The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss

October is Pregnancy and Infant Loss Awareness Month.

The designation dates back to 1988, when President Ronald Reagan first proclaimed it. 

Reagan’s proclamation recognized the support groups that had sprung up in the 1970s and 1980s to comfort grieving families and push doctors to acknowledge the emotional toll of miscarriages and stillbirths and encourage hospitals to offer perinatal bereavement care. But the President did not stop with miscarriages and stillbirths. He also praised at length the “Compassionate Americans… assisting women who suffer bereavement, guilt, and emotional and physical trauma that accompany post-abortion syndrome.”

This addition reflected Reagan’s ties to the anti-abortion movement and the very different way in which opponents of legal abortion perceived the procedure from those who championed abortion rights. To Reagan, every ended pregnancy was the tragic death of a child.

Flash forward 36 years and the meaning of pregnancy, and ended pregnancies, is very much on the ballot, and at the forefront of many Americans’ concerns. News stories of complicated pregnancies and criminalized miscarriages have piled up, while anti-abortion legislators continue to insist, as Reagan did in his proclamation, that every ended pregnancy is a tragedy to be mourned. Pro-abortion-rights activists and voters, by contrast, reject this idea.

This national conversation about ended pregnancies opens the door for another long overdue conversation. Is there only one right way to feel about the miscarriage of a hoped-for pregnancy? Is it beneficial to encourage every pregnant person to bond with her expected baby from the moment of conception? This expectation is relatively new historically, and it creates a source of distress and can discourage people from building the families they want. History suggests that we can be open to additional possibilities.

For most of history, fetuses were not considered “alive” and ensouled until the pregnant woman felt fetal movement — an event referred to as “quickening,” which typically took place approximately four months into gestation.

Early losses were particularly ambiguous and difficult to diagnose. If the loss occurred early on, it could be hard to tell the difference between a miscarriage and a heavy and crampy late menstrual period. The only way to identify a miscarriage was if the fetus had become recognizable — which happened around week eight — and emerged intact. Even then, the tiny fetus could be lost amid surrounding blood and tissue.

Read More: Understanding Pregnancy Loss Was Supposed to Improve Health Outcomes—Not Lead to Punishment

The result was that most couples didn’t perceive early pregnancy losses as losing a baby. Nor did they mourn the loss. The exception was women who had suffered from fertility issues. Because women’s security, prestige, and personal fulfillment primarily stemmed from childbearing, even early pregnancy losses could be a crippling blow for those who struggled to build a family. (Today, of course, no pressure to produce an heir is necessary for families struggling with infertility to be devastated by every cycle that does not result in a baby.)

The American Revolution introduced novel Enlightenment ideas about individual efficacy and the role of parents, reshaping women’s lives. During the 19th century middle-class women increasingly set aside the biblical injunction to be fruitful and multiply, and instead lovingly cultivated a small number of children into good citizens of the new republic. Rejecting fatalism and embracing family planning, they reduced the birth rate by half, from an average of seven children per woman in 1800 to an average of between three and four children per woman in 1900.

With more widespread agreement that each individual child was precious, activists and government programs around the turn of the 20th century cleaned up the water and milk supply and instituted public health programs, dramatically reducing infant mortality. Doctors encouraged women to seek prenatal care, and created new self-care pregnancy regimens that they hoped would result in healthier babies and save women from the dangers of preeclampsia.

During the mid-century baby boom, psychologists formalized Victorian ideas about maternal love into the idea of attachment between mother and baby, and pediatrician Benjamin Spock, celebrated author of the perennial bestseller Baby and Child Care, gave women permission to trust their parenting instincts and shower affection on their babies.

These patterns of love, cultivation, and control intensified in the 1960s and 1970s. The contraceptive pill gave women more precise control over when they started their families. More readily available pregnancy tests at doctors’ offices after 1960 and home pregnancy tests after 1978 made these planned pregnancies easier to detect early. Natural birth enthusiasts declared birth to be a crucial moment of mother-infant “bonding.”

