4.1 Introduction

The growth of research within the Development Origins of Health and Disease (DOHaD) and related environmental epigenetics fields has catalysed a shift in the understanding of how genes and environments shape phenotypes. The attention to embryonic and fetal development as critical periods with important long-term health effects has led to a focus on the gestational environment and maternal experiences like nutrition and stress, as intergenerational determinants of health [Reference Kuzawa1–Reference Thayer, Rutherford and Kuzawa3]. This emerging science has inspired claims that social exposures, including race-related inequalities, can drive physiological, developmental, and epigenetic processes operating in utero and during early postnatal life, becoming ‘embodied’ as relatively durable, albeit in principle modifiable, biological differences [Reference Kuzawa and Sweet4–Reference Gravlee6].

By eschewing fixed genetic differences, ‘biosocial’ perspectives on race have brought with them a renewed hope for a focus on the social, historical, and political bases of contemporary health disparities [Reference Landecker and Panofsky7]. This emerging understanding of the role of environment-driven phenotypic and epigenetic plasticity is often viewed as aligning with progressive policy goals because it demonstrates newly appreciated pathways by which major health differentials might be reversed by timely intervention. This is reflected, for instance, in the emphasis on the ‘first 1000 days’ in global health initiatives [Reference Victora, Adair, Fall, Hallal, Martorell and Richter8, Reference Martorell9] and a vibrant area of economics that harnesses DOHaD frameworks to promote investments in maternal and child health [Reference Heckman10, Reference Almond and Currie11].

However, despite the promise of DOHaD and environmental epigenetics to set out modifiable and plastic models of biological inheritance, social scientists have illustrated how enduring forms of ‘environmental determinism’ [Reference Saldaña-Tejeda and Wade12] may become intertwined with local conceptions of racial difference. As one example, one thread of research has argued that environmental exposure to poverty (which is highly racialised in many contexts) could impair early brain development and determine children’s lifelong potential [Reference Pitts-Taylor13]. Indeed, a growing number of scholars, in studies from microbiomics to brain development, have raised critiques of what could be characterised as a postgenomic reinstantiation of race [Reference Baedke and Delgado14–Reference Roberts18].Footnote ¹ As sociologist Dorothy Roberts has warned, ‘When scientists write that epigenetic effects of racial discrimination are durable across generations, it sounds perilously close to biological theories of race’ [18, p. 143].

As epigenetic and DOHaD analyses of racial/ethnic health disparities expand significantly in scope and impact, we echo others in urging caution in the collection and interpretation of these new data. We recognise that much of this growing work has gravitated to biosocial understandings of health disparities in part because these understandings both avoid reductionist genetic explanations and offer new explanations that can hopefully be harnessed to foster positive social change, such as making links between current health differentials and past injustices [Reference Nelson20–Reference Warin, Keaney, Kowal and Byrne22].

Our cautionary view stems from two arguments that we will lay out in the following: in the first, we seek to undermine the assumption that environmentally driven effects are always inherently progressive. Not unlike gene-centric models of race, environmentally driven models are similarly capable of being abused and used to promote racial hierarchies, as evidenced by work on race in Latin America [Reference Stepan23]. Here, we explore a lengthy history of proto-racism that traces presumed inherent group differences to environments, not genes. In the second, we explore the results of a review of current literature on racial health disparities in DOHaD and environmental epigenetics. This review demonstrates the enduring problems of reductionism and typological thinking in contemporary research. We believe that ongoing interdisciplinary work between social and biological scientists is key to correcting these creeping trends and strengthening this research in service of the goals of social justice. Towards these ends, we suggest various tools, such as community participation in all stages of research and moderation in reporting results, that can help avoid a potential reification of racial typologies in DOHaD research.

4.2 On the Long History of Biological Determinism and Racialisation

4.3 Current Work in DOHaD, Environmental Epigenetics, and Race

How common are essentialised and typological notions of environment-driven race and human difference in the DOHaD and environmental epigenetics literature? While an important catalyst for studies of developmental plasticity, DOHaD remains a niche in a wider trend exploring relationships between epigenetic changes, particularly DNA methylation (DNAm), and racial/ethnic differences. Within this broader field, do we see an emphasis on environmental determinism, a focus on negative environments understood as leading to permanent scarring, or perspectives that foster binary interpretations of exposures and outcomes?

Before we look specifically at research that addresses race and ethnic health disparities, there are some common practices within research design in the field generally that are worth noting for their potential to contribute to a reductionist portrait. For one, some DOHaD or epigenetic studies use observational and population-based case-control designs; these have a high potential for confounding because key influences on health, such as environmental stressors, diet, or activity levels, tend to cluster as a result of influences like socio-economic status, ethnicity, class, or gender [Reference Hernan46]. Other studies have harnessed natural or quasi-experimental designs, using ‘exogenous’ stressors such as a war-imposed famine, terrorist attack, global pandemic, or earthquake (for instance, [47]) to evaluate the impacts of maternal exposure during pregnancy. Because this work approximates a randomised exposure, it achieves a stronger basis for causal inference; however, it does so at the expense of studying severe shocks and stressors, which are not effective targets for intervention. (See Pentecost et al. in this volume on the move in DOHaD to preconception intervention trials.) Such ‘shock’ focused research is not capable of assessing more subtle exposures that reflect typical lived experience, let alone potentially beneficial or favourable exposures. On a similar note, experimental animal model research, which represents the ‘gold standard’ of causal evidence in this field, often imposes extreme prenatal nutritional stress on species with far less maternal capacity for fetal nutritional buffering than humans [Reference Thayer, Rutherford and Kuzawa3, Reference Kuzawa, Thayer and Hartigan5]. In addition to using models of severe stress, relatively little DOHaD work to date has been explicitly designed to clarify the potential reversibility of early life effects (see Lloyd et al. in this volume). This creates a default assumption that any effects induced by these (again, severe) exposures are also permanent. This simplified picture of permanent scarring may be further reinforced by the common convention in biomedical research of reporting relationships in a binary fashion, as being present or absent, depending on whether a threshold for statistical significance has been reached [Reference Wasserstein and Lazar48] (see also Sigurdadottir and Ayis in this volume).

As many of these observations apply to population-based health research more generally, we sought to offer a specific analysis of the use of the race concept in DOHaD and environmental epigenetics. We conducted a scoping review of studies within the fields of DOHaD and environmental epigenetics that address racial health inequities. We limited our review to empirical human studies that focused on race and ethnicity in health and related to epigenetics within a DOHaD framework. We reviewed 49 studies in total as they met all inclusion and exclusion criteria (see [Reference Meloni, Moll, Issaka and Kuzawa49] for a full description of our methodology).

Given the largely biomedical nature of the reviewed literature, an emphasis on pathology is predominant, and exposures are generally understood exclusively in the negative, that is, as a source of risk for chronic disease and mortality and dysfunction of biological processes. Populations emerging from often self-reported categories are reframed as aligning through differences in methylation level, for instance, from our sample: ‘African American adults’, ‘African American children’, ‘black women’, ‘black ethnicity’, ‘Hispanic ethnicity’, and ‘Native Hawaiians’. All these groups are defined as at-risk populations mostly via reference to abnormal methylation levels, even in instances when the data do not fit with this account (e.g. higher global methylation levels, suggesting reduced cancer risk in African American children). Intra-group variability in biological responses to environmental exposures is rarely given credence, and often differences – such as immigration status or the wide array of meanings, countries, and backgrounds coalescing under ‘Hispanic’ in the USA – are flattened into typological race categories.

Many social scientists have urged researchers to reframe their discussions and suggestions for policy towards structural factors – namely enduring systems of racism, widespread income inequality, and the historical legacies of colonialism (see Kenney and Müller, Keaney et al., and Karpin in this volume). In our review, we found that only three articles (6 per cent) mention or recognise the importance of wider socio-structural factors as ‘drivers of racial health differences’ [Reference Pepin, Ha, Potter, Bakshi, Barchue and Asaad50]. Similarly, reversibility is explicitly mentioned by 14 articles (28 per cent), but most discussions of this are brief and often limited to the conclusion.

Only a limited number of studies are self-reflective about the uncritical usage of racial categories (e.g., [Reference Pepin, Ha, Potter, Bakshi, Barchue and Asaad50]). A few go in the opposite direction and suggest that methylation markers differ significantly by race [Reference Giri, Bharadwaj, Banerjee, Chakraborty, Parekatt and Rajashekar51], and one claims that it is possible to separate distinct populations (Caucasian American, African American, and Han Chinese American) by using differences in methylation [Reference Heyn, Moran, Hernando-Herraez, Sayols, Gomez and Sandoval52]. One study is explicit about the importance of having one basal methylome map for each population and the potential value of epigenetic marks as distinct criteria for racial classification beyond and sometimes in contrast to genetic findings ([53], see [Reference Meloni, Moll, Issaka and Kuzawa49] for further details).

A final significant finding in our sample is the application of epigenetic clock studies, which use methylation to gauge the pace of biological ageing, to explain racial or ethnic differences in health outcomes. In a highly cited article in our sample, the authors remain cautious about the mechanisms by which ‘race/ethnicity and sex affect molecular markers of aging’ [Reference Horvath, Gurven, Levine, Trumble, Kaplan and Allayee53]. At the same time, the study uses several conventions that reify typological thinking around human population variation. As one example, the authors describe differences across these groups in largely typological terms, without devoting space to intra-population heterogeneities (e.g. ‘African Americans have been shown to have longer telomere lengths than Caucasians’; ‘Hispanics have a consistently lower IEAA (i.e. intrinsic epigenetic age acceleration) compared to Caucasians’; ‘Tsimane have a lower intrinsic aging rate than Caucasians’) [53, p. 170].

4.4 Fostering a Balanced Approach in Postgenomic Treatments of Race

Echoing a growing number of scholars [Reference Saldaña-Tejeda and Wade12–Reference Roberts18], we believe it is important to interrogate practices within DOHaD and environmental epigenetics that run the risk of reinstantiating new forms of biological race. For one, we believe it important to remain vigilant against ‘damage-centred research’, a term coined by Indigenous academic Eve Tuck [Reference Tuck54] to describe research that catalogues harms endured in a marginalised community with the intention of producing change, yet in practice rarely alters the social, material, or political causes of those harms and leaves populations labelled as ‘damaged’. Yet, we do not want to convey only criticism: these fields are stimulating crucial new understandings of the social and historical pathways underlying health inequalities, and many communities are leveraging this research to advance agendas of social justice and community resilience ([22, 55]; Keaney et al. in this volume). In the spirit of moving beyond critique, we end with recommendations for ways that researchers can help ensure that their work benefits communities while avoiding any unintended stigma or repetition of the simplifications and pitfalls of the past.

As noted in many of our above points, there are practices across biomedical research that may contribute to reductionist, simplified, and potentially stigmatising portraits of marginalised communities. The predominant focus in DOHaD research on documenting exposure–disease relationships that are characterised in such a de facto binary fashion (present or absent) can reinforce the idea that populations faced with early life adversity and stress necessarily carry negative biological baggage because of those experiences. These binary assessments can often also fail to find evidence of an effect simply due to a small sample size or, conversely, can find evidence that biologically trivial effects are significant if sample sizes are large enough [Reference Wasserstein and Lazar48]. Publication bias, as Non [Reference Non56] points out, also contributes to foregrounding research that shows dramatic methylation differences, but that may not translate into phenotypic differences.

This convention in reporting and discussing findings leads to a form of binary thinking in which effects are either present or not, and the magnitude of effect, or biological importance in a typical human population, often receives comparably little attention. Thus, we support the efforts in fields like statistics and epidemiology to do away with this focus on binary or ‘bright line’ assessments of the significance of findings [Reference Cummins and Marks57]. Furthermore, we identify practices that could prevent stigmatising groups: (1) moving away from interpretations of data that reinforce simplified cause-effect models, (2) avoiding characterisation of outcomes as present or absent, and (3) avoiding the generalisation of pathologies to entire groups without considering the magnitude, heterogeneity, or reversibility of these effects.

Non’s [Reference Non56] recent review also points to other conventional practices in biomedical research that may contribute, for instance, to sampling biases favouring white populations (which perhaps feeds into the use of white populations as the norm from which other groups are seen as differing as we have detailed in our sample, see above). This type of practice, which we have documented in our sample (see for wider materials [Reference Meloni, Moll, Issaka and Kuzawa49]), runs the risk of ascribing abnormality to marginalised communities ([45]; see also [58]). Researchers should consider the implication of their samples and the implicit racial ‘narratives’ (see Kenney and Müller’s chapter on narrative choreographies) that may emerge as a result.

