, the option of having a drink at a social occasion may give the mother a much-needed chance to relax in a way that she might normally, depending on her lifestyle. The value of this opportunity is not measured by well-meaning health officials who remove the option of a guilt-free glass of wine in order to ‘avoid confusion’ about recommended alcohol intake.
More seriously, the issue of listeriosis is one that is flagged up to pregnant women without much information about the likelihood of falling victim to this dangerous bacteria, as described by Zoe Williams in The Guardian. It is because of listeriosis that pregnant women are advised to avoid all unpasteurised cheeses. Unfortunately, it is not easy to predict which foods can be a source of listeriosis since it is spread through poor food hygiene – as evidenced through the most recent listeriosis warnings which centred on frozen sweetcorn that was recalled from supermarket shelves in the UK. Given the number of foodstuffs that can carry listeriosis, the advice for pregnant women to treat its avoidance as their responsibility, and something that can be avoided if only they obey the rules, seems to give the impression that women have far more control over the situation than is actually the case.
All of this advice is no doubt well-intentioned, but when health advice is not evidence-based it can have detrimental impacts, whether on the mental health of women blaming themselves for things that have gone wrong in their pregnancies over which they have no control, or mothers who are actually being put in danger by a medical establishment that prioritises the control of patients over keeping them well-informed. The temptation to diagnose a case of sexism is strong here – are there any situations in which male patients are given exaggerated or simplified advice in order to control their medical decision-making?