Interview with Jesse Olszynko-Gryn, author of A Woman’s Right to Know: Pregnancy Testing in Twentieth-Century Britain

Since the fall of Roe v. Wade, it’s clearer than ever how far attention-seeking political rhetoric about reproductive rights clashes with people’s lived experiences. Ohio’s recent vote to affirm abortion rights in the state constitution broadcasted this effectively. Yet, in all the righteous arguments over who gets to control pregnant bodies, the history of our ever-changing assumptions about pregnancy—when it starts, how it should proceed, who gets to call it to an end—too rarely comes up for investigation.

Jesse Olszynko-Gryn takes us back to the beginning with A Woman’s Right to Know: Pregnancy Testing in Twentieth-Century Britain. The story of a pregnancy most often begins with a test. That’s the galvanizing moment: the suspense of waiting, followed by the result, which may or may not reroute an individual’s life and health. How did that come to be, and how have the various forms of the test altered our cultural narrative about pregnancy?

It’s a chronicle of wild transformation. For centuries, the only reliable signs of pregnancy were a combination of amenorrhea, physical symptoms often nicknamed “malaise,” and quickening, or fetal movement. All of these were, for the most part, tracked by the person carrying the pregnancy. Early on, pregnancy was indistinguishable from a late period; hence the widespread acceptance of abortion, or “bringing on the menses,” before quickening had occurred. But by the turn of the millennium, home test kits made it possible to accurately detect a pregnancy at the barest point a menstrual cycle elapsed. These technologies brought about a new sense of agency and rewrote the story of pregnancy itself.

It’s easy to assume that people want a pregnancy-test result as early as humanly possible. But you open A Woman’s Right to Know by interrogating that assumption, asking, were people “always dreaming of earlier, faster, cheaper, and more convenient methods?” You also write, “‘Am I pregnant?’ does not mean today what it did four thousand, four hundred, or even forty years ago.” What do we miss in assuming our demand for knowledge and definition of pregnancy have remained consistent over time?

This is an important question, and one that I’ve been grappling with for a long time. It’s a special case of a more general problem in thinking historically about pretty much anything that is taken for granted in the present and seems inevitable, natural. Pregnancy all the more so, because it looks like a transhistorical biological constant, so how could it even have a history? And yet, it does, of course. Because cultures of pregnancy have changed so much. My book focuses very narrowly on pregnancy testing, which allows for a more in-depth analysis, and, like you say, I start by trying to problematize assumptions about demand: to what extent was it always there? Did it have to be produced? I find that the need to know as early as possible is a recent development. You only have to go back a couple of generations, to our grandmothers or great grandmothers, who typically waited a couple of months to find out. For better or for worse, there wasn’t the same kind of social or medical pressure to know as early as possible.

A Woman’s Right to Know covers three “regimes” of testing: the animal assays of the late 1920s to mid 1960s, lab test kits from the early 1960s, and home tests since the early 1970s. The book also tracks the cultural discourse about pregnancy, specifically how reproduction and abortion were handled in popular fiction. Things seem to have changed radically in the ‘30s specifically: can you describe this moment and what a difference it made?

The interwar decades are just really a fascinating period to study for all sorts of reasons. In the 1930s, there was a nationalist anxiety about maternal mortality and its apparent connection to a perceived increase in illegal abortion. The first feminist campaign to reform abortion law, to improve access to safe, medical abortion, also formed in this decade. Pregnancy testing emerged as a topic in these political, legal, and medical debates. But my chapter on the 1930s also explores women’s fiction (often thinly veiled memoir) and other sources, to get at everyday perceptions and experiences. The story is as much about the rise of new mass media and literary genres as it is about the adoption of new medical technologies.^[1]

My chapter shows that just because laboratory pregnancy testing had been invented and was being used (crucially, for medical reasons) around Britain in the 1930s, doesn’t mean most women even knew about them. Women’s writing constitutes good evidence of this: pregnancy and abortion begin to emerge as literary tropes, at least in the avant-garde. They are on their way from the margins to the mainstream. But pregnancy testing is conspicuously absent, or when it is mentioned, it is typically an “expensive luxury”; mass-market women’s magazines, for example, discourage its use.