Finally, we both echo the calls of communities involved in DOHaD research to study resilience and amelioration from early life adversity and reiterate alongside other chapters within this volume (Tu’akoi et al., Bourke, and Lovett) that future research needs greater collaboration with communities on DOHaD research. In the first, our review demonstrated an overwhelming, though not surprisingly, focus on pathology and ill heath arising from early life events. But DOHaD research cannot be limited to this. Future work should also explore the development of resilience from early adversity and the capacity for reversibility or amelioration of early life effects in response to later favourable experiences or other interventions. When reversibility is not explored, the default of permanence may often be assumed, thus increasing the potential for stigmatisation.

In the second, our point regarding reversibility has in fact been made by many communities that are the subject of DOHaD research, demonstrating the emergence of ‘bottom-up’ demand for research into practices that build resilience [Reference Müller and Kenney55]. This demand points to the need for researchers to conduct future work in ways that are aligned with the interests of affected communities, including requests for reparation. This will require meaningful engagement with participants across the research cycle. (See Tu’akoi et al. and Saulnier et al. in this volume.)

Collaborative and interdisciplinary endeavours will continue to prove essential to any future efforts to improve the production, interpretation, and consumption of epigenetic and DOHaD knowledge. This volume is a testament to the growing embrace, challenges, and value of interdisciplinary work in DOHaD. If we can apply the metaphors from this field to its development, early exposure to cross-disciplinary collaboration – from inception, funding, and through the research cycle – should also foster introspection and a stronger mature science.

5.1 Introduction

In this chapter, we explore how and why the application of Developmental Origins of Adult Health and Disease (DOHaD) theory has not led to social change and improved reproductive justice. We draw upon the framework of reproductive justice, paying homage to the work of feminist scholars of colour who argued that concepts of reproductive rights were too narrow in their focus on autonomy, choice, and abortion [Reference Roberts1, Reference Ross and Solinger2]. In combining ‘reproductive rights’ with ‘social justice’, the concept of reproductive justice encompasses much broader aspects of social life that intersect with reproduction, including family relations, conditions of work, housing, and welfare arrangements. Reproductive justice invites us to envisage DOHaD in a broader political field that takes account of how these social and structural inequalities profoundly shape the reproductive experiences of women.

In previous work, we have examined how DOHaD ideas can lead to blaming of mothers when health is seen as an individual responsibility, rather than socially determined. In this present piece, we try to understand more about the unfulfilled promise of addressing health inequities relating to food, gender, and reproductive justice. We suggest it is not just the tenacity of neoliberal ideas that gained prominence in the 1980s, foregrounding individual choice and responsibility while curtailing public services and welfare provisions (see [Reference Shrecker and Bambra3]). We argue that older entangled histories of nutrition and militarism as well as neoliberal politics have enabled a particular understanding, positioning, and uptake of nutrition within DOHaD.

We build on the arguments of others that the field of nutrition and health has long been dominated by a narrow mode of thinking that has been termed ‘hegemonic nutrition’ [Reference Hayes Conroy and Hayes4]; this is characterised by standardisation and reductionism, in which food is reduced to its constituents and bodies are decontextualised [Reference Hayes Conroy and Hayes4, Reference Sanabria and Yates-Doerr5]. In the United Kingdom (UK), as we will explain, this ideology resonates with a celebrated history of nutritional research from the early twentieth century that identified the causes of common, intractable diseases and enabled improvements to be achieved by simple means. The approach was only slightly modified when dietary imbalance and energy excess came to the fore as the nutritional problems of the second half of the twentieth century, with dietary advice now the remedy.

Drawing on Foucault’s concept of biopolitics and approaches used in the field of feminist science and technology studies (STS), we critically explore the deeply embedded logic of hegemonic nutrition, pointing to an assemblage of taken-for-granted politics and practices that work towards efficiency, bodies fit for purpose, and ‘proper’ moral conduct (long before the present neoliberal era). We trace this history and argue that this mode of thinking pervades the research that was undertaken to advance DOHaD ideas and the dominant interventions that were then devised. This stance continues to reproduce universal views of food and women’s bodies that render invisible the complex realities of daily lives.

5.2 A Feminist Science and Technology Studies Approach

We come to the field of DOHaD from our respective disciplines of social epidemiology and social anthropology, with central interests in health inequalities, gender, and feminist STS. Science and technology studies sees science and society as inextricably intertwined. The analytic approach entails tracing the histories that are written into scientific practice, of how ‘particular knowers, were embedded in, and influenced by, their religious, political, or gendered convictions, about how they could know depended on the people around them, the time and place, their class, and their own identities and interests’ [Reference Martin, Brock, Raby and Thomas6, p. 161]. While there are many different approaches within STS, a feminist STS approach draws attention to gender and its intersections with other relations of power and how these are smuggled into a science that is often presented as value free.

As feminist STS scholars, we actively interrogate disciplinary knowledge (including our own), their boundaries, and unequal power relations, reflecting on the taken-for-granted assumptions that underpin common-sense understandings of women’s biosocial lives in DOHaD. We attend to matters of power within DOHaD and where it is vested – manifest in the conference arrangements, the keynote speakers, the websites, the reviews, and special issues. We notice who and what gets funded; how calls for new grants are framed and specified. We notice what sort of research receives accolades. We notice what is marginalised or left out. We think about how this is the result of much larger historical and political agendas and the continued dominance of biomedicine [Reference Fisher, Baum, MacDougall, Newman and McDermott7].

We are attuned to the boundary work that defines the fields of nutrition and DOHaD, and how nutrition has been discursively constructed to align with the ‘epistemic authority of science’ [Reference Gieryn8, p. 12], that is, the biomedical model. Such ‘legitimation of knowledge claims [are] intimately tied to networks of domination and exclusion’ [Reference Lennon, Whitford, Lennon and Whitford9, p. Reference Roberts1], which are themselves tied to structural systems of inequality.

We know that many DOHaD researchers will not be familiar with the above ideas. More simply, but with much loss of nuance, we think about which disciplines are seen as authorities on women’s health and the implications of this view. When social conditions lead to health problems, surely this would invite social research and responses. Instead, what occurs is biomedical research and responses, and we seek to understand and critique this.

5.3 Social Inequalities in Health and the Promise of DOHaD

In 1980, the UK Working Group on Inequalities in Health reported that inequalities in health had widened since the National Health Service was established in 1948; this was attributed to various aspects of daily life and work, with implications for social policy [10]. Shunned by the Thatcher government, the ‘Black report’ (named after the chair of the Working Group) nevertheless received international attention and renewed research and advocacy around the social determinants of health.

Against this backdrop, within a decade, the theory that growth and development before birth influenced a person’s health over the life course was proposed by David Barker and his colleagues. It suggested a new mechanism for the link between social position and health [Reference Barker11], expanding the reach and relevance of ideas about the social determinants of health. With the accumulation of evidence and growing acceptance of DOHaD ideas, action to address social determinants seemed imminent with the 1998 Independent Inquiry into Inequalities in Health [Reference Acheson12].

Yet social inequalities have continued to widen, in the UK and elsewhere, accompanied by an increase in economic insecurity [Reference Stiglitz, Fitoussi and Durand13, Reference Paremoer, Nandi, Serag and Baum14]. In Western countries, DOHaD ideas have not led to improvements in the social determinants of health of women and infants. Instead, a narrow view of nutrition and its role in the first 1,000 days has taken hold [Reference Penkler15].

5.4 Developmental Origins of Adult Disease and Maternal Nutrition

The cohort studies undertaken by Barker and his colleagues in the UK in the late 1980s showed that an individual’s weight at birth was associated with the risk of death from cardiovascular disease many decades later. Extended work pointed to problems with nutritional supply in fetal life. This understanding was consolidated in discussions with specialists in fetal physiology and placental development in the UK, Australia, and New Zealand [Reference Barker, Gluckman, Godfrey, Harding, Owens and Robinson16].

Barker had been thinking about intergenerational nutrition for many years. In 1966, he published three papers from his PhD on prenatal factors and ‘subnormal intelligence’. He noted an excess of children with an intelligence quotient between 65 and 74 in the two lowest social classes and suggested this might be explained by poor maternal diet or physique (with short stature reflecting stunting). In subsequent research, he considered a wide range of explanations for geographic variations in disease (such as gout and gallstones) within Britain, including occupational exposures and trace elements in drinking water [Reference Barker17]. However, he is said to have been most interested in adult diseases as possible consequences of nutritional conditions or infections in early life, evident in the studies that commenced when he became director of the Medical Research Council (MRC) Environmental Epidemiology Unit at Southampton University in 1984.

Research on disease aetiology, as upheld in biomedicine, is inevitably reductionist through the emphasis on identifying mechanisms and insisting that causation is only convincingly demonstrated by the experimental manipulation of specific factors [Reference Davis, Davis and Gonzales18]. Thus, despite the appreciation by Barker and his colleagues of the relevance of social circumstances and structural factors [Reference Barker19], wider environments were erased in the laboratory experiments and clinical studies required to provide the proof that maternal nutrition has effects on fetal growth and development. Not only has this logic directed vast attention to the physiology (and later, epigenetics) of the fetus and placenta, but it has also heavily influenced ideas about how to respond to nutrition as a cause of poor health.

Research motivated by the DOHaD theory concerning women’s diets, pregnancy, and fetal growth indicated that the problem did not lie in specific nutrient deficiencies or in a specific condition such as anaemia. Historical and contemporary cohort studies of pregnant women suggested dietary imbalance or quality might be relevant, but also body composition (see [Reference Godfrey and Barker20]). Women’s diets in pregnancy are usually a continuation of their established dietary patterns, and older work had already suggested that cumulative nutritional status before pregnancy influenced fetal growth more than dietary intake during pregnancy [Reference Ounsted and Ounsted21].

By the early 2000s, the focus had shifted to body size and women classified as obese, partly in response to concerns about gestational diabetes and obesity in children [Reference Oken and Gillman22]. DOHaD researchers and practitioners might have emphasised the connections between obesity and stress and hardship [Reference Moore and Warin23]. Instead, they largely succumbed to what Scrinis [Reference Scrinis24] has called ‘nutritionism’, where individuals are provided with advice and detailed information on the constituents of food and induced to think in microbiological terms. This is an approach to problems involving nutrition that harks back to early-twentieth-century ways to address nutritional deficiencies. Excess body weight does not arise from a nutritional deficiency, but it is cast as a deficiency of information and willpower that is squarely located within ‘non-normative’ bodies [Reference Warin, Turner, Moore and Davies25].

5.5 The Treachery of Nutrition

We suggest that identifying nutrition as a cause of poor health invokes modes of research and institutional responses that do not involve social or structural change. As we will explore, nutritional causes of poor health are widely seen to require detailed biomedical analysis, translated into ‘lifestyle’ advice for individuals. This template does not attend to eco-social causes [Reference Krieger26]; thus class and racial/racist inequalities are unacknowledged and undisturbed. We refer to this as the treachery of nutrition. This epistemic privileging of biomedical sciences renders other disciplines (such as social sciences) marginal to DOHaD knowledge and acceptance and constrains possibilities: for multiple knowledge (including lay knowledge); for inclusive funding for different research questions, methods, and interventions; and for new policy agendas.

At the core of the treachery of nutrition are its historical roots in biochemistry and physiology and the biomedical model. This disciplinary alliance and approach were remarkably successful in addressing deficiency diseases (such as rickets) in the early twentieth century, as will be outlined. However, the nature of the pressing problems changed to dietary imbalances and over-consumption. The old emphasis on micronutrients and the need to instruct people to consume unpalatable substances (such as cod liver oil) was carried forward. The approach was renovated as profiling of nutrients in foods and diets and providing people with instructions around this, despite the fact that lack of knowledge was hardly the problem it had been. Others have criticised the reductionist approach that dominates thinking about nutrition and health, in general, and the narrow responses this offers [Reference Hayes Conroy and Hayes4, Reference Scrinis24, Reference Cannon and Leitzmann27]. Here we take this up specifically in relation to DOHaD, which has become a site for the reproduction of hegemonic nutrition and a means for its proliferation in healthcare and popular media.

The expectations of nutrition as a means to improve public health rest on portable, insertable solutions: a spoonful of cod liver oil, a dose of lime juice, a dab of Marmite. These do not improve the living and working conditions of people but rather make them fit for work (historically, as sailors or labourers) or bearing arms (notably in World War I). This has been carried forward: an ounce of education, a brief piece of advice, a mobile phone app. The legacy of this tradition is clear within DOHaD. Also clear is that certain views of bodies and food pervade the field: making women fit for childbearing and food as substrate for fetal growth.

