Pathologizing Pregnancy: Maria New & the Push to Gender Conformity

There’s that fabulous quote floating around about Ginger Rogers, saying that she “did everything that Fred Astaire did. She just did it backwards and in high heels.” I must have heard that at a pretty young age and internalized it, because for a very long time, I had the attitude that I could do anything I wanted – and I could do it in a skirt. Pants not required. (In fact, it was only ziplining in Costa Rica that broke what was something like a 10 year record of not wearing pants.)

I mention this just to illustrate that, at a glance, you would not mistake me for anything other than a very femme woman (and given my preference for dating men, a heterosexual one). I currently have my nails painted Iron Man red, I rarely go out of the house without at least a little bit of makeup on, I can be easily distracted by shiny sparkly pretty things, and for being goth-inclined, I have a pretty unhealthy preference for pink.

So, on the surface of things, I am a pretty stereotypically normal woman. Except for one thing: I don’t want children.

I have never wanted children. When I was a kid, when the other girls in the neighborhood were busy playing house, I was trying to determine the melting temperature of Barbie. (Note: higher than my father’s temperature at seeing a plastic doll on his barbeque.) Other girls dreamed of white weddings and Prince Charming – I wondered about space stations and aliens and contradictions in warp speed limits on Star Trek. I can only remember a single instance in the entirety of my life where I thought about having kids in anything other than a nose-wrinkled, distasteful sort of way, and that was in the middle of a high fever.

Which is not to say that I don’t like children – on the contrary, I find them fun to be around, I think my nieces are of course the most incredible children to have ever existed, and I thoroughly enjoy teaching. But as the trite saying goes, kids are great – especially when you can give them back at the end of the day.

Thankfully, I grew up in an environment where this was supported. Some people might be offended by their parents saying they shouldn’t have kids, they don’t have the temperament for it. I took it as validation of something that’s always seemed pretty self-evident. I was never told that my life was defined by the contents of my uterus, or that what I opted to do with it was anything other than my decision, and my decision alone.

And I was certainly never made to feel like there was something wrong with me, that I was somehow broken.

So it was with an extreme amount of shock and horror that I read about Maria New, a pediatric endocrinologist who so strongly believes that it’s a problem when women don’t want to have their own children that she includes it as part of the reasons prospective parents whose daughter may have Congenital Adrenal Hyperplasia would want to treat their children with prenatal dexamethasone:

Without prenatal therapy, masculinization of external genitalia in females is potentially devastating. It carries the risk of wrong sex assignment at birth, difficult reconstructive surgery, and subsequent long-term effects on quality of life. Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism (interest in being a mother) [emphasis mine], aggression, and sexual orientation become masculinized … We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization (Nimkarn and New, 2010, p.9).

Years earlier than this, New’s chief collaborator, Heino Meyer-Bahlburg of Columbia University, said:

CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups (Meyer-Bahlburg 1999, 1845—1846).

So, in essence, we have scientists – in theory, reputed scientists – deciding that a woman is normal or not based on criteria that includes “the traditional child-care/housewife role” and how often she fantasies about having children.

“Well, Kelly,” I can hear you thinking, “Surely this is one of those things where the bioethics community rises up as a whole and howls in protest!”

Sadly, no. In fact, quite the opposite. It’s certainly a divisive issue, but any debate on the subject seems to degrade quickly into personality disputes and conflict-of-interests, and there appears to be strong support for prenatal dex treatment that is, frankly, appalling.

Of course, the problem with prenatal dex treatment for CAH goes significantly beyond the idea that not wanting to be a mother is a pathology that needs to be fixed. Prenatal dex treatment is not a cure for CAH, it merely minimizes external symptoms of the disease. Yes, this can be a good thing if there are medically severe complications of an improperly developed urogenital system, but those complications are rare. The only other thing prenatal dex does? Is decrease those nastybad tomboyish, non-mothery, potentially lesbian inclinations. So, in other words, prenatal dex treatment is being used to make sure girls want to fulfill those outdated and stereotypical, reductionist gender roles of homemaker and mother/wife.

Now, let me just be clear: there are researchers doing actual clinical trials interested in valid uses of prenatal dex to prevent severe physical issues that require invasive and drastic surgery to fix (and I’m not talking “simple” intersex surgery here, but complications with the urogenital system that have to be fixed ASAP). But the researcher promoting and behind the majority of the prenatal dex use in the United States appears to be motivated by a desire to both eradicate lesbianism and non-traditional gender roles, including what is seen as an ‘unhealthy interest in with male games and occupations.’

In other words, in a time where women are celebrating breaking glass ceilings, pursuing occupations that take them out of the home, and stepping away from a social construct of enforced motherhood, there are prominent researchers who are pathologizing that behaviour as bad genes that need to be fixed.

“But Kelly,” you may want to protest, “New and her colleagues are merely saying that women with CAH have a range of undesirable symptoms that are an aspect of their genetic disease! They’re just trying to solve that!”

To which I say: oh really? Look at three women and tell me who has CAH, who’s a lesbian, and who is a heterosexual woman who doesn’t want children. Tell me how we determine that behaviour is abnormal for one of those three women and not the other two.

Pathologizing behaviour is pathologizing behaviour, period, across the board. You cannot issue a value judgment of “this is bad” and then have it stay limited to only a single and small group of people – that’s not how it works (and anyone, especially a bioethicist, who believes that, should be shamed right out of medicine and research).

And for the inevitable chorus or questions, let me clarify that I don’t have CAH. I’m a chromosomally ‘normal’ woman. I just happen to be following the rather well-established path of the childless aunt (and if things keep on the way they are, the spinster childless aunt). Many woman, though history, have found great satisfaction in choosing this role in life, and deciding that we’re all as a whole broken because we don’t really relish everything that comes with childbirth and pregnancy is more than just problematic: it’s essentialist and does the same thing to a woman as the anti-choice religious fundamentalists: reduces us to being nothing more than incubators.

Want to read more on the topic? Start with Alice Dreger’s To Have is to Hold, then read her paper with Feder and Tamar-Mattis; I obviously relied on this for my own irritated ramblings above. Or read a first-hand account of an intersex woman who had the unfortunate experience of being one of John Money’s patients. Note that Money collaborated with Dr. Meyer-Bahlburg, who is one of Dr. New’s chief collaborators. So in other words, much of this research comes out of discredited concepts of gender and sexuality.

Citations
Meyer-Bahlburg, H.F. 1999. What causes low rates of child-bearing in congenital adrenal hyperplasia? The Journal of Clinical Endocrinology and Metabolism 84(6): 1844—1847.

Nimkarn, S., and M.I. New. 2010a. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: A paradigm for prenatal diagnosis and treatment. Annals of the New York Academy of Sciences 1192: 5—11.