The sinister message behind Trump telling pregnant women to ‘tough it out’

The 19th century “doctrine of maternal impression” held that a woman’s thoughts and experiences could physically mark her child. Someone born with a strawberry shaped birthmark must have had a mother who craved strawberries during birth. The family of Joseph Merrick, known as the Elephant Man, said publicly that his disability was caused by his pregnant mother’s fearful encounter with an elephant.

This pseudoscience was promoted by the medical manuals of the day, according to cultural historian Karen Weingarten, and by American doctors long after their British counterparts dropped it. One 1869 book, George H. Napheys’ “The Physical Life of Woman,” warned that children would be born “idiotic or deformed” from “the influence of some severe mental shock received by the mother during her pregnancy,” with the implication that she should’ve avoided it. If a child departed from the norm in any way, it had to somehow be a pregnant woman’s fault.

I thought of that myth recently as President Trump once again offered scientifically unproven medical advice to pregnant women, in the form of an all-caps post on Truth Social on Oct. 26, telling them not to take acetaminophen lest they bear autistic children. Trump’s own Food and Drug Administration and the American College of Obstetricians and Gynecologists found insufficient evidence for the link, but for Trump and his secretary of Health and Human Services, Robert F. Kennedy Jr., it’s an obsession.

Trump earlier suggested that women who need pain relief during pregnancy simply “tough it out.” And at an October Cabinet meeting, Trump nodded approvingly as Kennedy rambled on about a video he said he saw in which a woman was “gobbling Tylenol with her baby in her placenta” to spite the president. (A fetus grows in the uterus, not the placenta). Opposition to Trump, Kennedy marveled, “could overwhelm millions of years of maternal instinct to put her baby at risk.” He added that “anyone who takes this stuff during pregnancy unless they have to is irresponsible.”

In their zeal to stigmatize autism and autistic people, both men show a grasp of science and human anatomy that should have been left in the 19th century. They are also exposing the latest iteration of America’s centuries-long obsession with controlling pregnant bodies, one with devastating real-life implications. The notion that selfish pregnant people are a risk to their own fetuses has been weaponized to prosecute them for addiction, for miscarriages, for stillbirths, even as the standard of gestational perfection is constantly shifting.

In my new book, “Unbearable,” I write about an Alabama woman named Hali Burns who was arrested in her son’s hospital room in 2022 only six days after giving birth and was charged with chemical endangerment of a child. Burns had struggled with opioid addiction and was on maintenance medication that at times she couldn’t afford.

When she tested positive twice for drug use during her prenatal care, the response wasn’t to offer her treatment, but to lock her up, even though her son was healthy. Burns spent months in jail, was denied sanitary supplies and adequate healthcare, and was told she could only make bail with both $10,000 in cash and a confirmed spot in rehab. The county jail she was confined to contained so many pregnant and postpartum women on similar charges that four of them shared a cell, nicknamed “the chemical crew.”

Burns had the misfortune of living in Etowah County, Ala., a rural northeast county that has aggressively charged women under “chemical endangerment” laws originally designed to police child neglect. On the theory that embryos and fetuses are the same as children who have been born, Alabama has long allowed pregnant people to be charged under the law. It’s how the state has led the nation in criminalizing pregnant people, according to data by Pregnancy Justice, a legal advocacy group that helped represent Burns in court. Between 2022 and 2024 alone, the group found that Alabama brought charges against 192 people for conduct related to their pregnancies.

Ironically for a state that touts itself as pro-life, if Burns had had an abortion — still legal in Alabama at the time — she might never have seen the inside of a cell. Instead, even though she was ready to enter treatment for her addiction, she was punished with the loss of her freedom, her dignity and the custody of her two children, the consequences of which she is still grappling with even after years of sobriety. Burns’ story demonstrates what happens when we treat pregnancy not as a human experience deserving of support, but as a crime scene; when we view the pregnant not as people but as vessels that must be monitored, controlled and punished.

In a way, America has only updated, never replaced, the myth of maternal impressions. In the 1980s, the crack panic led to the widespread criminalization of mothers, mostly Black women, on what turned out to be extremely flimsy evidence of fetal harm. Even evidence-based public health has moved to what sociologist Miranda Waggoner called “the zero trimester,” which expects women to act as if they could be pregnant at any time, and to follow the health dictates of the moment even if they aren’t pregnant.

The post-Dobbs era has sent this into overdrive. Most of the 412 cases of pregnancy criminalization documented by Pregnancy Justice nationwide in the two years since Dobbs concerned substance use. However, in 29 of those cases, the allegations against the women included a failure to get prenatal care. This in a country where, according to the March of Dimes, 35% of counties lack meaningful access to pregnancy care. The antiabortion movement has often said patients won’t be criminally charged with abortions where they are now illegal, but cops and prosecutors have had other ideas. Nine of the cases involved charges brought against pregnant women for obtaining, attempting or researching an abortion.

While offering women only prohibitions, both Trump and RFK have urged women to have more children; RFK called the birth rate a “national emergency.” But who, given the choice — increasingly elusive — would rush to have more babies when you get treated as a vector for harm rather than a human being?

Irin Carmon is a senior correspondent at New York magazine and the author of the new book ”Unbearable: Five Women and the Perils of Pregnancy.”