There’s a brilliant line in the book: “The liminal status of pregnancy, between the ‘normal’ and the ‘pathological,’ has continuously challenged the legitimate boundaries of health care, including the provision of medical services for early detection.” Physicians didn’t always embrace their role as pregnancy-test enablers, and many were burdened by the knowledge that imperfect technology meant they were practically guaranteed to give a certain number of false positives or false negatives. Could you tell us about the transition in the physician’s role between tests like the animal assays, and tests done in commercial labs or at a pharmacy?

Your question evokes quite a complicated tangle of social relations and power dynamics among possibly pregnant women, on the one hand, and the various professionals involved in pregnancy testing, on the other. At first, say from the late 1920s to the mid 1960s, physicians pretty much controlled who had access to pregnancy testing. To get tested a woman needed to become a patient, to submit to medical authority. But they are generally reluctant, as you say, to test just any “curious” woman. There must be a medical reason for testing. This policy began to relax in the 1950s, but increasing demand, especially from healthy married women, was being rejected. So, this is where entrepreneurial pregnancy testers step in.

In the mid 1960s, they set up commercial labs that serve women not as “patients” but as “clients.” This is a crucial development that paves the way for pharmacists, who start offering non-medical pregnancy testing services in the late 1960s, and self-testing, which arrives in 1971. Pharmacies, and later drugstores and supermarkets, became sites of reproductive choice and control. So, there is a story here about demedicalization through commercialization. Physicians are increasingly cut out of pregnancy testing. They protest as a profession, but “public opinion” (an ascendent keyword in the 1960s) is on the side of commerce and consumer rights: a “woman’s right to know” and her freedom from medicalization, the right not to be a patient.

Regarding the hormone-based tests of the ‘60s and ‘70s, like Primodos, a BMJ editorial claimed it was “rational as well as economical to use the patient herself as the test animal.” This is an unthinkable standpoint in a post-thalidomide world where we know drugs can and do cause congenital anomalies. Remarkably, Isabel Gal’s 1967 research into spina bifida helped bring about that change in perspective. What is the legacy of Gal’s work, specifically in how maternal and fetal health are prioritized in tandem with one another?

This is a big topic and the focus of my current research project, Risky Hormones. I scratch the surface in Chapter 7 of my book but there’s a lot more to say. Again, your question is spot on: how was it thinkable in the post-thalidomide world to prescribe Primodos and similar drugs to possibly pregnant women as a means of diagnosing pregnancy? Moreover, there was no medical need for these products because harmless, non-invasive urine tests existed. Norway recognized this and removed Primodos from the market soon after Gal’s warning. But it lingered on the British market for another decade. How could this be? On the one hand, thalidomide sensitized physicians to the possibility that any medication could pass through the placental barrier and interfere with fetal development. This is why Gal was on the lookout for medications as the culprit behind spina bifida in the years after thalidomide. On the other hand, however, and this is my working hypothesis, the irony of the thalidomide disaster is that it set a very high bar for what an epidemic of “birth defects” was supposed to look like. In other words, physicians claimed that they’d been using drugs like Primodos for decades and hadn’t seen anything on the scale of the thalidomide disaster, so they must be safe. Even so, medical experts accepted early on that Primodos caused miscarriages and intersex conditions in female fetuses. But many were skeptical of Gal’s research, and it didn’t help that she was a woman in science or a Hungarian Jew, so not very establishment. Today, as you suggest, maternal and fetal health are very much prioritized in tandem.^[2]

Talking about tracking or testing automatically raises issues of access and record-keeping. Accordingly, you write, “the purchase of a home test is often embedded in an elaborate and stressful regime of medical surveillance and self-discipline[.]” You also raise the question, should we have free pregnancy tests just as we need free menstrual products? How has the discourse around access and surveillance changed since testing moved from the lab to the home?

