Only a few days into the new year, the Heritage Foundation released its nearly 170-page plan to incentivize higher birth rates, at least within the families it would like to see reproduce. Over the past few months, we’ve also seen officials, and the panelists they invite, in the Department for Health and Human Services push a very narrow prescription for how pregnant patients, predominantly women, should behave; one that looks down upon such noncontroversial things as pain medication, mental health treatment, and the use of formula to nourish one’s baby.
Reproductive rights advocates say these goals work in tandem—and are in keeping with attacks on abortion access that we’ve seen in a post-Dobbs world, focusing on the individual pregnant person’s choices rather than the systemic issues that can impede a healthy life for both pregnant people and their babies, should they decide to have them. Physicians say many of these claims made by health officials are misleading and harmful.
“One of the tools … that women and people who have the capacity for pregnancy have to become equal members of society, to participate in society equally—abortion gave us that right,” said Kulsoom Ijaz, senior policy counsel at Pregnancy Justice, a group that advocates for the rights of pregnant people. “And all of a sudden we’ve taken that tool away. But it isn’t enough for the anti-rights movement. They want to do everything they can to ensure that we no longer have a voice and a seat at the table. That’s what this is about.”
With scant public notice and little transparency, the Food and Drug Administration has held panel discussions on several important health issues, including a July panel on the use of antidepressants during pregnancy. During the discussion, some of the panelists made claims about the harms of these drugs during pregnancy, including a link to autism in kids, that both the American College of Obstetricians and Gynecologists, or ACOG, and the Society for Maternal-Fetal Medicine said were “outlandish” and “unsubstantiated.” It’s unclear if this discussion will result in any official guidance, but advocates for both ob-gyns and their patients say the development is alarming when you consider that suicide is a leading cause of death for pregnant people, along with homicide.
Dr. Camille Hoffman, a professor of maternal fetal medicine in the University of Colorado Anschutz’s School of Medicine’s Department of Obstetrics and Gynecology and Psychiatry, described to The New Republic how she speaks to pregnant patients about antidepressants.
“The goal is for essentially optimal treatment, or in the case of mental health, this idea of the mood being as good as it can be before giving birth because we know the postpartum period is going to be an additional challenge on everybody’s mental health, so that’s how I frame it,” she said. “I talk about antidepressants being some of the most studied medications because they’ve taken such a beating, because they’ve been so stigmatized over the years, so we actually have pretty excellent data.”
In December, Health and Human Services Secretary Robert F. Kennedy Jr. also promoted breastfeeding, saying that corporations’ infant formulas couldn’t compete with breastmilk for health benefits to children.
“We at HHS are encouraging mothers to breastfeed as long as possible because there is no better food for your brain, your gut microbiome, for your physical growth, for your emotional growth than what’s in God-given breastmilk,” he said.
Although breastmilk has a lot to recommend it, Kennedy extolled its benefits without discussing many ways to support breastfeeding parents, beyond a brief mention of how airports could be more friendly to nursing parents. Nor did Kennedy offer consideration toward the challenges parents face when they can’t or don’t wish to breastfeed, which is common enough for a host of reasons that went unaccounted for during his harangue. Never mind the pain of mastitis or how unfriendly many workplaces can be to breastfeeding—despite the legal protections postpartum workers are entitled to—and let’s not discuss the labor that goes into planning when to pump or nurse or eventually wean a child. Earlier this year, HHS also announced an initiative to review infant formula, Operation Stork Speed, over which some formula experts and Democratic lawmakers have expressed concern, emphasizing the need for formula to remain affordable and accessible and to avoid stigmatizing its use.
Kennedy has continued to make unproven claims about a link between autism and the use of Tylenol, or acetaminophen, in pregnancy. At an October Cabinet meeting with President Donald Trump, Kennedy said, “Anybody who takes the stuff during pregnancy unless they have to is, is irresponsible.” Kennedy didn’t say under which circumstances someone doing the long and grueling work of growing a human being inside their body should be allowed to take the medication. ACOG has stated, “The conditions people use acetaminophen to treat during pregnancy are far more dangerous than any theoretical risks and can create severe morbidity and mortality for the pregnant person and the fetus.” It noted that acetaminophen is one of few options for treating pain and fever in pregnant people, which can be harmful to them when left untreated.