What this approach neglects is the gendered, sociocultural, economic, and political contexts of food and food systems, and the everyday lives of women and their emotional wellbeing, that shape the many practices of how eating, care, and nourishment are done. We acknowledge that some DOHaD efforts have been directed to these broader contexts [Reference Penkler, Hanson, Biesma and Muller28, Reference Strommer, Lawrence, Shaw, Correia Simao, Jenner and Barrett29], and we would encourage much more of this. We know it remains important to address micronutrient deficiencies in pregnant women in many parts of the world [Reference Keats, Haider, Tam and Bhutta30], and folic acid supplementation is important to prevent neural tube defects [Reference De-Regil, Peña-Rosas, Fernández-Gaxiola and Rayco-Solon31]. However, different approaches are needed for obesity.

5.6 The Overweening Shadow of Historical Nutritional Research

The history of nutrition research and its emergence as a science, as represented in imperial and colonial accounts, emphasises advances made in the UK and the USA from the 1900s [Reference Carpenter32]. These advances prioritised the discovery of nutrients, descriptions of nutritional deficiencies, and factors affecting nutrient availability. In the UK, this history is marked by concerted government efforts to research specific public health problems and then mobilise a response on a large scale. Unparalleled elsewhere, this reflects the much greater involvement of the UK than the USA in the two world wars. Nutrition was an ‘instrument of state’ [Reference Cannon33, p. 702], as outlined below, pressed into service to ensure the food security of troops as well as that of the home population, with the UK vulnerable to blockade and experiencing a shortage of agricultural labour (see [Reference Cannon33, Reference Smith34]).

As recounted by Acheson (who preceded Barker as the director of the MRC Environmental Epidemiology Unit and then became Chief Medical Officer 1983–1991), ‘The story of the Government’s triumphantly successful food policy in World War II has often been told …’ [Reference Acheson35, p. 210]. To ensure the food supply, there was rationing underpinned by nutrition science. Thus, staples of bread and potatoes were not restricted, while meat, fat, and sugar were; vitamins were distributed; expectant and nursing mothers had an extra allowance of milk. The physical health of the population, notably children, measurably improved [Reference Acheson35].

Less well known is an older history of endeavours, for example, to avoid scurvy in troops in World War I. An appeal by the War Office led to Harriette Chick at the Lister Institute recommending the consumption of beans and lentils that had been germinated or sprouted [Reference Smith34]. The political situation (war) made the study of vitamins (then known as accessory food factors) an imperative, and the functional properties of certain foods were used to solve the problem of maintaining the health of troops within the constraints of army food supplies; pulses for germination were much easier to store and distribute than fresh fruits and vegetables.

Also noteworthy is the history of rickets [Reference Carpenter32], which manifests in children as bowed legs and other skeletal deformities. Rickets was perplexing in research, long the subject of apparently contradictory findings and debate. In retrospect, we know that this confusion was because rickets is due to a deficiency of vitamin D (needed to absorb calcium), which can be sourced from sunlight or from diet (while some cereals can reduce absorption of calcium). In 1914, the (then) Medical Research Committee funded Edward Mellanby to undertake research that included his famous experiments with dogs; he fed puppies different diets to see which resulted in rickets, systematically identifying a deficiency of a fat-soluble accessory food factor that must be responsible and testing ‘anti-rachitic’ diets. Mellanby concluded that rickets was a deficiency disease that could be cured by providing animal fats or cod liver oil. After World War I, clinical trials with children in Vienna (led by Harriette Chick) demonstrated that rickets could be treated and prevented by these means (or sunlight) [Reference Carpenter36].

Mellanby went on to have a long career providing advice to the Ministry of Health and to the War Cabinet in World War II. His early work set a pattern for the interaction of clinical and experimental work that he advocated in a book with that title and as Secretary for the MRC from 1933 to 1949. Mellanby was hugely influential through the positions he held, and biomedical and nutrition science was shaped by his historically resonant presence. (See, for example, the celebration of this research tradition in the ‘Timeline of MRC research and discoveries’ on the website of UK Research and Innovation.) This pattern of clinical and experimental work was carried forward by McCance and Widdowson in their work on fetal and infant growth after World War II [Reference Buklijas37] and was advocated and upheld in the DOHaD field as the biomedical model par excellence.

Thus, after the initial findings from observational epidemiological studies, animal experiments that are the hallmarks of ‘proper’ scientific nutritional research were soon undertaken. This was vital to prove the principle that dietary manipulations in pregnant animals can alter long-term metabolic function in offspring. Most of the research was undertaken in rats, with consequences for offspring of maternal low-protein diets, in particular, described in detail: altered fetal growth; reduced size of truncal organs (but brain sparing); hypertension; abnormal glucose and insulin responses; impaired inflammatory responses; and shortened lifespan (e.g. [Reference Langley-Evans38]).

But these experiments should not be interpreted as demonstrations of what should happen in humans, in the way the older experiments on deficiencies provided direct guidance on what to insert into the diet. Even research with laboratory animals induced to have large amounts of body fat (e.g. [Reference Samuelsson, Matthews, Argenton, Christie, McConnell and Jansen39]) only proves that this condition can affect the morphology and physiology of offspring; it does not indicate when or how obesity in women forming families should be addressed. Kelly and Russo [Reference Kelly and Russo40] have identified this mistake in reasoning: the mechanisms of aetiology for non-communicable diseases are not the mechanisms of prevention. Thus, identifying obesity as a cause of poor health is not enough; it is not a pathogen or isolated behaviour to be eliminated; it has complex social origins that need to be understood for prevention to be possible.

We do not question a role of basic nutrition science, but we question it being viewed as almost all that is necessary, as providing a guide for clinical trials and related actions. The reductionism apparent in nutrition and in biomedicine more broadly was as strong as ever in DOHaD research, perhaps firmly embraced in the effort to gain legitimacy. The early findings from cohort studies had received the standard criticisms of observational epidemiology (see [Reference Joseph and Kramer41]): findings might reflect bias or confounding, correlation is not causation, and what was the mechanism? So the response was to undertake experiments in which nutrition was manipulated and to pursue biological mechanisms (eventually epigenetics). But more than this type of knowledge is required, and Penkler [Reference Penkler15] notes that DOHaD researchers are beginning to recognise this.

Biomedicine and the basic sciences have profoundly shaped the field of nutrition and health, leading to well-trodden patterns of organisation across the scientific community. Thus, nourishment is seen in reductionist terms, food and the food–body relationship are standardised, and expert knowledge is seen as the corrective. This hegemonic nutrition is decontextualised: it does not attend to the exigencies of everyday lives; the roles of place, racism, gender and gender relations; or the politics of food systems. It dominates at the expense of other ways of thinking about food and health and possibilities for intervention. Valdez refers to this pervasive logic as an ‘epistemic environment’ [Reference Valdez42, p. 9], as it highlights how scientific knowledge production is shaped and ‘how science imagines, manages and apprehends future health’ [Reference Valdez42, pp. 9, 10]. This boundary work involves selective foreclosures [Reference Guthman43], and in the case of DOHaD, this foreclosure consistently locates the ‘problem’ in maternal diets and in women’s reproductive bodies, not in the broader conditions of daily lives.

5.7 Biopolitical Deployment of Nutrition Interventions

The DOHaD field clearly reflects a genealogy of hegemonic nutrition that can be further understood through Foucault’s concept of biopolitics. Foucault argued that a new form of power emerged in the nineteenth century, with governments seeking to control and manage populations from a distance through expectations of collective conduct. Through shaping expectations about appropriate ways to live and behave, and having citizens monitor themselves and others, governments did not have to exert overt power (e.g. through threats of physical punishment or imprisonment). This form of power is known as biopolitics. Citizens learned about these expectations and how to conform through institutions such as schools and clinics (that had become widely accessible), as well as laws and regulations. Although the strategies and technologies of biopower (the ways expectations are created and maintained) have changed over time, one enduring focus has been reproduction and the role of mothers in serving the health of their children and in maintaining the population needed for labour and war [Reference Ginsburg and Rapp44, Reference Clarke45]. The biopolitics of reproduction is now extended to the health of their children before birth [Reference Lupton46].

Biopower works subtly as it operates horizontally in everyday worlds rather than appearing to be imposed directives. People are asked to take responsibility for their health through self-care and to work on their own bodies according to normalised standards (see [Reference Coveney47]). Autonomy is emphasised, and this resonates with a liberalism ideology. (But as the example of obesity makes clear, individuals are not free to reject expectations to do this work.) Expectations for collective conduct are set in conjunction with a range of networked agencies and professional organisations that authorise and legitimise norms. The medical profession and the basic sciences have long been sources of authority drawn upon in biopolitics (sometimes notoriously, as in the eugenics movement) [Reference Lemke48, Reference Rose49]. Biopower can be useful in organising communities and improving health, but it can also entail harm when problems are purely individualised.

There is a history of research in which pregnancy, childbirth, and caring for children are considered through the lenses of medicalisation and biopolitics [Reference Ginsburg and Rapp44, Reference Oakley50]. Mothers-to-be and mothers are subject to expert advice, medical monitoring, and public scrutiny, with discourses on appropriate self-care proliferating in popular media. Conforming is a personal responsibility and a moral imperative, regardless of a woman’s life circumstances or constraints. In general, biopolitics identifies certain groups as needing more scrutiny and guidance to comply with bodily self-regulation. The ‘problem’ groups are those that fall outside the normalised parameters of health or civility, such as the poor, the unemployed, migrants, or people of colour. Such groups are often represented as ignorant and uneducated, requiring heightened surveillance and education. In relation to pregnancy, women whose body size is classified as obese are now seen as a ‘problem’ group. Here lies the potential to re-inscribe discrimination.

Antenatal lifestyle interventions for pregnant women, particularly those with large body size [Reference Flynn, Dalrymple, Barr, Poston, Goff and Rogonzinska51], are an exemplar of gendered biopolitics. Women are typically counselled by dieticians and provided individual advice. There are now apps to track nutritional intake and physical activity and to receive behaviour modification messages. Other educational supports in the service of improving lifestyles include any number of pamphlets, social media sites, and food marketing. While the use of digital technologies gives this a veneer of twenty-first-century self-help, these lifestyle interventions have not significantly changed since the 1950s [Reference Valdez42].

Conceptually, biopolitics helps us see how medicine, nutrition science, and health promotion – now integrated in DOHaD – direct women to put more effort into managing their pregnant bodies and securing the future health of their children. For some women, this may be useful and provide a sense of control, but for others it is a source of unfair pressure. The individualisation of responsibility means that women are blamed, or feel blamed, when they do not act appropriately [Reference Warin, Zivkovic, Moore and Davies52, Reference Richardson, Daniels, Gillman, Golden, Kukla, Kuzawa and Rich-Edwards53], and the difficulties faced by women in disadvantaged circumstances and/or ethnic minorities are not taken into account. Furthermore, meaningful support and social change do not occur.

We are not trying to deny that improvements in antenatal care have reduced maternal and perinatal mortality and morbidity, notably over the first half of the twentieth century. We are not suggesting that women are not agents in biopolitical processes (especially middle-class, white women). However, we do criticise lifestyle interventions in antenatal care as the dominant response to DOHaD in Western countries. From within this paradigm, there have been questions about the efficacy of the approach because it probably occurs too late to benefit fetal development [Reference Catalano and deMouzon54], so a shift in focus to pre-conception care has been proposed [Reference Vogel, Kriznik, Stephenson and Barker55]. That would simply shift the problem of foreclosure we identify to an earlier point in women’s lives.

Biopolitics constructs health as an individual responsibility. But as Wells has argued, society has created ‘metabolic ghettos’ in which people are susceptible to obesity, and there are many steps that governments could take to address the commercial and corporate determinants of obesity and to support people to have healthier lives [Reference Wells56]. These are social justice initiatives – not the portable, insertable solutions exemplified by cod liver oil.

5.7 Interdisciplinary Approaches Are Needed

The challenges of broadening and transforming disciplinary boundaries are multiple, even for those working from within. Tensions in the field of nutrition concerning its disciplinary emphasis have long been recognised (e.g. [Reference Waterlow57]). In 2005, Cannon and colleagues [Reference Cannon and Leitzmann27] set out the basis for a ‘new nutrition science’ that was social and environmental as well as biological. Within the American Society for Nutrition, the case for ‘mode 2’ research (another term for applied research) has been made [Reference Pelletier, Porter, Aarons, Wuehler and Neufeld58]. Several European nutrition entities have jointly proposed embracing broader research domains and disciplines, including anthropology, sociology, and cultural studies [Reference Tufford, Calder, Van’t Veer, Feskens, Ockhuizen, Kraneveld, Sikkema and de Vries59].

