Editorial Note: Two months ago we were deep in a controversy about Antidepressants and Birth Defects. (See The Dark is for Mushrooms, not for Women, Preventing Precaution and Mumsnet). Many women hearing a message that they should be wary about antidepressants and the risk of birth defects hear that they are being regarded simply as wombs rather than women. Others hear pharma subtly manipulating the empowerment through antidepressants message, just as the first public relations companies got women to smoke by selling a message of empowerment.
This piece is written by Philippa Willitts who has been one of the most eloquent voices on the “I’m not Pre-Pregnant” side of the argument. We wrote to her and invited her to contribute. She did – and then found her piece parked as the AbbVie petition issue took center-stage on RxISK and davidhealy.org.
When it comes to adverse events, there is no more potent symbol than birth defects. The images of the Thalidomiders are still the most iconic there are. But equally symbolic is the fact that the children affected by Thalidomide, Bendectin and Epilim-Depakote-Valproate and a range of anticonvulsants are still seeking justice and recognition up to 50 years later.
Once it has locked you up in an adverse event, the system prefers to throw away the key rather than admit error. Among the few children who have ever got any kind of justice are the children borne to mothers taking Paxil – but only those borne in the United States.
I’m not pre-pregnant. I just have a womb.
Some months ago, David Cameron was challenged on the issue of what his government had done for women. He responded by talking about improved childcare provision, as though:
- Childcare is an exclusively women’s issue, and
- All women are primarily concerned about childcare.
The assumption is that women are either mothers or future mothers, and I am neither. It’s highly unlikely that I could have kids naturally but I also don’t want children so that is not too much of a burden to carry. However, according to societal rules of womanhood, my potential child-bearing ability is so precious and important that it should be considered more relevant than my autonomy.
This is why I was incredibly riled when, last year, media reports suggested that women of childbearing age should not be prescribed antidepressant medication in case they get pregnant. I am a long-term user of psychiatric medication and that is unlikely to change any time soon. While I am not overjoyed that this is the case I have come to terms, in my own way, with my need to take these meds and I have finally stopped feeling the need to apologise for, or justify, it to others. Antidepressants in particular are subject to many stereotypes and when people appear to make judgements about them – and those who take them – I can get somewhat defensive.
This is perhaps what happened on Mumsnet when a TV programme mentioned a link between taking antidepressants when pregnant and babies being born with heart defects. Some of these reactions were documented on this site. There are so many common myths and misconceptions about psych meds, along with thoughtless judgement of those who take them, that I am not at all surprised that some women reacted with anger, derision and criticism.
To non-scientists like myself, the plethora of new warnings in the news every day means that it can be difficult, if not impossible, to judge which are accurate, and which fit in the category of “things the Daily Mail says cause and cure cancer, sometimes simultaneously”. And because so many warnings in the media feel like thinly-veiled value judgements, the combination of not knowing whether something is true and not knowing whether it is being used to push a particular agenda, means that skepticism is, frankly, to be expected.
There is more to the puzzle too. Many women live their lives aware that our bodies are essentially public property. Being grabbed and groped, judged and objectified are so normal that we don’t even always register when it happens. Since becoming visibly disabled I have noticed this increase further and many strangers feel as if they have an entitlement to ask questions about, and touch, my body.
I understand that this is also a particular issue for women during pregnancy. Strangers touch their “bump”, ask intimate questions and feel as though they have the right to pass judgement on what a woman is eating or doing. It happens all the time. I can only imagine that this would increase the defensiveness that those who spoke out on Mumsnet may have felt when antidepressant use was criticised. How can they know the guy on the documentary is not just another person trying to make them feel guilty for Doing It Wrong?
It’s tricky because it is clear that antidepressants are not free of risk, whether in pregnancy or not. Side effects can be severe and we have very little information, as far as I know, of the impact of taking them in the very long-term. Responsible doctors, I hope, would balance the risks of taking them with the risks of not treating a severe depression, while also looking at other avenues of support where suitable. But as mental health services shrink and therapy provision gets harder and harder to access, the likelihood is that the use of meds will show no sign of shrinking in the near future.
