Tapping into the flourishing fields of the history and sociology of American pregnancy, Miranda Waggoner enters the fray with her engaging study of the emergence of pre-pregnancy care in the early twenty-first century. Waggoner seeks to determine why pre-pregnancy care emerged when it did and what its development can tell us about contemporary meanings of motherhood, women’s health and medicine. Utilising a wide range of interviews, medical publications and popular media stories and articles, Waggoner claims that this in-depth analysis of pre-pregnancy care exposes the continuing tensions between women’s health and reproductive health, as well as the continued distance between maternal health rhetoric and reproductive realities. Over the past 15 years, the CDC and many other health advocates have constructed a new framework for pregnancy, one that stresses the importance of the health and lifestyle of women who are not pregnant (regardless of whether they intend to get pregnant in the near future or not). Waggoner analyses the work and rhetoric of these groups and finds that while they often describe pre-pregnancy care as a new attempt to increase positive outcomes and combat the continual high rates of unplanned pregnancies in the face of modern acknowledgements of the limits of traditional prenatal care, the public campaigns, clinical encounters and medical publications coming out of this field reiterate old tropes of the centrality of maternity in American femininity and the differential racial understandings of reproduction and motherhood. Waggoner shows the current medical and public health interest in extending pregnancy care back in time to include a woman’s behaviours, health and choices before she gets pregnant, has a very rich history unacknowledged by most contemporary researchers. While many in the current field of pre-pregnancy care look to a 2006 CDC publication on pre-conception health recommendations as the beginning of the field, Waggoner instead traces pre-pregnancy concerns, health and management to early twentieth-century discussions of eugenics, syphilis and infant mortality. While primarily sociological in scope, Waggoner’s study is firmly grounded in the larger history of reproduction, women’s health and the medical supervision of pregnancy in America. Throughout the book, Waggoner expertly weaves between and together the multiple contradictions within pre-pregnancy care, both in rhetoric and in practice. Many of these contradictions centre around the paradox of how pre-pregnancy care can be both progressive and repressive in terms of understanding womanhood, motherhood and reproductive realities. On one hand, many of the researchers Waggoner talked with described pre-pregnancy care in terms of how it could improve women’s health for all women, not just pregnant women. Recognising the political trends of providing health care access to under-served groups of women only when they become pregnant, pre-pregnancy advocates see extending ‘pregnancy’ beyond the nine months as a politically expedient way to get health care to more women, providing a seemingly progressive and positive impact on women’s autonomy and power. At the same time, by redefining all women of childbearing age as ‘pre-pregnant’, regardless of any plan or desire to become pregnant, many critics see pre-pregnancy care as potentially dangerous to women’s autonomy and power by narrowly defining them as uteruses, or only of interest to the larger medical field for their baby-making abilities. While Waggoner does acknowledge both sides of this debate and explores how these concerns play out in the practice of pre-pregnancy, I would have liked Waggoner to spend a little more time on how pre-pregnancy sustains a powerful narrative of modern pregnancy as perfectly controllable, intentional and successful. When state health departments put together campaigns to promote the idea of a ‘reproductive life plan’, in order to get women to think about folic acid before they get pregnant, these campaigns also send the message to women that creating such a plan is feasible for all women and once a woman has a plan, ensuring the success of that plan is simple and fully under the control of individual women. While Waggoner does acknowledge that such reproductive plans might diverge greatly from reproductive realities, I would like to know more about how pre-pregnancy researchers and advocates understand how to fit miscarriage, stillbirth and infertility, not to mention domestic violence, racial disparities in health care and economic barriers to healthy practices into these seemingly straightforward plans. Overall, though, this is a small quibble and does not detract from the great utility of this book. Waggoner provides us with a sophisticated study not only of a new medical trend, but also of a contemporary result of a century-old construction of modern pregnancy, modern motherhood and women’s health care. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Social History of Medicine – Oxford University Press
Published: May 26, 2018
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