The intensity ramped up in the 1980s, pushing the parenting timeline into pregnancy and creating a new ideal in which pregnancies were planned and perceived as precious from the earliest moments. Public health campaigns warned women against the dangers of smoking, imbibing alcohol, and even drinking coffee in the first trimester of pregnancy. By mid-decade most pregnant women had at least one ultrasound, triggering a new ritual of “meeting the baby” before birth. In 1982, attachment parenting guru William Sears described prenatal care as “parenting your unborn child,” and told parents “you have formed a bond probably from the first moment you found out you were pregnant.”

By the 2000s, prenatal ultrasounds at eight weeks became routine in many places. Home pregnancy tests had also improved to the point that they could sometimes detect a pregnancy a week or so after conception — before a woman had even missed her period – and very accurately detect pregnancy by the fourth week (when her period was due).

Americans used these technologies to “see” their babies and begin bonding in the very earliest weeks of pregnancy.

The active anti-abortion movement encouraged this transformation. They disseminated ultrasounds and other images of embryos and fetuses, hoping to encourage maternal bonding as a way to discourage abortions. Increasingly savvy marketers aiming to sell everything from diapers to cars to new parents also encouraged excitement about pregnancy and fond imaginings of a future family.

Many of the consequences of these changes have been positive. Americans enjoy healthier pregnancies and babies than ever before, more ability to plan their families, and a panoply of baby goods to help them nurture their infants.

Yet, these changes have also created a culture in which pregnant people are encouraged, even pushed, to bond with their expected children starting from conception, no matter the circumstances and no matter the consequences.

The smartphone apps that are now a ubiquitous part of the pregnancy experience demonstrate the problematic hype around early pregnancy. A person who gets a positive result on a home pregnancy test the day she is expecting her period is far from guaranteed a baby: at that stage she has about a 25% chance of losing the pregnancy. Yet, if she is excited about the result and signs up for a pregnancy app, these apps will immediately push her to create a nickname for the baby and sign up for a baby registry.

Read More: Why There’s So Much Pregnancy Trauma on TV and Podcasts Right Now

They will serve her articles about baby names, apprise her of typical fetal growth at each stage of gestation, and even call her “mom.” 

Pregnancy apps encourage this excitement and attachment, because it translates into user engagement and because their advertisers want to reach women as early as possible — before they’ve had a chance to choose someone else’s brand of car seat or diapers.

This creates a culture in which early pregnancy loss is perhaps more devastating than it has to be, for some women — despite the relatively high odds of losing the pregnancy. In fact, the apps account for this possibility. They console users who have lost a pregnancy by affirming the inevitability of their grief, not acknowledging the apps’ own role in promoting attachment to still-tentative pregnancies.

An article on The Bump’s pregnancy app, for instance, tells users that “a miscarriage is still a loss, no matter how early it happens,” and presumes that those who lose pregnancies would prefer to recognize the lost baby by gender and name in order to mourn. Similarly, Pregnancy+ says, “Each woman processes pregnancy loss differently, but one thing remains the same. The little life that was inside of you changes you” and “he or she will always be a part of your life whether you knew about him or her for 2 weeks or 2 months.”

Yet, we know from history that a more cautious approach to the early months of pregnancy, and a more gradual beginning to parental attachment is possible.

Such an approach wouldn’t be right for every woman. But if it became culturally acceptable to put aside the apps, delay shopping or choosing a name, and wait for quickening (or at least a reassuring eight-week ultrasound) to confirm a pregnancy, there are significant potential benefits. Among others: it could reduce the anxiety around early pregnancies, make losses more manageable and trying again less stressful, and make the politics of pregnancy more nuanced. Pregnancies are not one-size-fits-all, and neither are losses. We used to know this. It’s time to bring this perspective back.

Lara Freidenfelds, Ph.D., is the author of The Myth of the Perfect Pregnancy: A History of Miscarriage in America and The Modern Period: Menstruation in Twentieth-Century America.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.

The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss

The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss

The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss

The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss

The Abortion Debate Could Open an Overdue Conversation on Pregnancy Loss