“Pregnancy is not an illness or a disease.” So says Bob Laird, a fellow at Human Life International and a board member for the Couple to Couple League, an organization that promotes Natural Family Planning based on Roman Catholic principles.

Laird’s remarks came in response to HHS secretary Kathleen Sebelius’ recent announcement that insurance plans will be required to offer contraception without copay, unless they meet the conditions allowing for a religious exemption. The HHS guidelines follow recent recommendations issued by the Institute of Medicine. Included are contraceptive methods like IUDs and tubal ligations which have a high upfront cost but, when offered for free, may be especially effective in reducing abortions.

Despite their promise for preventing unintended pregnancy and abortion, Laird criticizes the new guidelines based on his notion that:

Contraception does not fall within the category of preventative health services. These drugs, devices, and procedures prevent the bringing of children into the world. Contraception only prevents disease or serious illness if one considers pregnancy to be a disease or serious illness. Pregnancy is not an illness or disease, nor are children the side effect or the unintended by-product of disease. (emphasis mine)

Hm. Could it be that Laird is friends with Cardinal Daniel DiNardo, chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops? I ask only because Cardinal DiNardo said, in a statement about the Institute of Medicine recommendations:

“Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.” (emphasis mine)

Well, okay, that’s two. But as anyone who reads the New York Times style section, you have to have three instances of something for it to be a trend. Wait. What’s this?

From Ina May Gaskin, earth-mama midwife and not-Roman-Catholic hippie commune cofounder, in an excerpt from her March 2011 book, Birth Matters: A Midwife’s Manifesta:

[P]regnancy is not an illness in need of treatment, and nature’s design of women is not considered flawed. (emphasis mine, again. I am very emphatic.)

And we have a meme! But let’s consider this claim more closely. I don’t mean for this essay to serve primarily as a rebuttal, although it’s not hard to start to form the outline for one. (I mean, for the trillionth time, yes, sometimes getting pregnant can make some women very very sick. Also, on what basis are we supposed to accept that there’s a clear and non-culturally-laden way of sorting out Official Real Diseases from Things That Aren’t Diseases But Still Make Your Life Worse? I mean it’s not like “disease” is a category that’s written into reality as such, plain for all to see. More on that it a moment.)

Feminist-ish

I think it’s more interesting—and possibly more fruitful—to look at what makes the claim that “pregnancy is not a disease” compelling, right now. Why does it have cultural traction? Where does it come from? I suggest that this idea is idiosyncratic and particular to our own day. Precisely because it’s such a timely notion, it’s predictable that this would be the anti-contraception rebuttal. At the same time, it’s a claim that’s full of tensions.

Let’s start by looking at why some might find it compelling. For starters, it probably helps that the statement “Pregnancy is not a disease” isn’t identifiably religious. Indeed, at first hearing, it can sound almost appealingly feminist-ish. If you believe that misogyny is a real thing in the world, and that one of the hallmarks of misogyny is the notion that women’s bodies are gross and defective… well, a negative view of pregnancy seems like exactly the sort of data point you might expect, doesn’t it? Of course the forces of sexism would try to trick us into believing that pregnancy is dangerous and yucky, best avoided. But no! We will not be ashamed. Pregnancy (a condition that only biologically-female people undergo) is not a disease (and diseases are bad). Wow. That so nearly cancels out to “Women are good.” Hooray!

In this respect, the phrase “Pregnancy is not a disease” also fits well with a certain spirit of the times.

Now, let me say here that I know plenty of women who breastfeed for years, have unmedicated home births, wear their babies, and refuse artificial contraception mostly because they are simply happiest doing so. It’s the thing they’ve chosen to care about and are able to devote time to. They are lovely. But there are also communities out there with strong ideas about what women’s bodies are for, and the urgent need to enforce same.

