Medicalization, moral control, and risk adverse parenting:

Examining the ‘no drinking’ rule

Stephanie Knaak, Ph.D.Calgary, Canadasknaak@shaw.ca

Prepared for presentation for Monitoring Parents: Science, evidence and the new parenting culture, University of Kent, Canterbury, September 13-

14, 2011.

Purpose

Unpack the ‘no drinking during pregnancy’ discourse ◦ Making some observations about the policy itself

(Cdn context)

◦ Cultural uptake

◦ Discuss policy in relation to the state of the scientific evidence

◦ Tie observations into a larger argument about how medical authority active player in shaping the psyche of modern motherhood.

Paper still in formation

Theoretical premise “Medicine is becoming a major institution of social control,

nudging aside, if not incorporating, the more traditional

institutions of religion and law. It is becoming the new

repository of truth, the place where absolute and often final

judgments are made, not in the name of virtue or

legitimacy, but in the name of health. Moreover, this is not

occurring through the political power physicians hold or can

influence, but is largely an insidious and often undramatic

phenomenon accomplished by ‘medicalizing’ much of daily

living.” (Zola, 1972: 183)

Canada’s Policy Health Canada/Public Health Agency of Canada

recommend that any woman who is pregnant or at risk for pregnancy should abstain from alcohol consumption

Recommendation for abstention discussed nearly exclusively in context of FASD risk.

Public Health Agency of Canada has multi-faceted strategy◦ Level 1: broad-based awareness and health promotion

◦ Level 2: Brief counselling with pregnant & pre-pregnant women about alcohol use and pregnancy

◦ Level 3: Specialized prenatal support/treatment for pregnant women with addictions and alcohol dependency

◦ Level 4: Postpartum support for mothers with alcohol problems; may involve early intervention services for their children

Public Health Agency of CanadaHealthy Pregnancy: Alcohol and Pregnancy `2008; located at www.phac-aspc.gc.ca/hp-gs/know-savoir/alc-eng.php

Important FactsTHERE IS NO SAFE AMOUNT OR SAFE TIME TO DRINK ALCOHOL DURING PREGNANCYIf you drink alcohol while you are pregnant, you are at risk of giving birth to a baby with Fetal Alcohol Spectrum Disorder (FASD). FASD is a term that describes a range of disabilities (physical, social, mental/emotional) that may affect people whose birth mothers drank alcohol while they were pregnant. FASD may include problems with learning and/or behaviour, doing math, thinking things through, learning from experience, understanding the consequences of his or her actions, and remembering things. Your child could also have trouble in social situations and getting along with others. People with FASD may be small, they may have behaviour and/or learning problems, and their faces may look different. Research shows that children born to mothers who drank as little as one drink per day during pregnancy may have behaviour and learning problems.No one knows how much alcohol it takes to harm a developing baby. When you drink alcohol during pregnancy, it rapidly reaches your baby through your bloodstream. The effect of alcohol on the developing baby can vary depending on the health of the pregnant woman and also the amount, pattern and timing of drinking alcohol during pregnancy. Binge drinking (drinking a large amount of alcohol in a short amount of time) is especially bad for the developing baby.

Next StepsWhether you are trying to get pregnant or are pregnant already, stop drinking alcohol. No alcohol is the best (and the safest!) choice for having a healthy baby.

Ontario

Common features

◦ Language of Risk

◦ Language of Harm

◦ Emphasis on ‘no amount is safe;’ ‘no time is safe’

◦ Unequivocal in tone

◦ ‘Where to go for help’ at end

Message received?

Attitudinal measures – general population: * 95% believe that alcohol consumption during pregnancy can

lead to life-long disability in the child 76% believe that any alcohol during pregnancy is harmful to

the baby 52% say, top of mind, the single most important thing a

woman can do for a healthy pregnancy is to stop drinking

Drinking during pregnancy estimates:** 10.5% of women report drinking any alcohol at all during

pregnancy 0.7% of women drank frequently (once a week or more) ``Self-reports of alcohol consumption may be underestimated

due to the potential under-reporting of socially undesirable behaviours by mothers`` (p. 89)

* Alcohol use during pregnancy and awareness of FAS and FASD; Environics Research Group for PHAC, 2006**What Mothers Say: The Canadian Maternity Experiences Survey; Public Health Agency of Canada, 2009

But is the message correct? Science/policy mismatch, especially for light drinking

◦ e.g., Kelly et al., 2010; Kelly et al., 2009; Alati et al., 2008; Robinson et al., 2010; O’Leary , 2009; O’Callaghan et al, 2007 all show no increased risk of social/emotional problems or lower cognitive test scores among children born to light drinkers (1-2/per occasion/week)

◦ See also O’Brien, 2007; Lowe and Lee, 2010; Armstrong 2003; Sayal et al, 2007; UK Department of Health, 2007; other

What conclusions must be drawn when research upon which

the legitimacy of the discourse is based reveals itself to be much more equivocal, thin, contradictory, controversial than the discourse would have us believe?◦ Function of the discourse is not to provide a informative tool to

aid in rational decision-making. Rather, it is to promote a certain belief/viewpoint about appropriate maternal behaviour without having to acknowledge that it is just that – a viewpoint. Authoritative origin of the message obscures this very important point. “Health education campaigns, in their efforts to persuade, have the potential to manipulate information deceptively and to psychologically manipulate by appealing to people’s emotions, fears, anxieties, and guilt feelings....Health education can be coercive when it gives only one side of the argument.” (Lupton 1993: 431)

Shaping the Psyche of Modern Motherhood

Cultural saturation (and internalization) of the discourse key – allows for the monitoring/gatekeeping of maternal behaviour to function insidiously; seeps into the nooks and crannies of everyday life.

Moral straightjacketing of maternal behaviour. “The discourse of risk ostensibly gives people a choice, but the rhetoric in which the choice is couched leaves no room for maneuver.” (Lupton, 1993: 433). In Cdn context, language of choice discursively absent

These features are what give the no drinking discourse its ability to function as such an effective mechanism of social control

Shaping the Psyche of Modern Motherhood

Number of implicit ideas/assumptions about babies and mothers embedded in the no drinking discourse

These assumptions/ideas absorbed into the cultural psyche along with the actual ‘no drinking’ prescription (cultural saturation / internalization of the message does not occur unless the assumptions upon which it is based are also adopted)

Builds up/reinforces the idea that children are easily harmed; fragile, inherently vulnerable. ; damage can be severe, irreversible and lifelong

Builds up/reinforces a parenting mindset that is hyper-sensitive to risk and also keenly risk adverse

Builds up/reinforces the corollary risk=danger=avoid at all costs

Builds up/reinforces the idea that children require protection from ‘outside;’ parents (i.e., mothers) need watching over (Identification of risk may not be common-sensical; expert authority needed to ‘teach’ mothers about proper risk perception and management)

Builds up/reinforces the idea that one of the key ‘risks’ to a child is the mother herself (i.e., through bad ‘lifestyle choices’); normalises expectations for a ‘perfecting’ standard for maternal behaviour, also normalises moral surveillance of maternal behaviour