But where are the funds to be found? For decades, nutrition science has received enormous funding from industries involved with agricultural production and food manufacturing. We note that the food industry has a vested interest in human nutrition being framed as food composition, with consumers needing better education, as this deflects attention from the corporate determinants of health (via multinational corporations making huge profits from processed food that is high in salt, fat, and sugar [Reference Nestle60]). It is unclear how to fund the volume of research needed to provide depth and variety in the eco-social knowledge of nutrition, especially when health and medical research councils continue to see nutrition in biomedical terms. DOHaD could become a strong advocate for such research diversity.

It is not just through biomedicine and nutrition science that a repressive approach to diet and nutrition proliferates. This is reproduced across health and educational institutions as well as popular culture. DOHaD ideas have generated a great deal of wider interest [Reference Budds61], so there is an opportunity to engage with institutions and communities to ask questions about the traditional framing of nutritional problems and their solutions and to showcase alternatives [Reference Hayes Conroy and Hayes4, Reference Guthman43].

5.8 Conclusion

In conclusion, we would first like to acknowledge some limitations of this piece. There is also entangled colonialism and racism that we have not explored, nor have we been able to do justice to the biopolitics of the foundations of antenatal care (to avert population decline) (see [Reference Hanson62]). We have focused on hegemonic nutrition as seen in the UK and Australia (which ignores Aboriginal and Torres Strait Islander knowledge). We had to be selective with the references provided, and we acknowledge there are many other scholars whose work is relevant.

The UK, Australia, and similar countries have favoured individualised responses to obesity prevention, despite being urged to take a societal or systems approach [Reference Ulijaszek and McLennan63]. So far, this is also the dominant response within DOHaD, and DOHaD ideas have not changed social or structural factors that shape the health of women and their children. Indeed, the ideas might have found acceptance in an era that emphasises individual responsibility precisely because they follow a well-trodden path and are not disruptive. From our interdisciplinary standpoint, we recommend looking beyond biomedicine and nutrition science for answers to problems that encompass socio-economic-political-material-bio systems. Broadening attention to social environments includes appreciating and attending to the power relations of multiple knowledges, to differing disciplinary knowledges, and to the situated knowledges of the people and communities that are the focus of DOHaD. Without such interdisciplinary and co-constituted attention, DOHaD will not be able to address health inequalities.

6.1 Introduction

Contemporary scholars, many of whom are included in this edited volume, have highlighted the gendered dimensions of DOHaD research, noting its social and historical contours and consequences, particularly for women and mothers [Reference Richardson1–Reference Warin, Zivkovic, Moore and Davies4]. This chapter furthers these important discussions by highlighting how a gendered analysis of DOHaD must focus not only on how women’s bodies and lives are taken up and affected by science but also on DOHaD’s relationship to racism. By examining DOHaD through a feminist and critical race lens, we address how both gender and racism operate as relations of power in and through this science. Our analysis critically examines how gender has traditionally been studied as distinct from race and racism in DOHaD research, and the need to do otherwise.

This approach reflects our interest in transformational feminist interventions in the life sciences, and the need to centre reproductive justice and anti-racism in these efforts. Rather than seeing categories like gender, race, and class as discrete variables that merely need to be included or compared to one another in DOHaD and other areas of research, here we draw on Black feminist scholarship to highlight gender and racism as mutually constructed and reinforcing power relations that inform the history and contemporary contours of DOHaD and its ongoing effects. By analysing these dimensions of the science, this chapter reflects how gender and racism unequally survey and manage the living conditions and behaviours of Black, Brown, and Indigenous bodies, highlights the unequal impacts of DOHaD research, and reflects the need for a critical gender analysis of DOHaD and other postgenomic sciences [Reference Meloni, Moll, Issaka and Kuzawa5]. Our analysis therefore focuses on how gender is always already bound up with racism and other forms of oppression, and how this shapes the practices and possible futures of DOHaD in critical ways.Footnote ¹

6.2 Gender, Reproduction, and Biopolitics

We begin this chapter with a review of feminist and critical race analyses of reproduction and an emphasis on biopolitics and processes of medicalisation that are central to the focus on pregnancy and early development in DOHaD research. Biopolitics refers to how the population emerged as a political problem to be managed by the state, and medicalisation focuses on how domains of social life become defined as medical problems [Reference Foucault6, Reference Conrad7]. We discuss these concepts and their contributions to our analysis in relation to the ‘politics of reproduction’, which Ginsburg and Rapp [Reference Ginsburg and Rapp8] developed to explore the vital role that reproduction plays in social and institutional organisations [Reference Thacker, Clough and Willse9]. Engaging these approaches and their intersections is important, as DOHaD has increasingly become central to reproductive science, medicine, and conceptualisations of health and illness more broadly [Reference Armstrong10, Reference Waggoner11]. Further, Lappé, Jeffries Hein, and Landecker have framed DOHaD and its sibling science environmental epigenetics as part of an ‘environmental politics of reproduction’ to address the intersections of the environment and reproduction in late capitalism [Reference Lappé and Hein12].Footnote ² This approach and others explicitly highlight the racialised politics of reproduction in contemporary DOHaD and environmental epigenetics research and how broader relations of power shape these sciences and their effects [Reference Valdez and Deomampo13–Reference Rapp15]. Drawing on this rich set of literature, this section positions gender and DOHaD as part of a larger feminist discussion on the biopolitics of reproduction and in relation to race/racism, a term that Valdez uses to intervene on references to race as if it were not always already embedded in racist logics [Reference Valdez16]. While our own work is situated in the United States, Canada, and the United Kingdom, here we draw on scholarship across various locations to illustrate why a critical gender analysis is necessary anywhere DOHaD research is conducted and circulates.

Reproduction was and often still is conceived of only as a ‘woman’s issue’ with the science and medicalisation of reproduction centred largely on cis-gendered women’s bodies. Numerous scholars have analysed how DOHaD’s focus on pregnancy reinforces this emphasis and positions cis-gender women as central objects of study and primary targets of intervention [Reference Pentecost, Ross and Macnab17]. DOHaD researchers claim to study this period of the lifecourse because of the unique plasticity and programming of biological systems during ‘critical windows’ of fetal development. However, historians of maternal–fetal relations argue that this emphasis on pregnancy shapes and is shaped by gendered forms of social control and surveillance that have been central throughout the history of the reproductive sciences [Reference Richardson1, Reference Buklijas, Dohm and Helduser18].

Scholars of the contemporary also illustrate how a focus on the individual behaviours and exposures of pregnant people in DOHaD research overwhelmingly positions mothers as primarily responsible for the health of future generations. For example, Pentecost and Ross, Sharp and Richardson, Warin, Moore and Davies, Kenney and Müller, and others discuss how DOHaD emphasises pregnancy as an ideal time for research and intervention, despite the recognition that social environments shape health throughout the lifecourse [Reference Sharp, Lawlor and Richardson2, Reference Warin, Zivkovic, Moore and Davies4, Reference Pentecost and Ross19, Reference Kenney and Müller20]. These authors and others show how the focus on early life and pregnant bodies within DOHaD studies relies on and reinforces self-surveillance and anticipatory care work for people with the capacity for pregnancy [Reference Waggoner11]. In their chapter in this volume, Chiapperino and colleagues also detail how DOHaD influences gendered responsibilities for health in ways that reinforce the gender binary and unequally impact women’s bodies and lives. This occurs around food and nutrition, as Moore and Warin discuss in this volume, and in relation to pollutants, pesticides [Reference Mackendrick21], and stress [Reference Mulligan22], in ways that disproportionately affect Black, Brown, and Indigenous lives [Reference Valdez and Deomampo13, Reference Ross and Solinger23], as we discuss below.

Of course, as numerous scholars of gender, women’s, and queer studies reflect, reproduction is not only the domain of cis-gender women. Recently, feminist science studies scholars in particular have brought attention to the missing science of men’s reproductive contributions and paternal effects [Reference Almeling24], providing a necessary intervention into discussions of gender and DOHaD [Reference Richardson1]. Feminist science studies is a transdisciplinary area of scholarship that addresses how gender and other social categorisations shape and are shaped by science and technology. While these specific interventions are important to consider, our review of biopolitics, medicalisation, and the politics and environmental politics of reproduction in this section reflects that merely expanding scientific and medical surveillance to men deemed capable of reproduction will do little to address how power relations influence DOHaD science and its unequal impacts. Rather, we argue that a critical gender analysis must focus on the racial and gender politics of DOHaD and question the premise that individuals are the appropriate target for intervention at all. Doing so relies on well-established literature that actively positions reproduction as a topic crucial to social theory [Reference Ginsburg and Rapp25]. As we detail below, a continued focus on individual bodies as sites of intervention, rather than on broad social structures and power relations, reflects the convergence of biopolitics and reproductive politics within DOHaD and underscores the need to address the central logics that influence this science [Reference Foucault6, Reference Thacker, Clough and Willse9].

Biopolitics and the politics of reproduction illuminate how social institutions like medical and population health programmes, as well as the military–industrial complex, provide the infrastructure that makes it possible to systematically collect health data and the unequal impacts of these efforts. This is important for our analysis because foundational observational studies that inform DOHaD’s focus on the long-term health consequences of experiences and exposures during early development were originally based on the systematic collection of state and military health records [Reference Stein, Susser, Saenger and Marolla26]. The concept of biopolitics therefore allows us to address how power relations and social institutions have shaped DOHaD and its relationships to race/racism from its very beginnings and their ongoing effects today.

In his elaboration of the concept of biopolitics, Foucault argued that because of a fundamental shift in European nation-states during the seventeenth century, individual bodies became a key target for the maintenance of the nation. In that context, he argued that individual and aggregate bodies became important for protecting and defining the state, nation, or population, and keeping bodies healthy became crucial to produce labour and maintain the military. While Foucault focused on the management of ‘families’ as the fundamental units of the population [Reference Foucault6], feminist scholars highlight that the ‘family unit’ Foucault imagined was primarily the bodies and behaviours of women [Reference Roberts27]. Feminist scholars of colour have arbitrated further by emphasising that Black, Brown, and Indigenous reproduction is seen by the nation-state as a threat to the white supremacist imagination across multiple locations and time periods [Reference Ross and Solinger23, Reference Roberts27].

The connection between individual bodies and the body of the nation has therefore justified the control and intervention of people’s reproductive capacities in numerous ways. Public health campaigns from the nineteenth and twentieth centuries targeted poor women to reduce their fertility rates and prescribed a ‘domestic science’ of house cleaning for germ prevention [Reference Tomes28]. Later approaches focused on behaviours related to alcohol and tobacco consumption [Reference Graham and Der29] and breastfeeding [Reference Schiebinger30]. In more contemporary examples, forced sterilisation of immigrant populations, family separation at the United States and other borders, expansive juvenile detention, and the overturning of Roe v. Wade in the United States provide just a few of the state-endorsed reproductive and family policies that emerge from racist, nationalist, and xenophobic laws and policies [Reference Briggs31–Reference Dixon33].

The medicalisation of reproduction was also founded on the biopolitical aim of controlling and managing people’s reproductive capacities and frames pregnancy as an illness that requires medical intervention and surveillance [Reference Davis34]. Riessman argues that the medicalisation of reproduction is a ‘contradictory reality for women’ [Reference Riessman35, p. 16] as it provides certain women a way to gain some control and autonomy over aspects of reproduction while strengthening the control of biomedicine to define and survey reproductive experiences. We draw on this approach to emphasise that not all women and non-binary people experience ‘reproductive freedoms’. Rather, as Black feminists argue, current notions of reproductive ‘freedom’ that focus on bodily autonomy and choice are based on systemic forms of control, exploitation, and oppression forced upon formerly enslaved people over the course of hundreds of years and continue to affect Black, Brown, and Indigenous lives today [Reference Roberts27].

To study these dynamics of reproduction, feminist scholars have developed a varied repertoire of tools and frameworks important to a critical gender analysis of DOHaD. Central to these, and part of the politics of reproduction introduced at the beginning of this section, is Ginsberg and Rapp’s notion of ‘stratified reproduction’. This concept describes how political, economic, and social forces create the conditions under which people carry out reproductive labour [Reference Colen, Ginsburg and Rapp36]. Stratified reproduction emphasises the need to explore reproductive experiences based on social, racial, and gendered locations and reflects how the treatment of people’s reproduction is not equally valued: certain people’s reproduction is cherished, while the reproduction of others is denied and denigrated [Reference Valdez and Deomampo13, Reference Stein, Susser, Saenger and Marolla26, Reference Riessman35–Reference Davis37]. This is a critical lens through which to understand how gender has always been tied to race and racism within the sciences associated with reproduction, including DOHaD.

