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A healthier America starts with healthy pregnancies

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The case seems pretty clear: We should make a nationwide effort to ensure that every obstetrician checks every pregnant patient's mental state, along with her weight and blood pressure. Women who show signs of depression should be offered therapy or, in cases that warrant it, carefully administered antidepressant medication.

Adult behavior can be difficult to change, as we know from the general ineffectiveness of anti-obesity campaigns. But pregnant women are a special case: They're usually highly motivated, they're typically in regular contact with health-care providers, and they have to keep up their efforts for only nine months. Pregnancy therefore offers a singular opportunity to improve lives for decades to come, via interventions that cost little compared with the enormous price tags for obesity, diabetes, low birth weight and premature delivery.

So why isn't this critical window one of our top health-care priorities?

Part of the reason may simply be our preference for quick fixes and for dealing with only those problems that exist in the here and now. It can be hard to wrap our heads around the notion that a woman's diet or mental state today will have a serious effect on her children's health many years out. But there's a less obvious reason that resistance to maternal health initiatives might crop up among the liberal-leaning individuals who typically support public health initiatives and women's health-care issues: abortion politics.

Caring for the fetus, protecting the fetus from harm - to abortion rights advocates, such measures sound like the steps antiabortion forces have taken to try to establish a fetus's rights. What's the difference between controlling a diabetic pregnant woman's blood sugar and, say, charging a pregnant woman who uses drugs with child abuse? Between telling an obese pregnant woman that her weight may predispose her child to obesity and requiring a woman to look at an ultrasound of her fetus before proceeding with an abortion?

The crucial difference lies in the intent behind the intervention and in the way it's carried out. Help in achieving a healthy pregnancy must be offered to pregnant women, not forced upon them. And the aim behind such efforts must be to foster the health and well-being of the woman and her fetus, not to score political points.

Ultimately, research on the developmental origins of health and disease should lead us to a new perspective on pregnancy, one that's not about coercing or controlling women - nor about ogling or fetishizing them - but about helping them, and their future children, be as healthy and as happy as they can be.

Annie Murphy Paul is the author of "Origins: How the Nine Months Before Birth Shape the Rest of Our Lives."


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