Policing Pregnancy: A one-day conference on maternal autonomy, risk, and responsibility

Autonomy, risk discourses and pregnant women’s perception of the abstinence principle

Raphaël HammerSchool of Health Sciences (HESAV), Institute of Health ResearchLausanne (Switzerland)raphael.hammer@hesav.ch

Introduction

• “the pregnant woman is surrounded by a complex network of discourses and practices directed at the surveillance and regulation of her body” (Lupton 1999: 59-60)

• the “governmentality” perspective: a critical approach to the pervasive risk-thinking

- pregnant women as encouraged to police themselves and to abstain from drinking alcohol for the sake of their fœtus

- many pregnant women endorse the abstinence principle on the basis of the “good mother” social norm (Jones and Telenta 2012)

how do non-abstinent pregnant women understand and give meaning to the recommendation of “zero alcohol”?

• abstinence policy (zero tolerance)

• 30% to 40% of the women consumed alcohol during pregnancy (Meyer-Leu et al. 2011, Lemola and Grob 2007)

• 0.5-2‰ of children would suffer from FAS (Addiction Suisse 2015)

• 1% of newborns would suffer from FASD (Addiction Suisse 2015)

• maternal drinking is not (yet) a major public health issue (Schnegg 2013)

Maternal drinking in Switzerland

The study

50 pregnant women interviewed normal pregnancy between 24 and 41 y.o. most of participants were expecting their first child most of them were Swiss, married and in paid employment overrepresentation of well-educated women

part of a larger study on women’s experiences of professional follow-up and risks

Hammer R. and Inglin S. (2014) ‘I don’t think it’s risky, but...’: pregnant women’s risk perceptions of maternal drinking and smoking, Health, Risk & Society, 16(1): 22-35.

• all of the participants acknowledged that consuming alcohol during pregnancy may be harmful for the fœtus

• two profiles: abstinence and strong reduction of consumption (“once in a while”)

- reported behaviours!

- “abstinence” ≠ zero alcohol!

Questioning the need for total abstinence

1) Mode of consumption

- frequency, amount, type of alcohol, context...

value of moderation

“I don’t think that drinking a beer for a few months may compromise baby’s health, honestly... but your doctor will never tell you that!” (Françoise)

“this is what stopped me sometimes when I offered myself a glass and when I felt a bit of the drunk sensation” (Adeline)

Questioning the need for total abstinence

1) Mode of consumption

“to clink glasses”

“If I have already eaten well and I drink a little glass of red wine, I do not feel that I put my baby at risk” (Marie)

importance of the cultural and social dimension of alcohol in daily life (Gaussot 2004, Testa and Leonard 1995)

Questioning the need for total abstinence

2) Personal experience

“I have seen a lot of women who have been drinking a bit… not daily and they did not have horrific consequences” (Françoise)

“Everyone drinks moderately while pregnant without anything happening, so I think [avoiding alcohol entirely] is a bit extremist” (Monica)

Questioning the need for total abstinence

3) Perception of the normative environment

“I drink a little glass from time to time, and she [her midwife] told me “ok” and that’s it… so for her, it was acceptable’ “ (Marie)

scientific uncertainty social uncertainty:

“there truly are people who say and think that you definitely can drink a glass of wine while eating, even every day, and others who say “oh how horrible, we should never drink a glass of alcohol while pregnant”, so I really hear both discourses’ (Marie)

“Women described feeling pressure to both have a drink, “not to be paranoid,” and to abstain, “to be a good mother” (Loxton et al. 2013: 527)

Questioning the need for total abstinence

4) Social values

- logic of the body:

“the importance of listening to their own bodies and not denying themselves certain cravings” (Holland et al. 2015: 40)

- holistic view of pregnancy

- “pregnancy is not an illness” (April et al. 2010: 33)

claims of autonomy (making one’s decision, challenging the context of risk discourses)

Questioning the need for total abstinence

Comparison alcohol – tobacco consumption

1) the uncertainty about harmful effects of smoking during pregnancy was absent

2) smoking is dangerous in any case (irrespective of the number of cigarettes, the circumstances and means of consumption)

3) more evident moralisation of maternal smoking (personal failure)

Questioning the need for total abstinence

Two main features shaping perception of alcohol use during pregnancy:

• the uncertainty about the effects of low or moderate consumption of alcohol

• the cultural status of alcohol use as a normal and accepted behaviour

pregnant women construct their own representations of the riskiness of alcohol use during pregnancy, and their own understanding of irresponsible/responsible drinking

Conclusion

Haute Ecole de Santé Vaud Titre principal

Addiction Suisse (2015) Alcool et grossesse : un défi pour la société, Communiqué de presse, septembre 2015.

April N. et al. (2010) Représentations sociales et consommation d'alcool pendant la grossesse, Drogues, santé et société, 9(2): 17-48.

Gaussot L. (2004) Modération et sobriété. Etudes sur les usages sociaux de l’alcool, Paris, L’Harmattan

Holland K, McCallum K et Blood RW (2015) Conversations about alcohol and pregnancy, Canberra, Foundation for Alcohol Research and Education.

Jones S.C. and Telenta J. (2012) What influences Australian women to not drink alcohol during pregnancy?, Australian Journal of Primary Health, 18: 68-73.

Lemola S. and Grob A. (2007) Drinking and smoking in pregnancy: which questions do Swiss physicians ask? Swiss Medical Weekly, 137: 66-69.

Loxton D. et al. (2013) Acquisition and Utilization of Information About Alcohol Use in Pregnancy Among Australian Pregnant Women and Service Providers, Journal of Midwifery & Women’s Health, 58, 523-530

Lupton D. (1999) Risk and the ontology of pregnant embodiment, in Lupton D (Ed) Risk and sociocultural theory: New directions and perspectives, Cambridge, Cambridge University Press, 59-85

Meyer Y. et al. (2011) Association of moderate alcohol use and binge drinking during pregnancy with neonatal health, Alcoholism: Clinical and Experimental Research, 35(9): 1-9.

Schnegg C. (2013) A la santé de qui ?, EspacesTemps.net, Travaux, [revue en ligne]

Testa M. and Leonard K.E. (1995) Social influences on drinking during pregnancy, Psychology of Addictive Behaviors, 9(4), 258-268

References