Some reproductive rights advocates note that by prescribing one way of feeding your baby, limiting the ways to treat pain during pregnancy, and stigmatizing the treatment of mental health, the Trump administration is shifting the focus from the government and what it owes parents to the individual mother, in particular, all while disempowering many pregnant people in the process.
This is happening within the larger context of state attacks on reproductive rights and the right’s focus on creating the perfect conditions for its ideal heterosexual, cisgender, and white family with multiple kids, culminating in efforts such as the Heritage Foundation’s “culture-wide Manhattan Project.” In its report detailing this vision, the conservative think tank uses the term “natural family” to describe the family resulting from a married, monogamous man and woman and claims all others have been proven “inferior,” on average, “across space and time.” The report shows the nonmarital birth rate for Black women in the 1960s as it makes this argument for policies that favor these households over single parents, queer relationships, and cohabitating partners.
The policy document also details many of the gripes conservatives have with no-fault divorce, which does not require that marriages are dissolved through a showing of wrongdoing by either party. The authors list no-fault divorce as an obstacle to their goals of returning to traditional family life, bemoaning “the increased risk of marriage being ended unilaterally” and “perverse incentives” created by financial protections for spouses who “earned little to no money during the marriage.” Despite the report focusing so clearly on family life, the authors didn’t note in that paragraph what these spouses, many of them women, often do contribute—childcare and management of the home that allowed the primary breadwinner to avoid paying someone outside of the home for all of those services for many years.
The approach that the Trump administration has taken in its health policy complements the misogynistic, white supremacist, and anti-queer project that this report outlines. It is hard to leave your spouse when you’re pregnant—it’s a time when many pregnant people see abuse start or worsen, when you are physically or mentally unwell. People with disabilities are often at higher risk for abuse by their partners, and pregnant people often experience short-term disability because of conditions created by pregnancy, which is only made worse by a lack of access to pain relief and untreated mental health issues. Making it harder for pregnant people to be as comfortable as possible in pregnancy creates challenges for them to maintain employment, which provides financial independence and a path to exit abusive relationships. Taken as a whole, the views and policies of this administration and their allies are a multipronged effort to disempower pregnant people and leave them as dependent as possible on their partners, some advocates say.
“There are so many collateral consequences that come out of these kinds of policies,” said Ijaz. “There have been studies done that say people are way more likely to die from carrying a pregnancy to term than having an abortion. Part of that is because people get tethered to their abuser. Homicide is one of the leading causes of pregnancy-related death. And that’s because people are stuck in situations of intimate partner violence when they become pregnant and can’t actually leave.”
When a person doesn’t get the medical treatment they require during pregnancy, there are lifelong health consequences that can follow. Hoffman said pregnancy is a crucial point in a patient’s treatment because they are often more engaged in their health care—and the care they receive at that critical juncture can change their life trajectory, for better or worse, depending on how they are treated. That’s why the treatment of depression and anxiety is so important for pregnant people, not just during and right after their pregnancy, but for many years afterward.
“It’s an opportunity, or could be a giant missed opportunity.… We can also see pregnancy as something that unmasks how health will look later in life,” she said. “If you have gestational diabetes, you will be more likely to develop type 2 diabetes later in life, and if you have preeclampsia that’s a marker you may be more susceptible to developing cardiovascular disease, stroke risk … so depression is exactly the same. Depression and anxiety interplay with these conditions, so they can escalate their progression.”
Reproductive rights advocates say that they’re concerned that the approaches taken by HHS to discuss what pregnant people should do to treat their pain or feed their baby are in keeping with ongoing conservative efforts to control their behavior in other ways, up to and including criminalization. Abortion bans often exclude serious mental illness as a part of the exception to protect the patient’s life and health. There are cases in which men have been held responsible for child abuse or neglect because of their partner’s substance use in pregnancy—described as their failure to control their pregnant partner. Experts on this legal environment say that these issues arise out of the increased surveillance of pregnant people, and the removal of their bodily autonomy.
“Pregnant people are put in an impossible situation where every decision they make about their pregnancy and about their health care is subject to increasing scrutiny,” said Pilar Herrero, senior attorney at the Center for Reproductive Rights, a legal advocacy organization focused on reproductive rights issues. “I think there’s also a lot of fear. People are afraid to seek care because they are unsure of what the law is. They’re unsure of what their health care provider will do and of what kind of judgment they’re going to face. I think it’s creating an increasingly fearful environment around pregnancy.”
