I had been eagerly anticipating the release of Sarah Richardson’s meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history and philosophy of science, Richardson traces the scientific history of the idea that pregnant people’s bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.
A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations. Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the ‘quality’ of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form.
The idea that pregnant people’s bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden’s Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton’s “Risk and the Ontology of Pregnant Embodiment” (1999), Lisa Mitchell’s Baby’s First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers’ Bodies (2005) are all works firmly within this tradition. What is new about Richardson’s book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn’t manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it.
The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: “Epigenetic markers that help determine whether a particular site on the genome is active or silent can change in response to environmental stimuli” (4). Epigenetics is, Richardson argues, double-edged, in that it helps us get past a reductive genetic determinism, but in doing so it risks real implications for reproductive autonomy (and, I would argue, autonomy more generally for people who are or can become pregnant) (7). One twist that epigenetics specifically adds to the long history of theories of maternal influence is that its effects are potentially intergenerational, so that now pregnant bodies are framed as responsible not for shaping only their children, but also a whole line of descendants. On the one hand, Richardson argues, epigenetics gives us a tool for taking seriously the social and environmental forces that can shape human development, by providing a mechanism by which they can do so through the medium of the pregnant person’s body. But ironically, on the other hand, a focus on epigenetics also directs our attention away from structural social and environmental systems, narrowing our focus so that we see only the privileged vector of the pregnant body and worry only about how to control that body. Richardson points out that epigenetics and kindred theories may spark social interest in protecting women’s well-being, because generally, healthy, untraumatized, and resource-rich women can provide better fetal environments. Thus these theories and the rhetoric that they give rise to may have a surface-level ‘feminist’ sheen to them. But this social interest in protecting women’s well-being extends only insofar as women are reduced to risky material environments–environments whose functioning it is socially important to maximize for the production of ‘valuable’ children and perhaps grandchildren.
One of the most powerful parts of the book is Richardson’s discussion of how our causal reasoning is never purely empirical, in the sense of being value-free, but rather always shaped by our judgments of salience, our assumptions about what needs explaining, framing effects, and social interests. As Richardson puts it, the “overwhelming focus on maternal pregnancy effects—in isolation from paternal, postnatal, and wider social and environmental factors in development—is based on implicit, often unquestioned starting assumptions about the causal primacy of maternal effects, relative to other possible factors, in producing later outcomes. These assumptions are entrenched at every stage of research design, analysis, publication, and public translation” (207). In fact, though, she reminds us, quoting Dorothy Roberts, that “the best predictor of health is an individual’s position in the social hierarchy” (209). Indeed, Richardson points out, epigenetics, for all the excitement it has generated, has led to close to no meaningful interventions during prenatal care (214). Its effects are small, not practical to control, and unclear. The social uptake of epigenetics, meanwhile, has been reductive, and has amplified its effects: news stories and science reporting frame the path from pregnant people’s behavior and ‘lifestyle choices’ to the ‘quality’ of their children as a single, unambiguous causal vector leading to macro effects. There is, Richardson points out, a very quick pipeline, that takes small and uncertain epigenetic effects and translates them into broad lifestyle advice for pregnant people (10). This rhetoric stigmatizes pregnant women who are not in a position to provide the ‘ideal material environment’ with their bodies, heightens anxiety during pregnancy, and implies a simplified story about individual responsibility.
