Friday, December 06, 2013

Mother Guilt. How Bad Thought Frames Of Reproductive and Child Health Research Spread it.

You may have noticed a recent trend which picks up findings from epigenetics research (often about rodents) and converts them into direct advice to people, about how to behave or about what to eat.

That advice is pretty gendered, however, because rat studies about the impact of granddad or dad rats' "lifestyle" choices and their potential impact on the grandkid or kid rats doesn't immediately translate into advice to all men.  But anything about grandma rats does tend to elicit those kinds of argument*.

So there's an interesting gendered difference.  Rats teach women important stuff.  Rats are not expected to teach men important stuff.

But then, of course, men don't get pregnant, so anything having to do with what happens in the womb will be firmly on women's shoulders.**  Right?

But that's not the only frame some researchers use, these days.  Rather, anything that parents might do which affects their children's health is put firmly on the shoulders of mothers. A recent study, "Maternal Inactivity: 45-Year Trends in Mothers’ Use of Time"  tells us why parenting research of this type centers on women and not on men:
Contrary to the influence of maternal behaviors on the intrauterine environment, paternal behaviors have no direct influence on the intrauterine environment, but they may play a small role in the development of obesogenic behaviors in later childhood. While fathers report allocating more time to child care over the past few decades,35, 36, 37 it is trivial when compared with mothers’ allocation. As such, the influence of maternal behaviors is paramount from conception through early childhood because, in addition to controlling the intrauterine environment, mothers are the primary caregivers for most children throughout early life. For example, as of 2007, there were more than 5.6 million stay-at-home moms and fewer than 165,000 stay-at-home dads.67, 68

Bolds are mine.  So women get this extra responsibility to behave well (not for their own good but for the good of the future generations!) because they are the ones with wombs but also because they mostly take care of the children!  Here's more:***

There is growing evidence that body composition and energy metabolism are programmed in utero.21, 54, 55, 56 Because PA is a strong determinant of nutrient partitioning (ie, the metabolic fate of consumed nutrient energy to storage or oxidation57, 58, 59, 60, 61), preconception maternal inactivity may be causal to pregravid obesity62, 63 and when combined with prenatal inactivity may alter the programming of fetal body composition and energy metabolism, leading to an increased risk of obesity and chronic NCD. Additionally, there is strong evidence that maternal TV viewing behaviors influence children’s TV viewing behaviors,52 and large-scale epidemiological studies have revealed that one of the strongest determinants of obesity and cardiometabolic risk factors in later life is TV viewing as a young child.64 Given that most pregnant women spend more than 50% of their waking hours in SED and more than 15% of pregnant women report spending more than 5 h/d in screen-based media use,65, 66 it can be posited that, as with the intergenerational transmission of smoking behavior,53 children raised by inactive, sedentary, and therefore unhealthy caregivers may have an increased risk of being inactive, sedentary, and unhealthy as adults.

Bolds are mine.

I get the argument.  But on a different level it's a bizarre one.  It suggests that women's lifestyle choices and bodies indeed require additional societal oversight or at least strong propaganda aimed at women to behave a certain way.   Because of their societal roles and their biological roles.  Men are not required to think of their own nutrition or exercise as benefiting "others,"  because they are not the ones with the wombs or the ones taking care of children!****

If you don't see what's bizarre about all that, let me elaborate:
The best way for a woman not to have to feel guilt about how that extra chocolate bar she ate might destroy the health of future generations is by making sure that she doesn't have children, or that if she does have children, by making sure that she is not the primary caregiver for them.   

If those choices are not feasible for a woman, then this new socialized approach to women's behavior might mean that things like the citizen-police which examines whether a visibly pregnant woman has a glass of wine or not could become extended to lots of stuff women with children do.  Not exercising enough?  Evil woman!  Eating too much fat?  Evil woman!

At the same time, human beings are very bad about lifestyle changes, and many women will still fall for that chocolate bar or for lounging in front of the television.  Only now your guilt won't be limited to what you might be doing for your own body but it has become generalized! 

In the past all this focused largely on pregnancy, but the new trend is to expand it both forward and backward in time.  Thus, women with children are seen as modeling the correct eating and exercise patterns for their children, and women who don't have children yet are told that they should eat and exercise properly already, because they might get pregnant.

Add to this the possibility that new research, not yet available, finds different stuff about what you should have eaten or how you should have exercised during the pregnancy or while taking care of children!  Then your guilt will be retrospective. 

All this places different behavioral requirements on women as their role of mothers than it does on the rest of humankind, and those behavioral requirements are not necessarily possible to achieve for any human being.  Hence my argument that this creates unproductive guilt and frustration and possibly more of the kind of "public scrutiny" that pregnant women already face, only now expanded to post-pregnant and even pre-pregnant women.