So, because I am a cis woman in her 30s, some people argue that I should be refused these meds just in case I become pregnant. Sure, I have a uterus. Potentially it could carry a foetus but that is incredibly unlikely for several different reasons. And yet I am to be categorised as “pre-pregnant”?
I’m less pre-pregnant than I am pre-Alzheimer’s, pre-sciatica or pre-osteoporosis – three conditions picked entirely at random and admittedly somewhat obnoxiously, but still far more likely than pregnancy to ever occur in my body. Yet nobody is suggesting I should restrict the healthcare I receive, in case any other randomly-chosen condition should manifest itself one day.
It is only because I am a woman. The term pre-pregnancy makes such an assumption that becoming pregnant is an inevitability that it annihilates both my choice and my physiology in one quick soundbyte, making the language used in these discussions both oppressive and dehumanising. If I am defined exclusively by not even just my womb, but by what my womb might feasibly do one day, then I myself don’t seem to have any agency whatsoever. Just because there might (there won’t) be a baby.
It struck me early on that the term “pre-pregnancy” is reminiscent of the language of the “pro-life” movement in the States. They twist and turn words and phrases to such a massive degree that they unashamedly argue that black is white. The proliferation of the phrase “pro-life” in itself is, in many ways, a prime example of this shape-shifting: activists who argue that women should have to risk their lives in favour of a foetus, activists who “support” “children” until they are actually born, and ignore their poverty afterwards, and activists who fight abortion but are pro-death penalty and pro-war, are routinely described as pro-life, when all evidence suggests the opposite. They are happy to say that 4.5 months is six months if it helps the cause.
The language of “pro-life” also twists something that is going to happen into something that is happening now. The Priests for Life site criticises phrases like, “She is going to be a mother”, stating that, “By saying she is “going to be” a mother, we inadvertently reinforce the notion that motherhood begins at birth”. They go on, “If […] a woman is pregnant, she already has a child”. Do you see what they did there?
Limiting healthcare, of whatever kind, on the basis of a state of pre-pregnancy appears to suggest that by saying a woman is “going to be” pregnant, we inadvertently reinforce the notion that pregnancy begins at pregnancy. Because if a woman is a woman, she is already pre-pregnant. When medical terminology is comparable to anti-choice wordplay there is a real problem, and women are bearing the brunt of it.
Philippa Willitts is a freelance writer in Sheffield. She has written for the Guardian, Independent, Channel 4 News and New Statesman websites and is on the blogging collective at The F-Word. You can find her on Twitter @incurablehippie and @PhilippaWrites.
Johanna says
I have to thank Philippa for reminding us of something really important here: the question of what these drugs do to the potential child can never be separated from that other big question: what are they doing to, or for, the woman herself? If I’m taking a pill that I believe is essential to my health and well-being, but poses some risk of fetal harm, I have a right to keep taking it. Whether I decide to forego motherhood altogether, consider terminating the pregnancy if things go wrong, or simply live with the risk, no one should barge in to take the choice out of my hands.
But I think the two docs quoted in the British press as warning women about the hazards of prenatal antidepressants have been hit with a bit of a frame-up on Mumsnet etc. Neither Louise Howard nor Steven Pilling advocated anything remotely like a ban on these drugs for women of child-bearing age. What they did propose was right in line with what every feminist wants: Our right to know the facts.
Those facts include an elevated, although still small, risk of heart malformations and other catastrophic birth defects. They include a LOT of worrisome although not final data about a far greater risk of learning disabilities, autism-spectrum disorders and other cognitive problems in children exposed to SSRI’s in utero (https://rxisk.org/autism-awareness-day-antidepressants-in-pregnancy/ ).
They also include the very real risk that once on these drugs you may not be able to stop them – or that stopping could trigger suffering even worse than your original depression. That’s as important for women who will never reproduce, as for the woman who does want to get pregnant someday, and assumes she’ll be able to stop any teratogenic food or drug when that day comes.