Another key concept for understanding the politics of reproduction, especially in a postgenomic era, is the Reproductive Justice (RJ) framework developed by the SisterSong collective [Reference Ross and Solinger23, Reference Kanaaneh38–Reference Silliman40]. It focuses on how racism shapes reproductive experiences and prioritises the stories of women of colour as the foundation for new knowledge. Reproductive Justice also emphasises how social justice issues like mass incarceration, premature death, disinvestment in public services, and environmental justice are all reproductive issues. This approach highlights how the management of population health through the control of reproduction was operationalised at the level of the individual through ideas of responsibility that were always deeply connected to racist ideologies. Thus, the RJ framework aims to move beyond the individualistic and neoliberal discourse of ‘choice’ to recognise that not everyone lives in an environment that provides them with the same options from which to choose [Reference Hoover41].

Applying these feminist and critical race concepts allows us to explore how DOHaD theories deepen the stratification of reproduction. For example, in her book Weighing the Future, Valdez highlights how contemporary pregnancy trials that draw on DOHaD and epigenetic theories to study how maternal diet during pregnancy impacts children’s health outcomes are akin to nineteenth- and twentieth-century biopolitical strategies that focus on controlling, managing, or surveying women’s bodies and behaviours. Her analysis shows how, historically and presently, the surveillance and control of reproduction are unevenly distributed across populations based on race and class. Through her ethnographic study, Valdez illustrates how this occurs through what she calls the ‘politics of postgenomic reproduction’, a framework that examines how new science and technology emergent in a postgenomic era, including the fields of epigenetics and DOHaD, create conditions that both enliven twentieth-century reproductive politics and stimulate novel iterations of surveillance, risk, and control in the twenty-first century [Reference Valdez16].

This feminist lens critically attends to issues of race and gender in two main ways: its application is based on the premise that processes of racism are enacted in and through reproduction and that queering reproduction requires a reframing of the maternal environment that is not biologically and genetically essentialised or individualised to cis-gendered bodies deemed capable of reproduction. Queering reproduction reflects the need to rethink reproduction beyond heteronormative, cisgender, white supremacist, and biocentric ways of thinking and aligns with the ethic of recent feminist scholarship on the environmental politics of reproduction as well. Building on the politics of reproduction and the intellectual and advocacy movements of RJ and Environmental Reproductive Justice (ERJ), Lappé, Jeffries Hein, and Landecker’s analysis of the environmental politics of reproduction critically addresses the intersections of lived experiences of oppression, environments of late capitalism, and postgenomic sciences to illustrate how human reproduction is increasingly bound up with environmental issues in ways that are always already connected to gender and racism [Reference Lappé and Hein12]. Both the politics of postgenomic reproduction and environmental politics of reproduction therefore highlight how racism, white supremacy, and neocolonialism shape the unequal distribution of resources, lived experiences of reproduction, and the practices and ethics of emergent sciences [Reference Lappé and Hein12, Reference Hoover41]. Alongside the concepts detailed above, this scholarship provides a critical entry point for addressing the intersections of gender and racism in DOHaD science today.

6.3 Don’t Blame the Poor Black, Brown, and Indigenous Pregnant Person

Two examples from our own scholarship illustrate how the emphasis on the bodies and behaviours of cis-gendered pregnant women and a lack of attention to racism and stratification influence the practices and consequences of contemporary DOHaD science. Our findings and the work of others reflect that even when measures of race and socio-economic status (SES) are incorporated into DOHaD studies, merely including these variables does little to address how racism shapes lived experiences or to dismantle the gendered and racial logics that inform many DOHaD studies [Reference Valdez16, Reference Lappé, Fahey and Hein45]. These examples show that inconsistent and superficial measures of race and class often stand in for the deeply embedded power relations that influence health outcomes of central interest in the studies we follow. Thus, both examples introduced in this section reinforce the need for critical gender analyses of DOHaD and other postgenomic sciences that attend to the ways that gender and race/racism shape research practices, knowledge claims, and the impacts they have on experiences of reproduction and the broader environments that influence health across the lifecourse.

The first example comes from Valdez’s ethnographic study of contemporary postgenomic pregnancy trials in the United States and United Kingdom. Introduced briefly above, her influential project draws on critical race theory and Black feminist theory to address how race/racism is foregrounded at the recruitment phase of trials focused on maternal diet during pregnancy and children’s future health and then disappears during the collection and analysis of the trials, only to return as significant in the comparison of outcomes in the publication of results [Reference Valdez16, Reference Valdez42]. Her findings reflect how race is imbued with meaning, yet remains mercurial and mobilised in ways that distance it from the contexts and relations of power that shape the lives of trial participants.

Valdez’s findings illuminate the need to shift the focus away from diversity and inclusion efforts in postgenomic research and instead theorise how racist environments impact maternal health outcomes across the lifecourse [Reference Valdez16]. Her work shows that individual-level interventions, which are central to these trials, need to be read as symptomatic of systemic racism, rather than as a solution to multidimensional illnesses like diabetes and obesity that disproportionately impact communities of colour. This is because the ‘underlying logics of individual lifestyle interventions are cut from the same ideological cloth that assumes poor, fat, and ethnically diverse individuals have risky bodies and are responsible for changing their bodies and behaviors’ [Reference Valdez16, p. 10].

While such individual lifestyle interventions are framed as if all bodies live in similar environments and have equal access to ‘healthy’ opportunities, choices, and material conditions, Valdez shows that the pregnant people classified as ‘high risk’ for diabetes and obesity that are targeted for these interventions live in racist and poorly resourced environments that make it nearly impossible for them to comply with the intervention during the trial or sustain the intervention changes after the trial is completed. These findings reflect a key aspect of our argument here, which is that gender analysis without a critical understanding of race/racism is not a comprehensive framework for understanding DOHaD science and its consequences. This is particularly so when numerous studies show that focusing solely on individual interventions in maternal nutrition or early care is ineffective in addressing health and disease inequities [Reference Conching and Thayer43].

In our second example, Lappé’s multi-sited ethnographic study of epigenetic research related to children’s behavioural health finds a similar emphasis on cis-gender women and their individual care practices during pregnancy and early parenthood, rather than on the structural conditions that shape their lives. Lappé’s project focuses on the production and circulation of epigenetic and DOHaD knowledge related to children’s behavioural health across laboratories, clinics, and communities in the United States and Canada. By studying the material practices and epistemic cultures that inform this science and its translation, she shows how many studies and initiatives focus on early-life adversity (ELA) as central in their broader questions about children’s behavioural health. She finds that scientists and others often use ELA to capture how myriad early-life experiences, including neglect, abuse, and poverty, shape health trajectories across the lifecourse [Reference Lappé and Hein12, Reference Lappé and Hein44, Reference Lappé, Fahey and Hein45].

Through her observations of behavioural epigenetic studies and their translation, Lappé describes how past and present DOHaD theories and findings critically inform the practices and impacts of these efforts [Reference Lappé and Hein44, Reference Lappé, Fahey and Hein45]. For example, even when epigenetic scientists, clinicians, and community members emphasised the health impacts of racism as primary motivations for their work, she finds that standardised measures of race and disadvantage used in many studies provide poor proxies for how racism and gender mutually shape lived experiences of pregnancy, parenting, and children’s health. Often limited to self-reported race, maternal education, and SES, Lappé reflects how scientists themselves noted the limitations of these measures, which nevertheless became built into large-scale epigenetic studies of children’s health. Her analysis shows how these measures and the primary focus on cis-gender women’s behaviours do little to address how systemic oppression influences the outcomes of interest in the studies she follows [Reference Lappé, Fahey and Hein45].

Lappé also finds that epigenetic and DOHaD studies of early life often build on previous results from animal models to focus primarily on the effect that women’s behaviours and experiences during pregnancy and early parenthood have on their children’s future health. As a result, concerns about the health effects of racism become channelled through measures and analyses that emphasise the maternal–child dyad and women’s care practices, rather than on how racist and sexist environments influence their lives. Even when studies aimed to improve children’s health through supporting families, the focus on women’s behaviours and experiences during pregnancy and postpartum had the effect of individualising responsibilities for children’s health, rather than addressing the need for broader social and structural change [Reference Lappé and Hein46].

The analyses provided in these two empirical examples reflect how narrow and persistently individualistic models in DOHaD and epigenetic research focus on binary notions of gender and do little to address how systemic racism shapes experiences of reproduction and health across the lifecourse. The absence of racism as a central factor in prominent DOHaD studies therefore helps perpetuate understandings of health and inequity that overemphasise comparisons across racial and ethnic groups while ignoring the role of systemic racism in shaping health inequities. Such understandings reflect how race and ethnicity continue to be used in DOHaD and postgenomics research despite the knowledge that it is racism that fundamentally shapes health inequities across all gradients of income [Reference Meloni, Moll, Issaka and Kuzawa5, Reference Hunt and Megyesi47, Reference Sullivan48].Footnote ³ Further, the focus on behaviours during pregnancy and early life in these and many other studies reinforces the individualised focus on cisgender pregnant women and mothers, rather than emphasising the unequal social environments that shape their lives.

These findings matter as new epigenetic and biopolitical strategies in the postgenomic era emphasise how present exposures and experiences may shape both intergenerational and transgenerational health. This extension of individualised responsibilities can further white supremacist and neoliberal notions of health by ignoring the connections between gender, racism, and reproduction. A feminist and critical race lens draws attention to these dimensions of DOHaD science and their unequal consequences, particularly when studies are overly dependent on individual-level interventions. The persistent focus on cisgender bodies and race, rather than racism, in DOHaD research also reflects how systemic racism and late liberalism shape science. The findings described in this section therefore reinforce the importance of addressing how gender and racism operate as mutually constituted power relations that shape DOHaD research and its effects in the world.

6.4 Conclusion

Over the past several decades, scholars have drawn more awareness to how systemic racism and other forms of oppression impact health, pointing to structural and institutional power relations, rather than individual actions, as critical sites for intervention. This work builds on a history of activism by Black, Brown, and Indigenous communities to address how racism, violence, and environmental injustice shape health inequities and lived experiences of reproduction [Reference Pollock49, Reference Nelson50]. As we have illustrated above, these agendas and those in critical gender studies offer opportunities for DOHaD researchers to examine their research, its history, and its current mobilisations to address how gender and racism shape this science.

Through the frameworks and empirical research introduced above, we have shown that merely including gender, race, ethnicity, and class as variables of interest in DOHaD research does little to address how the mutually constituted power relations of gender and racism shape science and its unequal impacts on people’s lives. Addressing this is of utmost importance as Black, Brown, and Indigenous people have been and continue to be exploited through scientifically legitimised narratives that allow the state to remove their autonomy, force reproduction and sterilisation, and deny their reproductive rights [Reference Roberts27, Reference Roberts51]. As reflected in rates of premature birth and maternal mortality among Black women in the United States regardless of SES, the relationships between gender and racism shape health inequities in clear and ongoing ways [Reference Sullivan48, 52]. These forms of ‘obstetric racism’ and the analysis we provide above reveal how gender is always already bound up with racism and other forms of oppression [Reference Davis34].

To address gender and racism in DOHaD, interdisciplinary engagements with this science must explicitly name how power relations shape research and its effects. In this chapter, we have highlighted how a feminist and critical race approach to gender and racism in DOHaD is necessary to accomplish this goal. In doing so, we advocate for critical gender analyses that push social and biological scientists alike to examine how systems of oppression inform research and its unequal impacts in the world. We end by highlighting the need to move beyond description and critique to create real change in the structures that affect people’s lives. This requires not only rethinking how we analyse DOHaD science but also actively reshaping the racist environments that impact health [Reference Penkler53, Reference Penkler, Jacob, Müller, Kenney and Norris54].

7.1 Introduction

The Developmental Origins of Health and Disease (DOHaD) is now an established area of inquiry in the economics discipline, cutting across subfields like health and demographic economics. Orthodox economists increasingly use econometric methods to make the case that individual-level epigenetic changes have measurable impacts on labour market outcomes. While some literature seeks to document disparities in health outcomes, most economic research considers the effects of health or economic shocks on educational attainment, employment, and wages. This focus on ‘nonhealth endpoints’ is guided by assumptions and definitions in orthodox economic thought that direct attention to concerns typically – or ultimately – related to market outcomes.

A wide range of unorthodox, egalitarian approaches within economics could contribute to DOHaD by integrating social forces, social structures, and social inequities. These approaches consider the origins and impacts of hierarchical power relations between groups. Compared to orthodox economists, egalitarian economists typically have a broader understanding of what an economy is and what an economy is for. Some view economics as the study of provisioning life or as the reproduction of society itself [Reference Power1–Reference Cohen3].