The framing of the pregnant person as an environment whose purpose is to generate ‘quality’ children is literalized in much of our visual imagery of pregnancy. Richardson points out briefly that many images of pregnant people have no heads. More specifically, many human development diagrams consist of “a central, prominent profile of a transparent, nude, headless human female with an extremely pregnant abdomen containing an infant-sized fetus. Arrows flow into the abdomen, representing preconception and in-utero exposures, and then out of the abdomen” (205). This point about headlessness and the visual focus on the abdomen is worth more attention than it receives in the book. This visual trope is used not only in the context of science, but in representations of pregnant people—and particularly in representations of pregnant people engaged in ‘risky’ behaviors—much more broadly. This is easy to see for yourself: If you do a google image search on ‘pregnant’ or ‘pregnancy’, about half of the images you get will be headless and focused on the abdomen. If you search for ‘pregnant women,’ you get even a higher proportion of headless figures; apparently women who are pregnant consistently have no heads of interest. And if you add on keywords associated with fetal risk, such as ‘pregnant alcohol’ or ‘pregnant diabetes’ or, most extremely, ‘pregnant obese,’ you get a nearly unbroken parade of headless bodies. Often, if the relevant risk is from something consumed, like alcohol or drugs, the picture will represent the substance being directed right at the abdomen: for fun, google ‘pregnancy alcohol’ or ‘pregnant woman alcohol’ and note how many of the photos are of a wine glass being held right up against a headless pregnant abdomen, nowhere near the person’s mouth. And in images where the entire pregnant person, including the head, is represented, it is overwhelmingly often against a neutral, brightly lit, featureless background. We do not generally see pregnant people represented in their full living contexts, as individuals who are part of the social and material world, but rather as dehumanized and impersonal sites of reproductive risk and control.
I found Richardson’s arguments and analysis engaging and persuasive throughout. However, I do want to spend some time on what I saw as a somewhat surprising absence in the book, which strikes me as a crucial part of the story she is telling. What is missing, it seems to me, is attention to the role that disability and ableism play in both the scientific and social narratives around maternal influences. “Disability” and “ableism” receive no index entries in the book, and in fact the term “disability” along with its cognates only show up six times in the book, almost always just as a matter-of-fact mention of a disability as a possible birth outcome. Only once is the issue of disability framed as part of the larger political story, and here just in passing: “Eugenic-era prenatal advice to mothers and fathers also makes starkly clear the historical enmeshment of reproductive and genetic science in the politics of race, class, gender, disability, and nation” (107-8). Richardson does not further discuss or develop this inclusion of ‘disability.’ She nicely thematizes the racialization of our anxieties over maternal bodies and birth outcomes throughout the book, and race receives a chapter of its own, but the role of ableism receives no analysis. However, I believe that the story of these anxieties about maternal influences and birth outcomes, and the science that emerges out of them, is absolutely inextricable from our deep societal ableism and ongoing moral panic around disability. It seems to me that, especially given that most of the maternal effects we have discovered are small and uncertain, the whole project of framing maternal bodies as first and foremost sites of risk and responsibility cannot be understood except in tandem with the twin ideologies of ableism and disability-phobia.
It is not inherently ableist to want to have healthy children, and to take steps to avoid conditions that will cause suffering. But it is ableist to be obsessed with the idea of engineering ‘high quality,’ ‘high value’ children, and it is ableist to engage in moral panics over the ‘threat’ of the birth of disabled children. The history of scientific theories of maternal influence has been one of scientifically and socially framing the pregnant body as a control mechanism for avoiding disability and maximizing what are seen as desirable traits. From the beginning, concerns about the ‘maternal imagination’—that is, pregnant people’s supposed ability to mark the bodies of their children with things like birth marks and limb deformities if they had the wrong fantasies, emotions, or temptations—were deeply bound up with panic around ‘abnormal’ and disabled bodies, focused more on our fears around aesthetic monstrosity and disfigurement than with meaningful concerns about well-being. The recent moral panics both over thalidomide effects and over Fetal Alcohol Syndrome are each only comprehensible when we understand the deep fear and revulsion of disability that underwrote them—again, not because caring about fetal health is problematic, but because framing the disabilities that resulted from each as horrifying, tragic, and clearly a result of fundamental moral negligence reflects ideological ableism.
While eugenics, technically, is concerned only with the manipulation of the gene pool, it is clear that eugenic logic and a eugenic imagination pervade these scientific projects. Much of the rhetoric that Richardson unearths is not even directly about protecting well-being, but rather about not leaving fetal development up to “chance,” where uncontrolled human variation is portrayed as irresponsible and scary. The book is full of examples of scientists talking about “high quality offspring,” “high value females,” and the like. The entire project of figuring out ways of controlling the ‘maternal environment’ in order to intentionally and strategically produce ‘better’ or ‘higher quality’ children is a fundamentally eugenic project that, I suggest, can only be understood in terms of a contrast between derogated and undesirable disabled bodies and well-engineered ‘proper’ bodies.