Women also deserve the facts about these drugs’ impact on us, whether mums or not: their potential to trigger suicidal agitation in some people, the substantial risk that they will flatline your sex life and the well-founded fears that using them long-term may worsen your depression. Not to mention the close to 50-50 chance that they won’t help much in the first place. All these facts are routinely kept from patients male and female – but women are far more likely to be affected than men, with many justifying this silence as being “for our own good.” I wish just one major U.S. newspaper – just once! – would have the guts to interview Louise Howard or Steven Pilling about these concerns.
But no such luck. Here in the land of the “Right to Lifers”, who are allegedly all about the babies, we don’t hear a peep about these drugs’ prenatal effects. Instead, drug companies actively promote them for pregnant women who may even be pressured to take them “for your child’s sake.” Right to Life groups are no more bothered about this than they are about the slashing of food-stamps and maternal nutrition grants to the poorest of the poor. While some of the rank & file are well meaning, these movements have very little to do with the welfare of either potential children or real ones. It’s more about controlling women and policing families.
By the same token, people who work hard to bring us the facts about what our drugs, food or environment are doing to the developing fetus are generally NOT Right-To-Lifers. That may just be a rap hung on them by well-placed PR agencies, who have been known to sell us everything from boob-jobs to cigarettes as instruments of our “liberation” and who operate as freely online as in glossy magazines. Pharma has some of the best ones.
They’ll gladly blindfold us, spin us around like tops … and then wax eloquent about our “right to choose our own direction.” What right? Maybe I’m being cynical … but it pays to be cynical these days.
Darryl Willis says
Actually I am against abortion. And I think there is a lot of accusation thrown around that abortion opponents don’t care for children which is just unsubstantiated. There are literally thousands of non-profit organizations staffed by abortion opponents in the US that specifically work to help unwed mothers and pregnant women keep and care for their children. This has always been a Christian tradition (both evangelical and Catholic).
As the son of a man who held a Doctorate in Pharmacy, I have been very disturbed about the adverse affects of psycho-tropic drugs in all stages of life–as was my father before me. We have in our own way advanced the dangers of these meds and have always encouraged people to intelligently look at the adverse side-effects and the misuse of studies to get these drugs approved through the FDA.
You can disagree with my stance on abortion, but please don’t make a blanket statement suggesting that if you are against abortion that you only see a woman as a womb-in-waiting and that you have no concern about women as women or no concern about the horrendous side affects of a host of medications to every person regardless of sex.
lethe says
Did you EVER had a clinical depression? Because it doesnt sounds like you had.
What use is a pregnancy without ADs if i just kill myself? Yhe lethality of depression is known. I wouldn’t be the firstl. Other could kill their child postpartum-this is known and reported too(and its known that ppl like me who have/had depression are at a higher risks to get postpartal depression.
Thats a reason why i wont have and dont want kids. Cant be as good as getting that shit again.
Johanna says
Dear Lethe … don’t know if you were asking me, but yes, I write as someone who has struggled with major depression for thirty-plus years and has been on just about every drug in the book. And when it comes to the SSRI’s (Paxil, Prozac, Zoloft etc.) I’m a witness that they don’t work very well for severe depression. For many years I endured a situation where I felt lousy while taking these drugs, and really horrible every time I quit. I was told that proved I needed them for life. I was never told about withdrawal. I had to learn that myself, the hard way, in spite of the doctors. Thank god I did.
Like you, and for similar reasons, I never had children. However I was on Effexor and Depakote during my “now-or-never” years (late 30’s) and very nearly made a different decision. No one ever told me that Effexor could result in birth defects and that Depakote, an anti-convulsant, was even more hazardous. That was unconscionable.
As I said in the beginning, if someone really believes a drug is essential to her well-being she absolutely has a right to keep taking it. However, she also has a right to know the facts – both about fetal harm, and especially about withdrawal. My life could have been very different in many ways if these facts had not been kept from me. I can’t get those years back, but I still hope the next generation of women (or maybe the generation after that?) will finally win the right to know. That applies to those with severe depression, and even more so those who have these medications foisted on them for emotional distress that is due to very understandable (and not permanent) life stresses, and are told NOTHING about the risks. We all deserve better.
red says
Interesting you picked up on the userism of “pre-pregnant” but not the same for “cis” which is a pejorative. I am a Female, not a speciman under a microscope.