Differences between orthodox and egalitarian approaches are especially pronounced in analyses of the reproductive economy, an area of thought and policy relevant to DOHaD research. In orthodox economics, DOHaD research signals renewed interest in reproduction, but reproduction never fully disappeared from orthodox economic thought. Optimising economic outcomes through intervening in reproduction underlies eugenic research in economics, population control and ‘family planning’ in economic development, and DOHaD [Reference Murphy4, Reference Price, Darrity and Sharpe5]. The work and function of the reproductive economy, although essential for DOHaD, continue to attract little attention.

Some egalitarian economists highlight the critical roles of both. Reproductive labour includes the care work, housework, and other tasks associated with reproducing human life on a daily and intergenerational basis. Much of the work is unpaid. Functionally, production fundamentally depends on this unpaid labour, which reproduces the labour supply [Reference Laslett and Brenner2]. Despite its obvious economic importance, in the twentieth century, unpaid reproductive labour was defined outside of the boundaries of the mainstream economics discipline [Reference Cohen6, Reference Folbre7]. This historical erasure of women and their economic contributions devalues women and the work they do, with material ramifications among other costs. Like the labour itself, economic research about it remains undervalued and marginalised in the discipline [Reference Cohen6].

Hence, a resurgence of interest in reproduction by orthodox economists could be heartening. Yet when orthodox economists have been interested in reproduction historically, women have been instrumentalised in efforts to optimise economic outcomes such as gross domestic product (GDP) growth or income per capita by controlling reproduction. While women’s ‘maternal capital’ [Reference Moll, Meloni and Issaka8] is sometimes recognised as playing a role in the creation of future value (e.g., offspring’s wages), women themselves tend to be reduced to fetal environments, characterised as instruments of reproduction rather than as fully human people with valued lives.

Following a review of the literature, I demonstrate how egalitarian economic thought could usefully be brought to bear in DOHaD research, first by identifying weaknesses in the orthodox approach; second, by integrating social and historical context; and third, by suggesting areas for novel, socially grounded, collaborative DOHaD research. The egalitarian analysis indicates that richer understandings of social determinants of health could be a key contribution of DOHaD research. Egalitarians’ sophisticated understanding of social structures and constructed categories can situate DOHaD in a real-world context. I conclude that egalitarian approaches can address a critique of DOHaD research both inside and outside economics: the failure to adequately integrate social structures. The analysis reveals the real-world risks of this failure for women and girls, linking DOHaD literature to political debates about ‘fetal personhood’, women’s autonomy, and gender inequity.

7.2 DOHaD in Economic Research

To date, DOHaD-related empirical studies in economics take two main forms. One set attempt to document the effects of exposure to shocks, such as new access to medical technologies like antibiotics or adverse events like famines, epidemics, or recessions [Reference Bhalotra and Venkataramani9–Reference van den Berg, Lindeboom and Portrait12]. Many studies link women’s bodies (as in utero environments) to offspring’s childhood health or later-life outcomes. For studies in which health outcomes are dependent variables, health is a thing produced (an output) as a function of health investments (inputs) at different developmental stages of ‘childhood’ [Reference Cunha and Heckman13]. For example, some studies examine health outcomes such as adult height, a proxy for nutrition [Reference Bozzoli, Deaton and Quintana-Domeque14]. The second set of studies consider the efficacy of interventions to mitigate the detrimental effects of adverse events or social determinants of health, from public policy to micro-level service delivery [Reference Conti, Mason and Poupakis15]. This brief review of the literature focuses on the former studies as these are common in economics and can be foundational to the latter.

A distinguishing characteristic of economic research in DOHaD is the use of outcome variables aligned with most economic research: educational attainment, paid employment, and wages. According to Almond and Currie’s original review of the DOHaD literature, the addition of ‘nonhealth’ endpoints is one of four major contributions from economics [Reference Almond and Currie16]. The other three contributions are (a) novel identification strategies for working around data availability issues, (b) the variety of exposures modelled, including infectious disease, pollution, and recessions, and (c) the argument that studies that focus on survivors are likely to find weaker relationships than they would if data accounted for those who did not survive. Conti et al. identify contributions from economics as ‘rang[ing] from developing theoretical frameworks, to establishing causality, understanding mechanisms, and also computing costs and benefits of early interventions’ [Reference Almond and Currie16].

The theoretical basis of nonhealth-endpoint studies is human capital theory [Reference Yi, Heckman and Zhang17]. Human capital is typically understood by orthodox economists to mean education. The definition in the literature is more expansive. Conti et al. describe human capital as ‘…the intangible stock of knowledge, skills, personality, and other attributes – including health – that produce economic value in the life of an individual’ [Reference Conti, Mason and Poupakis15]. The economic model is an equation called a production function in which the thing produced, the output, is human capital. There are two periods of investment in the model discussed by Almond et al.: the in utero period of ‘childhood’ and the ‘second period’ of childhood [Reference Almond, Currie and Duque18]. In orthodox economic thought, human capital is the theoretical link between exposure to adverse events/shocks and wages: exposure impacts human capital that determines productivity, which in turn determines wages. Hence, for most economists, human capital is a key explanatory factor for labour market outcomes like wages – and wage inequality.

Empirically, the relationship between human capital and wages holds in general, but it does not hold for all people in all occupations. Where the relationship is present, its strength varies by demographic group because social inequities by race, gender, and disability status intervene. Racism, sexism, and ablism are oppressive systems of social relations that construct glass ceilings, glass elevators, and other impediments that constrain (or enable) advancement and mobility. For example, returns to human capital investment (education) have historically been lower for BlackFootnote ¹ people in the United States due to racial segregation [Reference Bhalotra and Venkataramani9]. Almond et al. note that long-run benefits of investment in human capital vary for Black men exposed to different degrees of segregation, ‘…suggesting that despite a strong economic climate (better early life conditions), institutional environment affects the rewards to investments in human capital’ [Reference Almond, Currie and Duque18]. The institutional environment encompasses systems of social relations like racism, sexism, and ableism. Those systems can translate into inequitable ‘returns to investment.’ Institutional economics and related egalitarian approaches have much to offer such analyses.

Orthodox and egalitarian thoughts about labour markets and wages differ considerably. In orthodox economics, occupational segregation, or the concentration of certain demographics in certain occupations, is the result of individual investments in human capital. In other words, occupational segregation is interpreted as the result of freely made individual decisions. The orthodox explanation for occupational segregation by gender and women’s lower earnings is that women choose to invest less in education or skills valued by employers and seek out jobs where experience plays little role in pay because they expect employment to be intermittent, due to their reproductive responsibilities [Reference Polachek19, Reference England and Browne20].

In some egalitarian approaches, gendered value systems and gender roles condition individual preferences, and gender discrimination crowds women into a subset of feminised occupations [Reference Bergmann21, Reference Cohen22]. Discrimination limits economic opportunities for the majority of the population – underrepresented men and women of all races – while restricting competition in occupations available to the minority [Reference Goldin23]. Benefits for men include reduced competition for well-paid jobs and skilled employment in sectors that have historically been closed to women, such as economics and STEM fields [Reference Cohen6, Reference Cech24]. Directly related disadvantages for women include economic insecurity and a relatively weak ability to pursue divorce or to save for retirement.

Another explanation is that occupations become feminised because the people doing the work are themselves of low status [Reference England25]. Feminisation is a demographic process in which the proportion of women in an occupation rises, but it is also a process of devaluing those occupations as women enter them [Reference Cohen6]. Evidence suggests that feminisation has a causal relationship with low pay and low status; hence, men have historically resisted women’s entrance into higher education and male-dominated occupations [Reference Levanon, England and Allison26]. Conti et al.’s definition of human capital as knowledge, skills, personality, health, and other attributes ‘that produce economic value in the life of an individual’ offers some insight into the relationship between feminisation and value, economic and otherwise (emphasis added) [Reference Conti, Mason and Poupakis15]. In societies with gendered value systems in which women and men are valued inequitably, skills stereotypically associated with femininity and masculinity also tend to be valued inequitably [Reference Cohen6]. Thus, some skills contribute far more than others to the economic value one’s life may hold. Finally, the same skill may be valued in male workers and penalised in women workers.

In summary, orthodox economists brought later-life labour market outcomes into DOHaD research, which they connect to health through human capital theory: investments in human capital should have positive returns in the form of higher wages. However, as egalitarian economists point out, systems of social relations like racism and sexism generate inequitable ‘returns to investment’.

This brief consideration of human capital theory reveals why social context matters in DOHaD literature. First, it is necessary for understanding existing economic analyses in which outcomes may be misinterpreted as the result of freely made individual-level choices. Egalitarian schools of thought, such as social economics, feminist economics, stratification economics, critical political economy, and institutional economics, draw insight from rich theoretical and practical understandings of the social context in which individuals make decisions. Egalitarian research offers historically grounded analyses of the origins and reinforcement of social structures. For example, feminist economists demonstrate how structural inequalities create gendered outcomes and explore how gender shapes understandings of economic activity [Reference Cohen6, Reference Folbre7, Reference Bergmann21, Reference Cohen22]. Some, especially women of colour, use intersectionality to describe how hierarchical social relations combine [Reference Banks27]. Institutional economists focus on evolving systems of power in which institutions coordinate economic behaviour, while social economists consider the ethical consequences of complex social interactions [Reference van Staveren and Knorringa28]. Stratification economics provides analyses of group-based inequality and is the product of research by Black economists [Reference Chelwa, Hamilton and Stewart29].

Second, social context is also requisite for designing public policy to address the causes of inequitable outcomes. Egalitarianism contains justice-oriented guidance for policy and interventions because integrating power relations into analyses widens the scope for seeking social solutions to social challenges. Lastly, placing analyses in a social context may prevent the misinterpretation or misuse of DOHaD research for racist or sexist purposes.

In the remainder of the chapter, I demonstrate the usefulness of egalitarian thought in DOHaD. In Section 7.3, I make visible how the marginalisation of women’s labour and, historically, of women’s economic research contributes to the dehumanising instrumentalisation of women in orthodox economic research in DOHaD. The following section suggests that DOHaD could contribute to research on determinants of health, but its current contribution is limited by a narrow focus on molecular factors and uncritical use of demographic variables. I bring these points together in a short exploration of some real-world risks of dehumanising instrumentalisation for women and girls, linking DOHaD literature to political debates about ‘fetal personhood’, women’s autonomy, and gender inequity.

7.3 Economic Orthodoxy and Reproduction

Most economists exhibit little concern about the unpaid reproductive labour typically done by women, like cleaning, cooking, and raising children, among other tasks [Reference Laslett and Brenner2, Reference Cohen22, Reference Duflo30]. Still, it is women’s perceived responsibility for reproductive labour that links gender roles/norms to economic outcomes. The social expectation that women are responsible for the unpaid reproduction of life has economic consequences for women and men:

Women’s unpaid work has been defined out of the economics discipline theoretically, professionally, and empirically through decisions made by powerful actors in the field. In economic theory, disciplinary boundaries are established and enforced through gendered interpretations of value that treat unpaid work as a ‘non-economic’ activity [Reference Cohen6]. Activities that are monetised are included on one side of this ‘arbitrary line’, while those ‘services gratuitously rendered by women’ are not [Reference Pujol31]. Professionally, a process of ‘defeminization’ of the discipline took place in the early twentieth century, excising the study of the household by women economists [Reference Philippy32]. Empirically, official state-based recordkeeping, such as the United States Census, excludes unpaid labour [Reference Folbre7, Reference Messac33]. The decision to exclude unpaid work from GDP was made by Richard Stone in pursuit of a ‘universal method’ against the advice of Phyllis Deane, a woman economist Stone hired to study the method’s accuracy in colonial territories [Reference Messac33]. Despite critiques by Deane and the only two women on international committees on national income statistics at the time, Hildegarde Kneeland (League of Nations, 1947) and Margaret Mód (United Nations, 1968), the method was promoted globally and widely adopted [Reference Messac33]. GDP is among the most commonly used pieces of economic information about a given country; ‘economic growth’ refers to a positive change in GDP.

The gendered method of calculating GDP and the gendered definition of value reinforce a hierarchical gender division of labour: monetised, valued labour associated with masculinity and the ‘public sphere’ termed ‘production’ is at the top, and non-monetised, devalued labour associated with femininity and the ‘private sphere’ is at the bottom. The division is informed by productivism, a bias that privileges monetised economic contributions, one aspect of reproducing life, over others. The gender division of labour and associated value judgements are so naturalised that they inflect the definition of what ‘The Economy’ is; what activities it includes, both popularly and according to most economists; and the ends of economic activities. It is deeply embedded in economic thought, with implications far beyond the discipline because of the influence economics and economists have on policy [Reference Cohen6].