I am interested in how ableism and fear of disability wind their way without direct acknowledgement through the story that Richardson tells, and infuse much of the rhetoric she quotes (My claim, to be clear, is not that Richardson’s own rhetoric is ableist!). For instance, she reveals a systematic fear of hidden and minute disabilities and imperfections that might compromise the normalcy or quality of a child even if they are undetectable. As one pediatrician that Richardson quotes puts it, “Just because the young of a deficient mother may appear externally normal doesn’t mean they are normal” (9). Richardson talks about “the specter of invisible, subclinical damage” (162) and the panic over “the difference between a kid who is going to average a B- rather than a B+” (178-9). This sort of quest, not just to avoid suffering, but to stamp out small or even imperceptible variations from the normal and the socially valued, has its roots not in reasonable concern for children’s well-being, but rather in a vision of a disability-free world and a neurotic fear of disability. Indeed, many of the outcomes that scientists seek to avoid through control of maternal bodies, including autism, obesity, and ADHD, are conditions that have been claimed by many as neutral variations and alternative forms of embodiment and cognitive functioning, which need to be destigmatized and supported rather than stamped out through eugenics or other forms of biodiscipline.
A different kind of ableism shows up in rhetoric that conjures the dehumanizing and derogating threat of a ‘wave’ or ‘flood’ of disabled babies, for instance in the fear of an “approaching wave of climate change babies bearing the imprint of prenatal exposure to weather disasters and presenting a wide range of health problems” (180, my emphasis).
On the other end, the rhetoric around maternal influences is also ableist in insisting that good, responsible mothers engage in regimes of eating, exercise, intellectual activities, and so forth that are unavailable to many disabled people, thereby casting them as unfit and irresponsible mothers from the start. Richardson mentions that these recommended routines require “money, freedom, and leisure” (70) and thus rule out many people, but “ability” should have a prominent place on this list as well. And while fat-phobia is not quite the same as ableism, it is a close and interlocked cousin, sharing with ableism a deep fear of and revulsion at bodies that do not present as ‘normal’ or meet social standards for what normative bodies should be like. And as Richardson makes clear (especially at 214-215), fat-phobia pervades the maternal influence discourse. We have a special obsession with what pregnant people eat, and with the denigration and distrust of obese mothers along with a collective horror at obese children.
To sum up, Richardson’s book is rigorous, entertaining, informative, and politically important. I have argued that it would have benefited from including a disability lens, but no book can do everything. The work is an important and very readable contribution to science studies, feminist theory, reproductive ethics, and philosophy of science.
Quill R Kukla
Georgetown University and Leibniz Universität Hannover
 Not all pregnant people are women, thus I do not use the language of ‘pregnant women’ in this review. I do, however, use the terms ‘maternal’ and ‘mother,’ because the science under discussion consistently uses these terms to refer to the person who has eggs and a uterus and gestates a fetus. Gendered language is deeply imperfect; this is the compromise I have chosen. I do not mean to imply that all pregnant people who carry their children to term identify as mothers, as a social or as an embodied identity.
 Throughout this review, all page numbers refer to Richardson 2021.
 To be fair, when I wrote about these issues in Mass Hysteria (2005), I did not see myself how deep the connection was.
 Richardson talks briefly about these early theories in this book. For a deeper dive, see my Mass Hysteria (2005), as well as Margrit Shildrick’s Embodying the Monster: Encounters with the Vulnerable Self (2001).
Duden, Barbara (1993), Disembodying Women: Perspectives on Pregnancy and the Unborn, Harvard University Press.
Kukla, Rebecca (2005), Mass Hysteria: Medicine, Culture, and Mothers’ Bodies, Rowman and Littlefield.