Regaridng women being seen as “pre-pregnant”: If anti-depressants are harmful for the fetus, they are also harmful for women, with or without a fetus. I believe that has been established by our host and others.
That’s the take home message here. Anti-depressants have huge potential to harm. It’s the nature of the chemical.
red says
“…I am a cis woman in her 30s, …”
I am deeply offended by Females being referred to with a term used for a bit of tissue in a lab. It is appalling that this term should be allowed here, on this respected medical site and in particular in this article which is for and about women’s health and rights to be considered as full human beings. Further Gender has NO role in procreation, it is our SEX which becomes pregnant.
I request that this term be removed.
Philippa Willitts says
Hi Red,
Cis really isn’t an offensive term, and it’s not one that is only applied to women. There is no sexism implied in the use of the term, it simply means ‘not trans’.
It’s not a value judgement, it’s just a description.
The fact that I used the term to describe myself indicates that it is in no way name calling, it’s just a word to describe a state of being. It does not imply goodness or badness, nor does it insult anybody.
This post – http://eminism.org/blog/entry/399 – provides some interesting information about how the term originated… “the reason “cis” is preferable to all the others is that it treats “cis” and “trans” as linguistic equivalents, rather than treating one as more normal or natural or otherwise standard and the other abnormal, artificial or exceptional”.
Philippa Willitts says
PS ‘cis’ doesn’t refer to ‘a piece of tissue in a lab’.
“Cisgender has its origin in the Latin-derived prefix cis-, meaning “on this side of,” which is an antonym for the Latin-derived prefix trans-, meaning “across from” or “on the other side of”. This usage can be seen in the cis-trans distinction in chemistry, the cis-trans or complementation test in genetics, and in the ancient Roman term Cisalpine Gaul (i.e., “Gaul on this side of the Alps”). In the case of gender, cis- is used to refer to the alignment of gender identity with assigned sex.”
red says
I see that the term “cis” has not been removed.
This term is sexist and misogynistic. This may be an infringement of the rightys of Females under the Human Rights Act of various jurisdictions.
It is a slur. Please apologize to Females for using this term and please remove it.
Red says
Red who commented above sent this comment to Rxisk
The term “cis”is a slur when used to describe Human Females. It is pejorative and sexist. I ask that it be removed from the essay on “pre-pregnancy”. I have made a complaint about it in the comments under that post.
This term may infringe protection under the Human Rights acts of various jurisdictions. I believe it also may, contravene your Terms:
I am offended and lessened by this slur being used here with impunity to refer to Females. I believe it is a contravention of my human rights to access this website and information without fear of being name-called and insulted in a way particular to my Female sex.
From your Terms:
6.3 Your user content must not be illegal or unlawful, must not infringe any third party’s legal rights, and must not be capable of giving rise to legal action whether against you or us or a third party (in each case under any applicable law).
6.4 You must not submit any user content to the Website that is or has ever been the subject of any threatened or actual legal proceedings or other similar complaint.
– See more at: https://rxisk.org/terms/#sthash.Rq1K1EwO.dpuf
Emma Friedmann says
Pre Pregnancy. I think your view of disliking the word, concept, association is selfish and ill informed.
I have a 15yr old Son with FACS. Birth defects caused by Sodium Valproate. I should have had preconception counselling and women of childbearing age should receive appropriate advice.
If I had received information about my life saving medication and its affects on the fetus during my teens I would have planned a life without giving birth. My Son has a happy life at the moment, his physical pain and suffering has not been extensive. Adulthood is just round the corner, residential care and vulnerability await and will not cease until he dies.
It is time that the priorities of a child were put before the desire of a woman to have a child and before the desires of women who want everything to be written and phrased in non offensive ways.