Women’s unpaid labour is the foundation of the reproduction of society on a day-to-day basis and intergenerationally. The term ‘labour’, as in ‘going into labour’, connects biological/physiological reproduction and the uncompensated work of social reproduction. There can be no production without the reproduction of life itself, including that of those in the paid labour force. If production is understood to constitute ‘The Economy’, then there is no ‘The Economy’ without women’s reproductive labour. Given this history and its negative effects on women materially and in terms of social status, orthodox economists’ newfound interest in reproduction could be welcome: it presents an opportunity to take the value of women’s reproductive labour seriously.

Historically, however, economic research on reproduction has embraced optimisation strategies that instrumentalise women. Eugenic projects sought to improve ‘the race’ with policy interventions like forced sterilisation that primarily targeted women, especially women of colour, in developed and underdeveloped countries from the United States to Sweden to Bangladesh as recently as 2020 [Reference Patel34, 35]. Forced sterilisation was thought to ‘improve the race’ in part by controlling population growth and therefore raising economic output (measured as GDP per capita). In this dehumanising project, women are reduced to instruments for economic growth.

DOHaD research in economics has often in similar ways emphasised the optimisation of economic growth, mainly by proposing forms of intervention in women’s lives. Critically, optimisation is framed in economistic terms with effects on knowledge production beyond the discipline: scholars point to the ‘“growing adoption of economics” “cognitive infrastructures” or “epistemic infrastructures” in global health governance’ [Reference Moll, Meloni and Issaka8]. DOHaD studies often employ economic language, framing economic benefits as ‘resource savings’ in the form of reduced child deaths, reduced morbidity, and the savings from potential adult chronic disease [Reference Moll, Meloni and Issaka8, Reference Pentecost, Meloni, Cromby, Fitzgerald and Lloyd36]. Authors also find returns on investment in the forms of increased worker productivity, school attendance and achievement, and better employment in the future [Reference Pentecost, Meloni, Cromby, Fitzgerald and Lloyd36]. The economic logic driving some epigenetic research finds its rationale in human capital and the future earnings of fetuses.

Economistic thought, in which economic ends dominate other possible commitments, such as equity and justice, is enormously consequential. Some DOHaD research constructs women as vessels that [should] act in the interest of potential future progeny, a normative position that violates basic premises of orthodox thought. In some studies, the ‘future value’ of fetuses appears to take precedence over the value of actually - existing women, whose preferences are unaddressed. Women’s autonomy – especially that of women of colour – may carry relatively little weight in studies that prioritise economic growth over justice (see Section 7.4.2.1). As Chiapperino and colleagues discuss in this volume, this introduces a set of moral paradoxes for DOHaD.

7.4 Egalitarianism in Economics and DOHaD

The critiques of (a) the devalorisation of women’s reproductive labour and (b) of the dehumanisation and instrumentalisation of women in Section 7.3, and the implications that I explore below, exhibit the kind of historically grounded, socially informed insight that egalitarian economists can bring to DOHaD research. The analysis here makes two main points: first, it demonstrates how DOHaD research could contribute to more complete understandings of social determinants of health. Egalitarians integrate social context and can steer DOHaD analyses away from biological and/or cultural essentialism. Second, it shows how reducing women and girls to instruments of reproduction reinforces gender inequities.

7.5 Conclusion

Orthodox economists brought later-life labour market outcomes into DOHaD research, which they connect to health through human capital theory: investments in human capital, including health, should have positive returns in the form of higher wages. However, systems of social relations like racism and sexism are sources of inequitable ‘returns on investment’. Further, inequity-generating social structures and their unjust consequences are made less visible by research that uncritically uses social variables. The gender division of labour is part of the social structures that reinforce gender inequities.

Reproductive labour, and who is believed to be responsible for this low-status, poorly paid, and unpaid work, is key to understanding persistently gendered and racialised inequity. Social structures that devalue women and ‘women’s work’ are institutionalised in practices like gender-based discrimination in the labour market. Women are discriminated against in the labour market because of their perceived responsibility for reproductive labour (i.e. because of gender roles). Women are obviously more than instruments of reproduction but have been instrumentalised in the interest of optimising economic outcomes. DOHaD research continues this tradition, but it does not need to.

Many opportunities remain in the field for ‘exploring structural factors that capture intersectional and interlocking systems of oppression’ [Reference Evans, Engelman and Mikulas37]. Egalitarian economists are well equipped theoretically and methodologically for analyses of social structures and oppressions. Many of the people conducting equity-oriented research in economics are members of underrepresented groups and have related experiences that inform their research. Those experiences can be sources of insight from which a diverse group of economists develop economic theories that better reflect power dynamics in the social world.

8.1 Introduction

Knowledge of the molecular and physiological mechanisms of the Developmental Origins of Health and Disease (DOHaD) is no longer confined to the lab and/or to research. Rather, the idiom of DOHaD is part and parcel of a scattered landscape of policy initiatives; that is, endeavours directed at translating DOHaD’s central tenets into political discourses, programmatic statements, as well as implemented public health measures. Policy initiatives around DOHaD both inspire new policy approaches in public health [Reference Hanson, Poston and Gluckman1, Reference Jacob and Hanson2] and cast a new outlook on several policy domains in our societies – crafting, in some cases, previously overlooked links between existing policies and novel opportunities for intergenerational health promotion [Reference Goodman, Boone-Heinonen, Richardson, Andrea and Messer3].

Yet, the central policy messages of DOHaD research are not devoid of criticism, especially on the side of the social sciences and/or ethical, legal, and social aspects (ELSA) analyses. The reason is that translating DOHaD messages into policy means walking a difficult tightrope. On the one hand, the field has the political potential to illuminate the temporal extension and far-reaching implications of the social determinants of health [Reference Marmot4]. What happens during the developmental period has ramifications that extend to the lifecourse of parents (not just the pregnant mother-to-be), much like to the relational, social, and material environment of gestating bodies, or the structural patterning of health inequalities in our societies. If anything, DOHaD is – to this reading – only a demonstration that social inequalities hit harder in developmental times. As such, DOHaD policies would be expected to lean towards a syndemic approach to health; that is, to affirm a holistic conception of health, which considers risks as biosocial complexes emerging at the intersection of biological predispositions as well as social and environmental modulators of disease [Reference Singer, Bulled, Ostrach and Mendenhall5]. On the other hand, scientific literature and circulating evidence often provide a rather different take-home message from DOHaD research. This message affirms the importance of maternal–offspring dynamics for the programming of adult health and only recently has expanded into a broader focus on periconceptional and family-related dynamics, including effects following the paternal line [Reference Soubry6]. Key to the enactment of DOHaD findings is – to this alternative reading – behaviour change, parental (and especially maternal) lifestyles, and more generally responsible actions based on literacy of developmental effects. In a nutshell, the key policy objectives of DOHaD research are highly idiosyncratic and taken in a tension. What could be called the ‘moral paradox’ of DOHaD is the idea that, while the scope, foundations, and practical implications of DOHaD research call for structural interventions addressing social determinants of health over the lifecourse, DOHaD messages can at times boil down to simplistic claims of individual responsibility [Reference Meloni and Testa7, Reference Penkler, Hanson, Biesma and Müller8].

In what follows, we attempt an explanation of these paradoxical implications of DOHaD research. We do so by offering a comprehensive analysis of claims towards individual responsibilities in the DOHaD literature. The chapter draws from a systematic literature review documenting the whole spectrum of policy and normative discourses in DOHaD research. Within this diverse set of policy interventions, the chapter unpacks the often-underlying normative claims pointing to the responsibilities of individuals (e.g. parents, parents-to-be, etc.). Complementing previous publications from our group [Reference Chiapperino9–Reference Chiapperino11], the literature review highlights the complexities of scientists’ engagements with the moral and societal aspects of DOHaD research. Systematically analysing scientific publications allows us to unpack the intricate processes that bring about an economy of individual-oriented norms, responsibilities, and obligations [Reference Fassin12] to the detriment of other ethical orientations of the field. DOHaD scientists, we argue, hardly make any straightforward argument in favour of individual responsibilities for health. The ‘moral paradox’ of DOHaD rather arises from an ambiguous stance on the possibilities of health promotion strategies inspired by DOHaD. This stance mixes up the current practical possibilities of the field with its policy framing, opportunities, and political ambitions.

By clarifying the normative scope and limitations of policy debates around individual responsibility in DOHaD research, we hope to prompt a deeper appreciation of the political ramifications of DOHaD knowledge and concepts. A higher awareness of the normative ambiguities and moral idiosyncrasies that raise critique of DOHaD research may help redefine the boundaries, priorities, objects, and representations of this research. In the discussion, we elaborate on how knowing the modalities and emergence of the ‘moral paradox’ of DOHaD calls into question the policy advocacies currently animating the field and points to the need for finally embracing the social justice framing of the field David Barker had hypothesised [Reference Jacob and Hanson2].

8.2 The Hyper-responsibilisation Critique of DOHaD Research

Several critiques have addressed normative and policy discourses in DOHaD research or the way its concepts and evidence circulate in the wider society. Anthropologist Megan Warin and colleagues have followed the genealogy of obesity discourses in Australia and highlighted the gender inequalities ‘squeezed out’ of Barker’s hypothesis. How did his research programme – inaugurated with the discovery of a gendered socio-economic patterning of undernutrition and its effects on adult health – end up paradoxically reinforcing the social acceptability of a gendered stigma for obesity [Reference Warin, Moore, Zivkovic and Davies13]? Along the same lines are those critiques that underline the reduction of the maternal body in DOHaD research to a ‘vector’ [Reference Richardson and Stevens14], or a ‘capital’ holder [Reference Wells15] for the healthy development of the child. According to these scholars, there is a risk that DOHaD research inspires a hyper-responsibilisation of women in contemporary societies [Reference Richardson16]. Not only does DOHaD evidence replicate narratives of responsibilisation for women [Reference Pentecost and Ross17], but it also adds an ethics of stewardship and responsibility for future generations, which virtually extends over multiple generations [Reference Penkler, Hanson, Biesma and Müller8, Reference Pentecost and Meloni18] (see also the chapters by Valdez and Lappé as well as Warin and Moore).

Others have shifted the focus of normative critique of DOHaD to studies of the epigenetic mechanisms of inheritance via the gametes – hence potentially both from the paternal and the maternal lines [Reference Chiapperino and Panese10]. This line of research reaches beyond the intrauterine environment to include epigenetic predispositions via both parental gametes. While the increasing role assigned to paternal influences partly counterbalances ‘the tendency to pin poor outcomes on maternal behaviour’ [Reference Richardson, Daniels, Gillman, Golden, Kukla and Kuzawa19], these attempts are not devoid of criticism. Besides raising questions as to their stereotypical treatment of paternal roles and responsibilities,Footnote ¹ studies of parental effects still tend to support over-simplistic attributions of individual responsibilities. In fact, they only mark a switch to an extended version of gendered claims of individual responsibilities for health, which includes the environments, behaviours, life trajectories, and actions of the father (and fathers-to-be). In other words, the ‘moral paradox’ of DOHaD holds even without an exclusive gendered emphasis on women’s bodies. We could in fact reformulate it as follows, by including also the injunction to protect one’s gametes that virtually applies to all individuals of reproductive age: how did a research field founded on the socio-economic patterning of parental influences over development end up promoting discourses of individual behaviour change, parental responsibilities, and health literacy to promote the health of future generations? Let us turn to a tentative answer drawn from scientists’ treatment of these normative matters in the DOHaD literature.

8.3 Methods and Materials

The literature review draws from peer-reviewed publications indexed on Web of Knowledge and follows the PRISMA guidelines for systematic literature reviews and meta-analyses [Reference Page, McKenzie, Bossuyt, Boutron, Hoffmann and Mulrow20]. Data collection took place between October 2020 and January 2021; source consultation and analysis were led by Luca Chiapperino (LC) and Cindy Gerber (CG) between March 2021 and December 2021. Francesco Panese (FP) and Umberto Simeoni (US) intervened later in data analysis. We searched Web of Knowledge for papers including the phrases ‘1000 days’, ‘developmental origin*’, ‘DOHaD’, and ‘fetal origin*’, each accompanied by the specific search term ‘polic*’. The star at the end of search terms allowed us to include papers using any derivative of these terms (e.g. in plural and singular forms). This database query returned different kinds of articles: reviews, editorial papers, perspective articles, commentaries, and theoretical discussions, much like empirical studies (n = 287). The substantive number of duplicate records across the different combinations of search terms (n = 93) hints at the evidence that ‘1000 days’, ‘DOHaD’, or ‘fetal origins’ are often used interchangeably within the literature. After these duplicate items were removed from the database, CG and LC proceeded independently with the screening of records through abstract reading. This excluded a set of articles as out-of-topic items (n = 33). Either these articles did not inscribe themselves within DOHaD literature (e.g. they mentioned DOHaD for comparison, or in opposition to their subject matter) or they mentioned policy/policies in ways unrelated to translations of DOHaD in society (e.g. the manuscript mentioned policies on animal research or, more broadly, ethics policies governing research). The remaining records retrieved (n = 161) were grouped and imported into Nvivo for coding and analysis.