And these idealized pairings of gynecology and nature often come, surprisingly, with an anti-patriarchal gloss. You don’t need an epidural, Hypothetical Laboring Woman, because your reproductive system was designed to give birth. Of course you can breastfeed, Hypothetical New Mom! Breasts are for nursing! That’s their purpose. Really, lady, did you honestly think your body was designed to take a web design class, sing Glee karaoke, boil mac and cheese, read the Washington Post, wonder why Bradley Whitford and Jane Kaczmarek split up, or do any of the other things you’ve so far chosen to do with your body? Silly. How, then, do you account for your ladybits? The existence of ladybits MUST be accounted for!

When Worlds Collide

Ultimately, I think, the not-a-disease notion of pregnancy is a lot like the Watchmen/My Little Pony mashup in the sense that it depends upon radically different discourses colliding into each other in counterintuitive ways. Specifically, we have:

Classical Christian notions of nature, borrowed from Greek philosophy. Briefly, the idea is that something’s nature—what the thing really is, in the most fundamental sense—is tied to its purpose.

Within Christianity the purpose of sex was, for centuries, held to be procreation. And the purpose of sex was most definitively, most emphatically, not to get one’s jollies. Thus was Justin Martyr able to anticipate, in his work On the Resurrection, the great day when marriage, “made lawless through lust,” would be destroyed. Augustine of Hippo likewise believed that the purpose of sex was to propagate the species, and was famously haunted by the fact that sex seemed so often to have a compulsive, self-gratifying, degraded quality unrelated to the bearing of children.

(Centuries later, the Roman Catholic magisterium would designate two purposes of sex: the “procreative” purpose of generating new people, and the “unitive” purpose of fostering love and closeness between a heterosexual married couple. It did so partly to correct a prevailing notion that any non-procreative sex was a sin—even, for example, sex between a married couple where one or both partners were infertile.)

Yet even with all their emphasis on procreation, ancient theologians didn’t bring much rosy optimism to pregnancy and childbirth. To the contrary, many thought God had punished humanity by forcing them to reproduce physically, in the same undignified and brute manner as animals. Remember, this was in antiquity. Most people lived at subsistence levels. The average lifespan was far shorter and average living conditions more squalid than today, outbreaks of plague were frequent, and death in childbirth was commonplace. In that context, it would have made no sense to say that pregnancy and childbirth were fundamentally safe, well-designed, healthy, blissful processes that if left alone would result in a healthy mother and baby. That idea wouldn’t come along until…

Grantly Dick-Read and the early natural childbirth movement. Grantly Dick-Read was a controversial early 20th-century British obstetrician who wrote a book called Childbirth Without Fear. In it, Dick-Read advised pregnant women and doctors to interfere with childbirth as little as possible, because women were able to carry and birth children entirely on their own. And, indeed, should give birth on their own. And that’s where it gets interesting.

The Hysteria Playbook

Because remember hysteria? If so, you know that hysteria actually was a legitimate disease, at least according to the conventions of 19th-century North America and Western Europe. It afflicted well-off women who were, it just so happens, enjoying increased education, paid employment, and declining fertility. And it just so happens that the cause of hysteria was thought to be “overcivilization.”

In good 19th-century colonialist fashion, there was a not-so-subtle racial and sexual hierarchy at work here. You didn’t want to be primitive (i.e. non-white); and indeed, it was great to be civilized (i.e. white). But if white women in particular got overcivilized (i.e. had fewer babies and worked outside the home)… well, then they’d strayed from their natural role, and nature punished them with a slew of gynecological problems: difficulty having sex, difficulty conceiving children, difficult pregnancies, and difficult labor and delivery. “Primitive” women, by contrast, were thought to reproduce frequently and easily. (If you hear a veiled worry about non-white people taking over, you’re not wrong.)

Decades later, in Childbirth Without Fear, Dick-Read follows the earlier hysteria playbook. Fear, argued Dick-Read, is a physical form of protection for the homo sapien—much like a skunk’s odor or a turtle’s shell. Fear deflects physical dangers. And that’s how fear still functions for “primitive” humans, whose chief concerns (he seems to imagine) involve things like falling off a cliff or getting eaten by beasts.

