Stephanie knaak drinking during pregnancy-kent 2011
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  • Alcohol and Pregnancy Alcohol and pregnancy don’t mix.If you need help to stop drinking, you should ask your doctor, community health nurse, midwife or other health care professionals for advice. Tell your partner, family, friends, and community members who can all support you with this decision.
  • Motherrisk: treating the mother, protecting the unborn
  • Strong cultural internalization of message that consuming alcohol while pregnant is dangerousGeneral survey of women and men 18-40Specific amounts of consumption,:80% believe it is not at all safe for a pregnant woman to drink three or four alcoholic drinks each weekend during the pregnancy (4/week) 69% believe its unsafe to drink two drinks on two or three different occasionsduring the pregnancy (4-6 beverages during an entire pregnancy)Over half (54%) believe it is unsafe to drink a total of one or twoalcoholic drinks during entire pregnancy
  • Similarity with breastfeeding discourseNo coincidence -- discourses used as pedagogical tools to promote a particular cultural mindset and moral framework for what proper mothering looks likeboth discourses deal specifically with ‘early motherhood’both discourses deal specifically with what mothers should/should not be doing with their bodies vis-a-vis their children; interested in regulating maternal bodiesBoth discourses are unequivocal in message and tone (less a guideline than a prescription) Both discourses have this science/policy mismatchBoth discourses have saturated the cultural consciousnessHealth education emphasizing risks is a form of pedagogy, which, like other forms, serves to legitimize ideologies and social practices (432)

Stephanie knaak drinking during pregnancy-kent 2011 Stephanie knaak drinking during pregnancy-kent 2011 Presentation Transcript

  • 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 Facts
    THERE IS NO SAFE AMOUNT OR SAFE TIME TO DRINK ALCOHOL DURING PREGNANCY
    If 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 Steps
    Whether 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