"The Pregnancy Pickle": Damned if You Do, Doomed if You Don't
As a person in possession of a uterus, I don’t need to be told that the thing is an impenetrable lump of darkness, mystery, and sometimes malice. As a historian, I definitely don’t need to be told that these facts about the womb, along with a large quantity of myths, have long been the reasons men give for the unfitness of women for everything, from reading complicated books to governing countries. And as a person with a twitter account, I absolutely don’t need to be informed that we’re still having the same conversations, forever until we all die, about how the female body is a terrifying, inherently diseased baby-making machine that women obviously shouldn’t have control over. And for all that, we uterus havers are tempted to lean on science to help us assert that we too are human people, but science doesn’t always have our back.
Earlier this month, we were presented with the double-edged sword of a new hypothesis about the outsized instance of autoimmune disease in women, one which purports to offer an explanation for this troubling mystery in the form of a bummer suggestion that our bodies, as well as our society, punish us for not using our bodies to make babies. In the July, the journal Trends In Genetics published a paper on the so-called “pregnancy compensation hypothesis,” entitled “The Pregnancy Pickle: Evolved Immune Compensation Due to Pregnancy Underlies Sex Differences in Human Diseases.” The pregnancy compensation hypothesis, based on a survey of published literature, is an untested hypothesis about the connection between placental pregnancy and human immune response, which researchers say might shed light on the reasons why women experience autoimmune diseases at much higher rates than men. Researchers propose that human females evolved to be pregnant multiple times throughout their adult lives and that pregnancy causes changes in immune response, which people don’t undergo if they do not become pregnant. As a result, the higher prevalence of autoimmune diseases in women may be a result of modern people having fewer pregnancies or never becoming pregnant at all.
In The Atlantic earlier this month, Olga Khazan reported on the study in an article sporting the predictably hyperbolic headline “A Breakthrough in the Mystery of Why Women Get So Many Autoimmune Diseases.” The subheading reads “Evolution might have played a trick on women’s immune systems.” Apart from the fact that an untested hypothesis is not a breakthrough, the article itself is fairly circumspect about the implications of the paper. Khazan takes care to note that the hypothesis is untested and that researchers proposed analyzing the instances of autoimmune disease alongside a number of pregnancies as a way of establishing the correlation. What Khazan doesn’t do is place enough emphasis on the fact that even a correlation hasn’t yet been established, though the authors of the paper do suggest some ideas for going about this. Khazan, at least, notes near the end of the article the authors aren’t advocating that women get pregnant frequently to avoid autoimmune disease. So, that’s good.
The idea that pregnancy is the natural state of female animals and, as a result, not being pregnant can result in disease is, of course, an ancient one. The Hippocratic writers of ancient Greece claimed that women who do not become pregnant suffer more from menstruation and related complications than those who do. Given that the obvious prescription for such suffering was for women to have more sex—with men—and get pregnant, feminists have understandably approached this understanding of the female body, and the medical establishment built on top of it, with extreme skepticism. But that has not prevented these ideas from being trotted out by everyone from forced-birth advocates to moms who want grandkids. Dewey skin, cured acne, relief from depression and anxiety, elimination of allergies—all of these and more have been proposed as salutary benefits of being pregnant.
But being pregnant is itself dangerous, and some people just don’t want to have babies. It really sucks to have someone tell you to your face that you’re doomed to be unhealthy for the rest of your life unless you crank out a couple of kids you don’t want. It really really sucks when someone not only tells you that but also prevents you from getting the healthcare you need because you don’t want to be pregnant. That’s why the glib headlines of the paper and the media coverage are so upsetting; the “pickle” of the former and the “trick” evolution played on women in the latter heavily land in a post-heartbeat bill world in which even the suggestion that pregnancy is the natural state of women’s bodies can be enlisted to further curtail bodily autonomy and reproductive rights.
Coverage like this, which purports to report on a discovery about some fundamental property of human biology, also leans on a progressive understanding of evolution, as if today’s humans are its finally finished product. If the evolutionary pressures of frequent pregnancy created this immune response, surely the altered pressures of access to reliable birth control and increased social choice around pregnancy will again alter the response. Of course, for practical medical purposes, the only evolutionary state of humans that matters is the present one, but we might do more to counter these fatalistic and deterministic narratives of the female body to which pathology and social stigma so easily attach themselves.
The most depressing thing about the whole episode is that it illustrates just how entrenched patriarchal ideas about the body remain and how they confuse and complicate both our science and our attempts to talk about it in a measured way. Khazan’s piece in The Atlantic is completely fine, from a journalistic ethics standpoint. Nowhere does she misrepresent the nature of the paper as hypothesis only. The problem is something deeper, which has to do with those endless conversations with would-be grandmothers, the passage of heartbeat bills and the prosecutions of miscarriages, and what feels like a deep reluctance of science and medicine to engage seriously and systematically with understanding the female body. Seeing coverage like this, of an untested hypothesis that amounts to nothing more than an educated guess, which again attaches pathology to “wasted” reproductive capacity, makes me and my uterus feel like a lost cause.