So, one thing is that self-testing has become utterly taken for granted. This is what, I think, makes its history seem invisible; it’s hard to believe that self-testing ever caused trouble. And yet, as the book shows, the history is rife with controversy—between physicians, pharmacists, consumer rights advocates, feminists, government officials, and others. I don’t have definitive answers to all the questions I hope the book will raise. On the one hand, I do not want it to be read as a celebration of market capitalism. On the other, it is not really a critique either. But maybe it identifies a problem: in Britain, and possibly elsewhere, the public healthcare system has a problem with sexual and reproductive health services. Like contraception and abortion, the British welfare state typically tried to keep pregnancy testing at arm’s length. So the private sector stepped in to meet demand. The market triumphed over alternatives, and this entailed losses as well as gains. The book, however, also documents that serious alternatives (including free testing) were proposed along the way and that, at every juncture, things could have turned out otherwise. Today, the ubiquity of home pregnancy tests, like that of so many other technologies of everyday life, seems like the inevitable, almost natural culmination of scientific progress and commercialization. The book, I hope, punctures the illusion of inevitability, and (spoiler alert) concludes by suggesting that we might yet resist some elements of the broader culture that home pregnancy tests help to sustain, for instance, the social pressure on women to have the “perfect pregnancy.”

Meg Crane, who developed the first home pregnancy test kit in the late 1960s, is another standout character in the book. When she took her sketches and models to her superiors at pharmaceutical company Organon, they worried a consumer test would cost them lucrative medical business. Because she stubbornly continued to believe in her work and solicited public support for it, eventually the design, named Predictor, was first tested in Canada in 1971 and commercialized in the United States in 1978–though Crane never saw any profits. What is illustrative about Crane’s story, and what does the future of testing look like?

Delighted to end with Crane. One of the absolute pleasures of writing this book has been getting to know some wonderful people, including Meg, Audrey Peattie (the middle woman on the cover of the book), and Karen Weingarten, who was interviewed last year in Nursing Clio regarding her own fantastic book about pregnancy testing in America. Meg’s a national treasure and should be a household name; I’m hopeful that the planned biopic will cement her place in history. As to your first question, what I think is really instructive about Crane’s story, is that it is part of a larger history of commercialization, and demedicalization. This isn’t quite what we expect from the histories of reproduction, which have thematized medicalization. Something different happened in the case of pregnancy testing. A reproductive technology started out medical and ended up commercial. By the time Meg enters the story, self-testing is thinkable, not only for her; it’s sort of in the air. But she comes up with this just brilliant, minimalist, modern design. And until the advent of Clearblue, twenty years later, home pregnancy tests look like Predictor. This is an incredible achievement that she deserves a huge amount of credit for. At the same time, and without taking anything away from her achievement, part of what I try to do with the book is shift historical attention away from the most obvious turning points and shine the light on the subtler process of routinization. So, Meg’s test debuts in the US in 1978, but it didn’t sweep away alternatives or transform mass culture overnight; most women kept going to their physician. Mass change comes later, with Clearblue. This is a general feature of technological change. It may take a generation for an innovation to move from the margins to the mainstream.

As for the future, a flushable, plastic-free pregnancy test designed by two young women at the University of Pennsylvania received FDA approval a few years ago, but it doesn’t seem to have reached the market yet. At various times, others have advocated for the commercialization of a “semi-quantitative” pregnancy test that women could use to track the progress of their pregnancy, miscarriage, or abortion. Since Dobbs, cycle-tracking apps and pregnancy tests have become fraught in new ways. From a technological perspective, home tests haven’t changed much in the decades since Clearblue. But history doesn’t stop and cultures of pregnancy have continued to change in unexpected ways. In the US, people are rediscovering the tactical uncertainty about whether, in the absence of testing, a late period signifies menstruation or miscarriage. So, perhaps the only thing we can really say for sure about the future is that it will be shaped by human agency and, more specifically, the decisions people make about whether and how to use, or not use, available technologies.

Stephanie Gorton

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