It is difficult to imagine the psychiatrist Ibone Olza (Leuven, Belgium, 54 years old), founder and director of the European Institute of Perinatal Mental Health (IESMP), a private entity that is a pioneer in perinatal training in Spain and in Spanish-speaking countries, without speaking passionately about pregnancy, childbirth, breastfeeding or mothers. Her own experience as a mother, more than 20 years ago, prompted her to investigate and learn about sexual and reproductive life from a comprehensive perspective, which encompasses not only the physical and biological, but also the social and cultural context that surrounds it. In his latest book, Gestate. The creative origin of human life (Vergara, 2024), Olza, who collaborates as an expert in the Normal Birth Care Strategy of the Ministry of Health, has decided to address the complexity of pregnancy, exploring issues about conception, maternal desire, assisted reproduction, the importance of care during pregnancy or the impact of excessive medicalization.
In a context of uncertainty, where birth rates continue to decline and a growing delay in motherhood is observed, this specialist in child and perinatal psychiatry, also co-founder in 2003 of the El Parto es Nuestro Association and consultant to the World Health Organization Health in maternal and child health issues invites us to value pregnancy as a process that involves profound changes in the psyche, identity and relationships with the world. A process that transcends the individual and requires a collective approach that supports mothers and redefines the concept of family. Because pregnancy, he affirms, “is an asset that as a society we must take care of.”
ASK. Is getting pregnant today almost a miracle?
ANSWER. More than a miracle, I believe that getting pregnant today is a heroic act because as a society what we encourage is the opposite. Many young women do not even dare to express their desire to be mothers because they do not have job or housing stability. Being a mother is heroic, especially when the baby has a disability, and the longer the moment is delayed, the more difficult and expensive it becomes, not only financially—due to the cost of assisted reproduction—but also on a physical and emotional level. It is very hard and we have normalized it.
Q. It has been normalized that before the age of 30 one does not have children, but this, as you say, complicates everything much more. Are women really aware of what it entails?
R. No not at all. I think this is a victory for capitalism, which has made us internalize the idea of prioritizing work and the economy over life and desire. If at 20 or 25 years old you are in love and feel the desire to gestate and give birth, that is life, and it is a wonderful thing. But the system has convinced us that work and the economy are more important than love or desire.
Q. Does social status influence this?
R. Yes, in Spain, migrant women or women from backgrounds with fewer resources tend to have younger children than those with greater purchasing power or access to higher education. In Nordic countries, for example, being a young mother is something more accepted, even if the couple is not permanent, because they have support to continue their studies. Here, on the other hand, there are no policies that make it easier to combine motherhood with continuing to study, and we are far from achieving it. Furthermore, in Spain we tend to associate the idea of family with the right, when in reality support for the family could be promoted from a broader perspective, recognizing and supporting the diversity of family models that exist.
Q. Do you experience pregnancy with fear?
R. Yes, this has gotten worse over time. I compare pregnant women today with how we experienced pregnancy two decades ago. and I see that control, monitoring and medicalization have increased, but emotional care has not increased. Many pregnant women are distressed by things as simple as eating a piece of cheese, fearing that they will harm the baby. Although it is true that we prevent risks, we also know that pregnancy is not an illness, but a moment of calm and creativity. A moment to fantasize. We investigated this in Pregnancy psychology (Synthesis, 2020), together with Patricia Fernández Lorenzo and Susana Carmona, and we verified that pregnancy has a very important psychological and creative process that must be made visible and cared for.
Q. She mentions that pregnancy is a time of calm and creativity, but how many women can really enjoy that tranquility if you think about the current work model?
R. The idea that pregnancy is not a disease has led many women to work until the last day, as if it were normal. Even if pregnancy goes well, it would be important to reconsider the need to stop the pace in the last trimester through universal financial aid that allows us to do so. Gesting a child requires a great deal of physical and mental energy, and this is something we should protect. What happens is that we have not understood that pregnancy is a good that as a society we have to take care of, that concerns us all.
Q. And what would you say about mental health care during pregnancy?
R. In this aspect there is a great lack of training. Pregnant women’s physical health is closely monitored, but they are rarely asked about how they are experiencing their experience emotionally. It is crucial to understand that mental health is as important as physical health during pregnancy. Therefore, it is essential that health professionals develop greater sensitivity and training in mental health to be able to detect and address these problems. Caring for the psyche of pregnant women involves listening to their stories and offering a safe space for them to express their concerns and needs.
Q. In the book she insists several times on how disconnected women are from their bodies and their processes. How has it come to this?
R. It is difficult to answer this because I think there are many factors behind it. For example, we can think about how the body is controlled from the moment of schooling, how little the needs for movement and sphincter control are respected… In schools, the academic and intellectual part is prioritized, but the connection with the body, which encourages disconnection and a lack of listening to our own needs. It is true that now we are beginning to see a change in relation to the reproductive part; We talk more and more about the menstrual cycle and sexual desire. This increase in conversation is positive, but there is still a long way to go for women to fully reconnect with their bodies and processes, for there to be a deeper understanding of our own biology.
Q. How does the birth control pill affect women’s relationship with their fertility?
R. I’m talking about heterosexual women, but we know that taking the pill alters our innate ability to feel attracted to men with whom we have a better chance of reproducing successfully due to histocompatibility issues, and it seems that this is lost with this type of drug. We forget that we are nature, that our body has its own intelligence. Part of mental health problems has to do with this: that we are negligent of our own nature, from rest needs to relational needs.
Q. Would advances in feminism regarding motherhood also have a B side?
R. Advances in themselves are not always good or bad, black or white, but when you analyze them you do find nuances. Things that make our lives better and things that make them worse. You only have to listen to mothers to realize the difficulties they face today, the exhaustion they carry. Or what lies behind the fact that there are women who, even wanting to be mothers, cannot fulfill their wish precisely because they have delayed it for so long. And here is another thing that I think is important to point out: delaying motherhood for so long is also a way of encouraging an idealization of motherhood. The first-order feminist debate is, without a doubt, all of this.
Q. Surrogacy also worries her. He says that it must be made visible that it entails planning an orphanhood from birth. Should this practice be banned in all countries?
R. I’m in this. I have signed the Casablanca Declaration for the universal abolition of surrogacy because I believe that it is, without a doubt, a sale and purchase of human beings that must be stopped. That is why in the book I explain the consequences and risks for the health of people conceived in this way, who lose their mother as soon as they are born, as well as the implications that this loss of identity that is now promoted entails: no matter how much you want to erase the origin , we carry the body memory of pregnancy in every cell of our body for life.