Promoting Maternal Visions

This chapter examines how the pre-pregnancy care model has influenced public health promotion, illustrated through the “Show Your Love” campaign that was created by the Centers for Disease Control and Prevention (CDC) in 2013. This chapter reveals how the campaign’s message drew on and promoted gendered and racialized tropes in its goal of promoting pre-maternal love for future babies and, in so doing, further stratified reproduction. Discussion in this chapter highlights the social control aspects of public health and how the power of this particular messaging potentially reframes practices of “intensive mothering” into an ethic of “anticipatory motherhood.”

Get a Reproductive Life Plan!

This chapter details how pre-pregnancy care has been taken up clinically and culturally, especially through the emergence of the “reproductive life plan” as a clinical tool. Drawing on expert interviews and an examination of medical pamphlets, professional literature, public health campaign materials, media depictions of pre-pregnancy care, and popular books, this chapter focuses on the individualized and gendered aspects of contemporary pre-pregnancy health ideas. Specifically, the pre-pregnancy care model is shown to reflect a neoliberal health ethos in which women are held individually responsible for the optimization of reproduction in America in the twenty-first century. This chapter makes the case that as reproductive knowledge and policy were produced, so were medicine, morals, and markets.

Anticipating Risky Bodies

This chapter examines how maternal and child health experts defined risks to healthy pregnancies around the turn of the twenty-first century, especially amid scientific uncertainty regarding the etiology of birth outcomes. Drawing on interviews with maternal and child health experts and physicians who were involved in drafting and/or disseminating the pre-pregnancy care model, this chapter details how individuals drew on long-held assumptions about strong ties between women’s bodies and reproductive outcomes in order to craft a new “common sense” about future reproductive risk. Pre-pregnancy care as an anticipatory care strategy highlights how medicine and public health today focus on preemptive clinical intervention and on future risk. Moreover, pre-pregnancy care serves as a bellwether for where this trend is headed: toward preventive interventions in the name of the health of future generations.

From the Womb to the Woman

This chapter traces the history and evolution of health professionals’ thinking about how medicine and public health should intervene to ensure healthy pregnancies, focusing specifically on the extent to which medical thought has implicated pre-pregnancy health and health care as influencing reproductive outcomes. Analyzing medical and public health literature from the nineteenth century through the turn of the twenty-first century, this chapter reveals how medical faith in prenatal care—and its attendant focus on the womb and pregnancy—declined over the course of the twentieth century. As a result of this and other demographic and political changes, pre-pregnancy discourse resurged in the medical literature—shifting, in many ways, the locus of risk for a healthy pregnancy from the womb to the woman.

Governing Risk, Governing Women

This concluding chapter revisits the social and medical trends that have intersected with recent knowledge shifts in understanding pregnancy health risk, especially the contemporary tendency in medicine and public health toward the anticipation of risk, the persistence of cultural and medical assumptions that link all reproductive outcomes to women’s individual behaviors, and the ongoing debates in reproductive politics that hinder discussions about comprehensive women’s health care. This chapter ends by considering ways to think through, with, and beyond the pre-pregnancy care model in women’s health policy.

Whither Women’s Health?

This chapter reflects on the state of women’s health care and the policy that undergirds the contemporary vibrancy of the pre-pregnancy care framework. It explains why pre-pregnancy care was initially met with opposing interpretations about its vision and potential efficacy. Analyzing interview data in conjunction with historical materials, this chapter shows that pre-pregnancy care was, in part, created to advance reproductive justice by bridging the long-divided realms of maternal care and reproductive care. By traversing the boundaries of entrenched reproductive silos, the pre-pregnancy care model expanded health care during women’s reproductive years—an outcome that seemingly served progressive goals. However, the idea of couching women’s health in terms of their maternity status followed a long tradition of maternalism in American policymaking, further entangling motherhood and womanhood.

Someday, Now

This chapter introduces the contemporary medical and cultural visibility of the pre-pregnancy care model and details what the zero trimester includes. It covers the evidence and assumptions undergirding the pre-pregnancy care model and explains why the model has invited variable interpretations of its potential consequences for women’s reproductive autonomy and for maternal and child health. The rise of pre-pregnancy care is also discussed in relation to the history of prenatal care in the United States. Finally, key social science perspectives on medicine, motherhood, and reproduction are reviewed, setting up the argument that, with the rise of the zero trimester, medical and cultural ideals of womanhood and motherhood are increasingly intertwined.