The latest instalment in the Minimise Project’s list of recommended books is Expecting Better: why the conventional pregnancy wisdom is wrong – and what you really need to know, by Emily Oster. Oster is an academic economist, and so reading her book is a sort of a rite of passage for pregnant economists. I duly read her book during my second trimester of pregnancy.
Unlike the previous two books I have reviewed so far, Expecting Better does deal with the subject matter of pregnancy, and touches tangentially on abortion (more on that below). The genesis of the book was Oster’s experience during her first pregnancy, and in particular the medical data, or lack thereof, behind the list of various dos and don’ts she was given, mostly from her doctor. Doctors tend to use medical data to make a series of hard and fast recommendations, not just in pregnancy but in general: Do X, don’t do Y. The end.
Believe it or not, this framework of taking data on risks and benefits and using it to come up with a list of definitive things to do and to avoid is pretty foreign for economists. Economists like Oster (and me) are used to making decisions within a framework of trade-offs – you evaluate the benefits of each decision, you evaluate the risks, and crucially, you take into account your own personal preferences. Different people weigh up risks and benefits differently, and so two different people faced with the same data may make two different choices, both equally good. For example, when considering whether to avoid caffeine during pregnancy, we want to know what the risks, if any, from caffeine consumption are, but we also want to know the woman’s preferences regarding caffeine. If a cup of coffee per day increases the risk of miscarriage from (let’s say) one in ten thousand to one in nine thousand, someone who’s not that pushed about coffee might decide it’s worth avoiding caffeine. Someone who really loves coffee (me) might decide that the tiny increase in risk is worth it for them.
These trade-offs appear all through the book. In addition to summarising the findings of the various studies available, Oster also evaluates the quality of the studies. Some of the evidence is pretty compelling – even one or two bouts of heavy drinking during pregnancy, for example, can really impact on your baby’s health, and we have good studies to demonstrate this. Others aren’t so clear-cut – the evidence behind the recommendation to avoid lying on your back from the second trimester onwards is pretty poor, for example. It has a tiny sample size, and is based on postpartum women retrospectively recalling whether or not they slept on their back. In general, the literature behind so many pregnancy recommendations turned out to be far more nuanced, not to mention interesting, than I could have imagined.
I think pro-life and pro-choice people could all benefit from reading this book, even if they never plan on being pregnant. Why should pro-choice people read this book? For one main reason. Oster is definitely not pro-life. In fact, she dedicates a disturbingly large portion of the book to the evidence behind various types of pre-natal testing, and makes it quite clear that the reason this was so important to her and her husband was because they would have had an abortion if their baby had turned out to have a chromosomal abnormality – including a disability such as Down Syndrome. I know many good, decent pro-choice people who would never dream of aborting their baby for such a reason, and who also believe that it is wrong in general to do so, even if they support abortion access in other circumstances. In my experience, these people believe that parents having a casual acceptance of prenatal testing with a view to abortion in the case of a disability such as Down Syndrome is an exaggeration at best. Many pro-choice people believe that if abortion for reasons of disability happens at all, it’s under very specific and horrifically difficult circumstances. It may be an eye-opener, if an uncomfortable one, for pro-choice people to read a highly educated academic economist, in a stable marriage to another tenured academic economist, living in a progressive liberal Western democracy, making the deliberate choice to determine whether her baby was in any way “abnormal”, and to abort if so. It was certainly eye-opening for me.
Why should pro-life people read this book? Sometimes, in our zeal to protect pre-born babies, we can veer away from the territory of “It’s wrong to kill an unborn baby” and towards the territory of “It’s wrong to do anything that might in any way endanger an unborn baby”. If you think about it, this is actually nonsense – no one has ever (to my knowledge) recommended that pregnant women never get in a car, for example, even though being in a car crash runs the risk of harming the baby. This is because it’s not reasonable to expect women to avoid cars for nine whole months. However, is it any more reasonable to expect women to avoid caffeine, or alcohol, or yoga, or sleeping on their backs, just because there might be a risk to the baby? It’s rather heavy-handed to presume that avoiding cars is a greater inconvenience than avoiding coffee for each and every pregnant woman ever.
Pro-life people would do well to remember that every restriction we place on pregnant women, even restrictions that seem trivial, makes pregnancy more difficult, more stigmatising, and less normalised. If we want to reduce the abortion rate, we should be trying to make pregnancy less restrictive, not moreso. We should be building a culture where we treat pregnant women as normal human beings, rather than wrapping them up in cotton wool for nine months. Oster’s book gives great peace of mind to those of us who want to normalise pregnancy, but don’t want to endanger the lives or health of unborn babies or pregnant women.