What about those pre-pregnant or preconception women?  The term "preconception" seems to mean the time a fertile woman is not pregnant.  It's not a limited time period when a couple plans on pregnancy, say, but all of that woman's fertile life.  Here's one example of how "preconception" is defined:

Preconception health is a woman's health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned.
Bolds are mine.

So being in the state of preconception means all the time from menarche to menopause, except when you are actually pregnant!  Wow.  And you should consider yourself to be in the state of preconception whatever your contraceptive use might be or whether you abstain from intercourse altogether, because half of all pregnancies are not planned.  This often-heard quote equates to women having no agency over their potential pregnancies.

But is this really true?   The Guttmacher Institute seems to be the source for the finding that half of all pregnancies in the United States are unplanned, and this pie graph appears to support it:

But then there is this pie chart, which looks at contraceptive use and unintended pregnancies:

So let's summarize, from that bottom pie graph:  The two-thirds of US women at risk of unintended pregnancy who practice contraception consistently and correctly account for only 5% of unintended pregnancies.

Yet the preconception medical discussions ignore that, and so we get to the idea that women have no agency over whether they might become pregnant or not.

So it goes.  Returning to the most recent study about all those mothers who don't exercise, it tells us that all women in the state of preconception should exercise.

But what about the references to epigenetic rodent research at the beginning of this post?  Some of those studies suggest that what granddad and dad rats do, before mating, could influence their offspring, too.  So why not give men in the state of preconception (potentially a lot longer chunks of their lives, from pre-teen years to death) the same eager advice about the need to exercise and eat correctly?  After all, almost half of all pregnancies are unintended!

I don't think men would accept such meddling in their lives.  But should women?

That's why I'm concerned with this new trend of turning all fertile women into categories on the basis of their in-theory-possible or actual children.  On the other hand, perhaps the trend is beginning to take off about men, too:
Yet recent research has shown that men’s preconception behavior also matters. According to the CDC, tobacco and heavy drinking can damage sperm DNA, and we’re just starting to understand how older men’s sperm may affect their offspring adversely. The only venue where male preconception health gets much attention, the authors point out, is at the sperm bank, where men’s sperm is scrutinized in a way it’s not elsewhere.

To conclude, it's obvious that women's role in affecting the health of future generations is specific during pregnancy.  What is problematic about the current sociological framework in medicine is the implicit assumption that everything about reproduction and child-rearing should be coded female, that women should think about reproduction even when they are not planning to reproduce and that only women should think about their behavior in the context of future generations, because they are the major caregivers of children.****

This assumes that men have very little preconception impact and that men (who, after all, often live in the same households with women and children) provide no role models for their children, so their behavior matters not at all.

All this is, I believe, the fault of the research frames people have inside their heads when it comes to reproduction.  Those research frames seem to have started from pregnancy as the focal point of anything having to do with parental behavior and child health.  This research frame has then stretched and stretched so that it now covers preconception (women's whole fertile lives except when pregnant) and child-rearing.  That men may have an important role to play both before conception and after the child is born becomes invisible because the initial focus began with the part of reproduction which women perform:  gestation.

But the consequences of that frame (less research done on fathers, less research done on men's "preconception" lives, more maternal guilt) are serious, both in their potential impact on how good the research results are (areas people don't research could matter) and on the consequences of how women are viewed more generally.


*Rats do not ordinarily develop breast cancer and therefore the rats used in this study had to be treated with a cancer-causing drug.  The rapid shift from a rodent study to advice for human women (and grandma blaming?) is fascinating in some of those popularizations.

I looked for popularizations of the granddad and dad rat studies but didn't find a single one which gave advice to men.  Almost all the popularizations of the breast-cancer-in-rodents study gave direct advice to women.

**The junk-food reference in that article is to a study about rats.

*** I checked out the two references in that quote which relate to "preconception maternal inactivity may be causal to pregravid obesity62, 63".  One of them is a study about people between the ages of 53 and 57.  The other one is about the correlation between physical activity and weight from adolescence to adulthood.  After thinking about this a bit, I think the researchers mean that people get fatter if they don't exercise.   That can make sense, but to call all this "preconception" is a bit silly.

****I believe that argument is seriously flawed.  As long as fathers have any contact with their children, they are modeling behavior, and how fathers act in that context matters, both in good ways and bad ways.  

Just think of what the researchers' argument would imply:  As long as a family uses the gendered division of labor in child-rearing, what the father does Doesn't Matter At All.  So he can live in the same household, spend his time watching television or eating fatty foods, and none of that models anything for the children?  Alcoholism would matter if the mother is an alcoholic but would not matter if the father is an alcoholic?  Beating the children would matter only if the mother did it?