February 24, 2014 | Posted By Lisa Campo-Engelstein, PhD

There is a cultural perception that women are very likely to cause fetal harm, reflected in limitations on women’s participation in clinical trials and certain jobs, public service announcements telling women not to drink alcohol while pregnant, and extensive media coverage of ‘‘crack babies.’’ The long history of the medical realm treating women’s bodies as weak, permeable, and inherently diseased contributes to the worry that women’s bodies will ‘‘infect’’ fetuses. Men’s bodies, in contrast, are as seen as stable, bound, and healthy; therefore, they are not a risk to fetuses. However, this belief is scientifically inaccurate. Men’s behaviors and characteristics can cause paternal-fetal harm. For instance, paternal smoking and drinking can result in an increased chance of birth defects and low birth weight. Paternal use of illegal drugs (such as cocaine, hashish, opium, and heroin) can also lead to fetal health problems because of abnormal sperm. Additionally, older paternal age has been associated with a higher risk of children with autism, Down syndrome, and schizophrenia.  

Despite these scientific facts, there is little public and academic discussion of men and fetal harm, which implies that men do not (or cannot) cause such harm. The cultural narrative that men are not causally or ethically responsible for fetal harm has been reified in law, policy, medicine, and the media.  Even the language we use to discuss reproduction and childcare minimizes the role men play in reproduction. The verb “to father” is synonymous with ‘‘to sire’’ and refers to impregnating a woman, that is, the one time event of fertilization. In contrast, “to mother” refers to constant caregiving and nurturing. There is legal precedent that men’s role in reproduction is just ejaculation. A 1998 case determining which member of a divorced couple should have custody of their biological embryos used this reason to rule in favor of the wife. Whereas men’s role in reproduction is reduced to a onetime event, women are seen as constantly at risk for harming potential fetuses during their reproductive years. The potential for women to become pregnant—the idea that women are constantly in a state of pre-pregnancy—was the main reason why the FDA issued new guidelines in 1977 that recommended prohibiting women of childbearing age from the early phases of clinical trials, except for life-threatening diseases. It was not until 1993 that the FDA changed its policy to include women in clinical trials in order to study sex differences in treatments.

The cultural belief that only women cause fetal harm is not limited to clinical trials, but is also seen in public life. For example, warnings on alcohol bottles caution only against pregnant women drinking. There is no similar warning for men seeking to become fathers, though men’s alcohol use can cause low birth weight and an increased risk of birth defects. Although illegal in the United States thanks to the 1991 unanimous Supreme Court decision International Union versus Johnson Controls Inc., the UK still permits employers to exclude women from certain occupations if there is potential harm to potential fetuses. Here again, women, rather than others, such as their mostly male employers, are held responsible for fetal harm. Indeed, the solution to avoiding harm is removing women rather than the chemical. No workplace chemical has been outlawed because of its effects on women’s reproduction, yet the pesticide dibromodichloropropane was banned because of its harmful effects on male reproduction.

The cultural narrative that women are agents of fetal harm also plays out in the media. There is a huge discrepancy in the number of articles about maternal-fetal harm versus paternal-fetal harm. While the number of newspaper articles addressing paternal-fetal harm has increased in recent years, the tone of these articles is less negative and more reassuring than the tone in articles about maternal-fetal harm. There is much more blame directed toward women for fetal harm than there is for men.

My concern with the different treatment of women and men regarding fetal harm is two-fold. First, the failure to recognize how men’s behaviors and characteristics can cause fetal harm precludes addressing and preventing such harms. Second, placing all the blame on women for fetal harms is not only scientifically inaccurate, but it is also unjust.

For more on this topic see Campo-Engelstein, L. “Paternal-Fetal Harm and Men’s Moral Duty to Use Contraception:  Applying the Principles of Nonmaleficence and Beneficence to Men's Reproductive Responsibility.” Medicine Studies (forthcoming).  

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