On Jan. 22, 1973, the U.S. Supreme Court handed down its decision in Roe v. Wade, declaring a Texas law prohibiting abortion, and similar laws in other states, to be unconstitutional. Not quite 50 years later, on June 24, 2022, the Supreme Court overturned the Roe decision. In Dobbs v. Jackson Women’s Health Organization, the court declared: “The Constitution does not confer a right to abortion.”
The Dobbs decision was the result of a half-century of pro-life activism pushing the notion that the fetus is a person, entitled to the protection of the state. But it also reflects a much longer history of harmful ideas about pregnancy and fetal development.
Although our current biomedical understanding of pregnancy and fetal development is relatively new, dating back to the mid-20th century, many of our most cherished ideas about reproduction trace their origins back thousands of years. That includes the notion that fetuses require protection from their mothers. For centuries, medical writers have argued that pregnant women frequently harm their fetuses, either through carelessness or malice. These ideas extend into the present and have consequences far beyond the debate over abortion, in our failure to provide healthy food, clean water, safe housing, and medical care for pregnant people and new mothers.
A great deal of what we think we know about procreation owes more to ancient religion and philosophy than it does to modern science. If you imagine a very old tree with deep roots, the latest scientific understandings of procreation are the newest green shoots on that tree. But those shoots connect to a much vaster and older set of ideas, and these older ideas continue to influence the way we think about fetuses and the way we treat pregnant people.
For example, we still use the expression “a bun in the oven” to mean pregnancy. This metaphor appears in a text attributed to the Greek physician Hippocrates who lived four centuries before Christ. It has been in continuous use for well over 2,000 years. The metaphor suggests that the fetus grows in the womb the way dough rises and expands in a hot oven. It evokes a visual parallel between the swelling dome of baking bread and the growing belly of the pregnant woman. And it feels especially appropriate since baking is a stereotypically feminine and maternal activity.
But the metaphor is strange as well. As anyone who has ever baked will recognize, most of the work of creating bread or buns comes before the dough is placed in the oven. Proofing yeast, mixing flour, salt, and water, kneading, letting the dough rise, punching it down, and letting it rise again — these are the steps that take effort and skill. Once you put the dough in the oven, there is nothing to do but watch and wait. So, why did a physician two millennia ago choose a metaphor implying that the maternal body is just a heat source that does no real work in making a baby? Or, the more urgent question is: Why does the metaphor still make sense to us despite our vastly superior understanding of reproduction?
Artists and writers compare their creations to children, and the creative process to gestation. But when we talk about actual pregnancy, most of our metaphors and similes compare the female body to a vessel, an incubator, or an oven. We describe pregnancy as passive, not active, something that happens to women, not something that women do. This mindset has consequences. An artist needs social, emotional, and financial support to create works of art. Your oven does not need social, emotional, and financial support to bake bread. “A bun in the oven” might seem like a perfectly innocent expression, just a quaint and old-fashioned euphemism for pregnancy, but it is part of a broader pattern of thinking about reproduction that we have inherited from the ancient world, and one that continues to shape how we treat pregnant people in negative ways.
In the half century between Roe and Dobbs, Americans have become increasingly familiar with images of fetuses and descriptions of fetal development. In the opening decades of the 21st century, we encounter fetuses in a much wider array of medical and nonmedical contexts than our counterparts in the mid-20th century did. We see these images in doctors’ offices and public health messages, at political demonstrations, in movies and television shows, in advertisements, and myriad other settings. Pro-life material, which has proliferated since the Roe decision, is full of descriptions and images of fetuses. The purportedly human features of the unborn are used to demonstrate their personhood. And yet even when pictures of fetuses are not accompanied by an explicitly pro-life message, they almost always show the fetus detached from the maternal body, suggesting that the fetus is an autonomous individual.
Advances in the care of premature infants make it possible for younger fetuses to survive outside the womb, pushing the point of viability earlier in pregnancy. Fetal surgery enables physicians to save the lives of fetuses with congenital abnormalities that would once have caused death before or shortly after birth. We now know about the hazards that alcohol and tobacco pose to fetuses. These medical developments, and the ways they have been presented to the public, blur the line between fetuses and babies, treating fetuses rather than pregnant people as patients. As our awareness and concern for fetuses has increased in the years between Roe and Dobbs, so too have our suspicions and surveillance of pregnant people.
The metaphor of the bun in the oven suggests that the pregnant body is passive. Even more troubling is the notion that the womb is a dangerous environment and that fetuses need to be protected from the women who carry them. This too has an ancient pedigree. Writing in the first century CE, the Roman physician Soranus claimed miscarriages were caused by strong emotions, vigorous motion (including jumping, dancing, having sex, coughing, and sneezing), and poor diet. In other words, miscarriages were almost always the fault of the pregnant woman.
Another idea that shaped medical thinking about pregnancy was “maternal imagination,” the notion that anything that made a strong impression on a pregnant woman, especially if it was frightening or repulsive, might leave an imprint on the fetus. For 2,000 years, the main explanation of birth defects and neonatal abnormalities was maternal imagination. Because women were irrational, unstable, and emotional, they made poor caretakers of fetuses.
In recent years, states have prosecuted women for using illegal drugs while pregnant, even if their babies were born healthy. Doctors and midwives have violated patient confidentiality to inform police of illegal drug use by pregnant patients. Hospitals have tested newborns for drugs and reported findings to the police. Doctors have obtained court orders forcing women to undergo cesarean sections and other invasive medical interventions, on grounds that such interventions were in the best interests of the fetus. In such cases, laboring women have been denied the right to make their own medical decisions. Perhaps most cruelly, states have prosecuted women who miscarried or gave birth to stillborn babies, even when these women had no intention of ending their pregnancies. All these trends reflect the insidious idea that the fetus requires special protection from the mother, an idea that has ancient roots. In the interests of “protecting” the fetus, the mother’s right to privacy and bodily autonomy can be abrogated.
Since Roe, disturbingly, the maternal mortality rate in the United States has risen, and it is now among the highest in the industrialized world. The infant mortality rate has also risen disastrously. Concern for “potential life” could, in principle, lead to better conditions for pregnant or potentially pregnant people. We could, as a society, make it a priority that all pregnant people and all who could become pregnant have access to healthy food, clean water, safe housing, and medical care. We could guarantee these things to all fetuses when they are born. But we do not. Instead, we treat pregnant people themselves as the greatest threat to fetal life. To protect fetuses, we ban abortions, regulate the behavior of pregnant people, and punish them for miscarriages and stillbirths. Our beliefs, attitudes, and policies surrounding reproduction are not saving babies, and they are harming women.
Like Hippocrates and the “bun in the oven,” the most harmful ideas we have about pregnancy have been around for so long that they seem natural and inevitable. Examining the historical development of these ideas shows that they are not. This perspective is critical as we face the challenges of the post-Roe world.
Kathleen M. Crowther is an associate professor in the Department of the History of Science, Technology, and Medicine at the University of Oklahoma.
Adapted from “Policing Pregnant Bodies: From Ancient Greece to Post-Roe America” by Kathleen M. Crowther. Copyright 2023. Published with permission of Johns Hopkins University Press.