Women’s History Month: Professor Marian Knight

Reflections on women’s health today and the role of history

Women’s history month has given me an opportunity to consider the role history has played, and still plays, on issues affecting women’s health today, particularly health in and around pregnancy. I am not a historian, so this really represents a personal reflection on challenges I still identify in my current research and how these are rooted in historical events or practices.

My research focusses on severe complications in pregnancy and early life. We know that there are substantial disparities in outcomes for women and babies from diverse population groups, for example those from different ethnic groups or who live in socioeconomic deprivation. We also know that pregnant and breastfeeding women do not receive the same quality of care as non-pregnant women, simply because they are pregnant or breastfeeding. Pregnant and breastfeeding women are usually excluded from clinical trials and therefore we don’t have the best evidence about how to treat them for a range of conditions.

Some of the events underpinning these observations will be obvious to many. Concerns around medication use in pregnancy and potential adverse effects followed in the wake of the thousands of babies who died or were born with birth defects after the introduction of the drug thalidomide without prior investigation of potential toxic effects in pregnancy. In 1977, the US Food and Drug Administration (FDA) banned most women of “childbearing potential” from participating in clinical research studies, and this was not reversed until 1993. Thirty years later pregnant and breastfeeding women are still largely excluded from these studies.

Why does this matter? The characteristics of women giving birth have changed over time. More women now give birth who have pre-existing physical or mental health conditions than ever before. However all too frequently essential medication may be stopped because either they or their clinicians have concerns about use in pregnancy and we don’t have high quality information on medicine safety and effectiveness. Women’s health worsens and this can have tragic consequences for them or their baby.

So, my wish for Women’s History Month is that we recognise the negative impacts of these historic perspectives. The ethical imperatives to include pregnant and breastfeeding women in clinical trials are very clear. Let’s ensure care in pregnancy and during breastfeeding is underpinned by the same high-quality evidence as care for people who are not pregnant or lactating.