A preliminary screening of sample records (n = 20) conducted by LC and CG revealed that some papers included a mention of policies that was rather abstract or rhetorical. With this, we mean papers that offered only a generic appeal to the ‘need to bring DOHaD evidence closer to policy-making’ without really expanding on the reasons, motives, nor the strategies and objectives to be achieved through these translations. We excluded these papers (n = 50) due to their poor informational value for the present analysis. This iterative screening, selection, and analysis retained a total of 111 articles, which were coded through Nvivo. Within this set of papers, 50 offered at least one reference for coding to potential policies and interventions addressed at individuals (e.g. behaviour change, lifestyle change, ensuring breastfeeding, and health responsibilities) or made an explicit mention of ‘mothers, fathers and families’ as ‘critical agents for change in setting up healthier trajectories for their children’ (e.g. [21]).

8.4 The ‘Paradox’ Explained: Ambiguities and Difficulties of Translating DOHaD into Policy

All papers included in the analysis argue – through different formulations and to different degrees – for ‘a process of broad societal engagement’ ensuring that individuals adopt ‘DOHaD-informed practices as feasible, positive and lifelong options’ [Reference Norris, Daar, Balasubramanian, Byass, Kimani-Murage and Macnab21]. Of note, even the articles offering a substantively individual-centred rhetoric (e.g. putting a strong emphasis on the need to inform/educate mothers-to-be about healthy lifestyles) still acknowledge that choices and lifestyles of individuals are tied to broader ‘political or financial incentives’ that could motivate people to ‘change modifiable risk factors for adverse health outcomes’ [Reference Arabin, Timmesfeld, Noever, Behnam, Ellermann and Jenny22]. In simpler terms, the main result of our review is that DOHaD researchers do not make straightforward arguments in favour of individual responsibilities for health. We did not find a paper treating individual obligations to adopt a healthy lifestyle in the periconceptional period in isolation from the need to target institutional or collective factors. Rather, individual and collective, public and private actors eminently mix and overlap as those responsible for a societal implementation of DOHaD research. Some, for instance, plead for the ‘establishment of properly functioning economic and financial structures which supports children from underprivileged households’ [Reference Akombi, Agho, Hall, Merom, Astell-Burt and Renzaho23]. Others argue for the reduction of exposures to environmental chemicals found in the air, water, and soil [Reference Barouki, Gluckman, Grandjean, Hanson and Heindel24]. Researchers from the Global South argue that ‘nutrition-sensitive agricultural investments’ are required to achieve ‘income generation and nutrition outcomes’ [Reference Albert, Bogard, Siota, McCarter, Diatalau and Maelaua25]. Finally, even marketing regulation is a widely recommended measure by DOHaD researchers [Reference Arabin, Timmesfeld, Noever, Behnam, Ellermann and Jenny22, Reference Schott, Aurino, Penny and Behrman26].

Thus, the ‘moral paradox’ of DOHaD is partly explained at least by the ambiguities and challenges scientists face in elaborating these normative claims. DOHaD authors do recognise that the developmental patterning of health inequalities largely depends on structural configurations of our societies. However, when turning these considerations into values, norms, and expectations, they still reproduce figurations, claims, and expectations that situate action at the individual level. None of the articles we analysed dwells in fact on a simplistic injunction towards behaviour or lifestyle change to be promoted with policies that, for instance, ‘simply [recommend] a “good diet” to optimizing nutrient delivery for the developing child’ [Reference Schwarzenberg, Georgieff and Nutr27]. Rather, scientists’ policy thinking often acknowledges the need to consider ‘direct education, social marketing, and policy, systems, and environmental changes’ that could accompany the promotion of ‘healthy diets for mothers, infants, and young children in the first 1000 days’ [Reference Schwarzenberg, Georgieff and Nutr27]. What seems to be missing from these different policy articulations of DOHaD is a recognition one could easily draw from the fairly developed body of social sciences and/or ELSA scholarship on these matters [Reference Penkler, Hanson, Biesma and Müller8, Reference Chiapperino9, Reference Dupras, Saulnier and Joly28]. Healthy eating, lifestyle changes, and healthy behaviours during this crucial time – or, in normative terms, individual responsibilities to act on DOHaD knowledge – cannot really be separated from social, economic, and political structural conditions of agency – much like, it should be added, from other material determinants of programming such as genetic variation and stochasticity [Reference Chiapperino11]. The responsibilities for epigenetic and developmental predispositions to disease can therefore hardly be handled individually, or ‘easily’ translated into practice through ‘modifiable behaviours that can be targeted during pregnancy’ such as ‘diet and exercise’ [Reference Bansal and Simmons29].

Of interest is how DOHaD authors guard their work against simplistic responsibility claims [Reference Hanson, Poston and Gluckman1]. The publications we analysed often situate the objective of acting on the determinants of developmental programming, such as, for instance, maternal nutrition, within ‘multisectoral and broad double-duty actions by policymakers’ [Reference Schott, Aurino, Penny and Behrman26]. Yet, in most cases, these articles fail to advocate straightforwardly in favour of addressing these responsibilities as a collective matter. The ‘moral paradox’ of DOHaD thrives therefore in the following ambiguity: failing to underline and prioritise social and political interventions – instead of individual behaviour change – as critical instruments of health promotion policies. This is the reason, we argue, policy translations of DOHaD research lend themselves to critiques alleging them to reinforce the idea we are morally accountable for these predispositions as individuals. In what follows, we draw from our literature review to offer several illustrations of this ambiguous stance as it touches upon a) reflections on the actors in charge of enacting DOHaD knowledge; b) the concrete policy proposals DOHaD should inspire; and c) the kind of health promotion interventions derived from DOHaD knowledge.

8.5 Discussion

Our systematic and critical review reveals that DOHaD scientists are no less concerned than public health advocates or ELSA scholars with the pathogenic environments and the social determinants of health that modulate developmental predispositions to adult disease. While they do not lack awareness of the relevance of these complex and multi-level processes for DOHaD thinking, they also know too well that reordering those socio-material circumstances is beyond their reach. As one gets closer to the ways DOHaD scientists write about individual agencies, parental behaviours, maternal/paternal lifestyles, and periconceptional health promotion, one cannot but notice their difficult position. On the one hand, they deplore the social, environmental, and multi-generational inequalities that pattern developmental exposures and reproduce health inequities in our societies. On the other hand, they lack the evidence (validated knowledge), tools, and influence to fully take issue with the complex biosocial origins of developmental programming and act upon the structural problems that interfere with periconceptional health behaviours, gestational lifestyles, or infant health. In the face of this situation, what remains open to these practitioners is the possibility to address DOHaD knowledge and advice to parents-to-be, pregnant women, prospective fathers, or couples in a reproductive project. Hence, the primary finding of our critical review is that the ‘moral paradox’ of DOHaD gets in part explained by the challenges scientists face when elaborating upon the policy options backed up by their research and practice. A thorough appreciation of their situatedness reveals that appeals towards individual responsibility in DOHaD are far from being (yet) another neoliberal disciplining strategy for health promotion. Quite the contrary, they are a suboptimal compromise. It is the necessity of tailoring the complex policy messages of DOHaD to the concrete opportunities for action and change available to most periconceptional health practitioners. To them, what is better, rather than worse, in the absence of an opportunity for structural change, is to encourage and educate prospective parents to become the actors for change and protect the health of their future children.

This does not mean that the hyper-responsibilisation critique we highlighted above is misplaced or unfounded. The truth is that, although grounded on pragmatic reasons, the public policy strategies of DOHaD researchers often boil down to providing mothers, fathers, and families with the ‘right’ information and to warning them about the long-term health consequences of their lifestyles and behaviours. In this respect, social scientists and ELSA scholars hit the right note when writing about (what we call) the ‘moral paradox’ of DOHaD. By foreclosing the reflexivity on the syndemic and multi-level implications of their knowledge, DOHaD scientists offer an ambiguous societal uptake of this evidence. This paradoxically ends up reinforcing problematic discourses of individual responsibility for health, especially in their uneven, gendered version that overburdens pregnant women and mothers-to-be. By targeting health behaviours as a main interventional strategy within their reach, DOHaD authors hamper the production of more elaborate policy imaginaries flowing out of their field. Thus, the hypothesis by David Barker that gestational socio-economic hardship translates into an unequal distribution of non-communicable adult disease turns into an admonishment to individuals on how to behave ‘best’, urging them to take the kind of control over their health that may simply be unaffordable to them from their own social and environmental positionality. Here lies our second conclusion: the ‘moral paradox’ of DOHaD represents an ambiguous normative stance that mixes up the pragmatic possibilities of clinical and public health sciences with the policy discourses, practical ambitions, and political potential of a scientific field.

So, what can scientists do to avoid this situation? Taking scientists’ situatedness seriously, no ready-made solution exists to complexify DOHaD knowledge and its policy translations. This notwithstanding, scientists could at least embark upon two kinds of concrete actions that might defuse the ‘moral paradox’ of DOHaD. First, they could make explicit the tensions highlighted above at the core of their research: between the individual intervention and the social aetiology of a condition, between the behavioural recommendation and the need for political/structural change, between the tools and knowledge of biomedical sciences and the possibilities of populational health research, or, finally, between mechanistic knowledge and the need to remove the so-called ‘causes of the causes’ of diseases [Reference Marmot4]. When discussing their data, presenting their results, and, especially, when positioning their science’s implications for policy and society, they could explicitly acknowledge that what can be proven in the context of their research does not capture the complex biosocial dynamics that bring about these phenomena in the real world. DOHaD scientists could – as some of the authors we studied have already done – clearly state in their writing that the individual ‘capacity to improve … children’s developmental environments, their bodies and behaviours’ is just ‘a small piece of a large and complex environmental puzzle’ [Reference McKerracher, Moffat, Barker, Williams and Sloboda40]. While the knowledge they produce is of immense value to shed light on bits and pieces of this puzzle, they can advocate caution in extrapolating general solutions from partial knowledge. If such a provision were systematically part of the discussion sections of DOHaD papers investigating any of the biological, behavioural, relational, social, structural, and environmental dimensions of early-life programming (studied in conjunction, as much as in isolation – as they often are), there would be little doubt about the policy framings of DOHaD research. The ‘moral paradox’ of DOHaD would simply be dispelled.

Second, another opportunity to counter the ‘paradox’ is to ensure that explanations, interventions, and policy discourses support or initiate social interventions in relevant developmental windows and biosocial pathways of disease. This is, of course, easier said than done, as detailed by sociologist Michael Penkler in the context of DOHaD studies of social-biological transitions [Reference Blane, Kelly-Irving, D’Errico, Bartley and Montgomery45] leading to diseases [Reference Penkler46]. The challenge is not simply identifying early-life predictive (epigenetic) biomarkers of relevance to adult disease [Reference Shanthikumar, Neeland, Maksimovic, Ranganathan and Saffery47]. Rather, it resides also in the identification of the structural ‘windows of plasticity’ and intervention in body–environment interactions [Reference McEwen48]. Resilience and reversibility of programming processes at different life stages are also largely unexplored corollaries of DOHaD evidence; a far more complex biopsychosocial approach to early life in research settings is in order for the proliferation of different DOHaD policy discourses.

The present work has tried to sketch a few points of normative ambiguity in scientific writing as potential paths of improvements for the social and political circulation of DOHaD research. In the wish to make social science critique instructive of novel avenues of biosocial research, these suggestions should be read as no more than an analytical contribution to finally dispel the ‘moral paradox’ of DOHaD. And, perhaps, also as a contribution to a collaborative push to unleash DOHaD’s full political potential for social reform, development, and change.

9.1 What’s Law Got to Do with It?

9.2 Law’s Reliance on Discourses of Epigenetics

9.3 How Can Law Respond?

Because epigenetics blurs the distinction between the physical and the psychological by revealing a physical register for psychological harm through changes to methylation and the epigenome, it is possible to show how social adversity has physical effects. This kind of evidentiary trail is particularly appealing to law.