But in this modern world of ours today, there aren’t these sorts of physical perils (again, so he imagines) and so healthy fear has given way to chronic and nebulous anxiety. This is especially bad when a fancypants civilized woman has to do something primitive, like carry and bear a child. Then ALL KINDS of zany, unheard-of stuff goes wrong:

When a woman whose nervous system has been invaded by incompatibilities, becomes pregnant, there is considerable risk of her focusing her half-buried anxieties upon childbirth. Such complaints of pregnancy as persistent nausea, sickness, constipation, desire for unusual foods, excessive salivation, headaches, backaches and the weariness of general malaise, should draw the attention of every clinician to the possibility of her condition having a psychological basis. As pregnancy progresses, if these physical manifestations of her fear are inaccurately diagnosed and allowed to remain untreated, they may be intensified by the added strain of childbirth.

Nausea and backaches! In pregnancy! Can you even imagine? So strange, these modern civilized women! So unlike skunks and turtles! How did we get from Dick-Read’s “It’s all in your head, little lady! [pat, pat]” to a more legitimately feminist call to understand pregnancy and childbirth as normal and healthy physical processes? For that, we shall need to give credit to:

Feminist advocacy for women’s health: Many people my age (I’m 34) are surprised to discover that you used to not be able to say “breast cancer,” simply because it was indelicate to utter the word “breast.” Obituaries primly referred to women dying “after a long illness.” Likewise, for those of us who remember Margaret’s secret club nickname in Are You There God? It’s Me, Margaret, or whose college orientations included a condom demonstration session, it’s difficult to fully grasp how little most women once knew about their own reproductive health, or how much they had to leave up to doctors’ judgment.

It was this lack of knowledge that inspired the Boston Women’s Health Collective to print a pamphlet on the very basics of women’s health—a booklet that later became the nearly-300-page book Our Bodies Ourselves. It addresses gender identity, sexual orientation, abortion, drugs, relationships, and partner violence, as well as the more straightforwardly gynecological topics of contraception, menstruation, pregnancy, and childbirth.

That was in 1973—two years after Stephen and Ina May Gaskin, plus a few hundred of their hippie friends from San Francisco, had founded The Farm, an intentional community in Tennessee. There Ina May helped to start a midwifery center, and in 1977 wrote Spiritual Midwifery, for which she became well known.

In her way, Ina May and her midwifery colleagues from The Farm were, like the BWHC, trying to reclaim women’s health for women. Like the BWHC, Gaskin continues to call for greater involvement of women in maternity health policy and standards of care. Yet the differences between The Farm and the Boston Women’s Health Collective aren’t hard to spot. When it comes to the purpose of female bodies—and whether that’s even an appropriate question to ask—Gaskin ultimately has more in common with the classical Christian view, wherein women’s reproductive organs exist for a clearly-discernible purpose, reflecting a sacred and beneficent design.

Starting Over

So, anyway, that’s where we are. The notion that pregnancy is not an illness draws, I daresay uneasily, from a number of sources. There’s the classical notion that a thing’s nature is derived from its purpose, and the purpose of female bodies is to bear children. There’s the persistent early modern fear that women, especially privileged white women, are becoming overcivilized and unnatural, not having as many privileged white babies, relying on technology and pain relief, and not finding their bliss by giving birth. There are the (very laudable, in my opinion) feminist efforts to make women’s health something that women understand, so that they can make their own decisions and be advocates for themselves.

And there is, lastly, the plain fact that for some women, getting pregnant really honestly will make them sick(er), (more) abused, poor(er), and/or (more) mentally unwell. That’s a public health concern. And free contraception holds promise for addressing it. This is the overriding concern behind the IOM recommendations and the HHS guidelines.

In a public health discussion, isn’t that the appropriate place to start?