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.
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:
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.