Policing Pregnancy: Who should be a mother?
Session 1: ‘Ideal pregnancies’ and the new family planning
The 1967 Abortion Act and the ‘problem pregnancy’
English law does not confer a right to access abortion services. Rather, the 1967 Abortion Act carves out an exception whereby women and health care professions may avoid the crime of ‘unlawful procurement of miscarriage’ only where two doctors certify that an abortion is permissible under one of the grounds laid down in the Act (typically, that continuation of pregnancy would pose a greater risk to a woman’s health than would ending it). The need to distinguish between the ‘problem pregnancy’ (which may be legitimately terminated) and an implicit maternal norm (where the desirability of continuing a pregnancy is assumed) thus lies at the heart of the regulation of abortion. This paper traces some broad trends in how a ‘problem pregnancy’ has been identified in the context of abortion over the five decades since the 1967 Act was passed.
Sally Sheldon is a professor of law at Kent University and a trustee of bpas. She has written on a range of issues in healthcare law and ethics, including a book on abortion law (Beyond Control: Medical Power and Abortion Law, 1997). She is currently part of a research team working on a biography of the Abortion Act (1967).
Constructing the ‘perfect pregnancy’ today
Over the course of the 20th century, women gained increasing control over the question of whether or when to have children. Access to contraception and abortion allowed sexually-active women to avoid or terminate pregnancy, and the development of Assisted Reproductive Technologies held out the possibility of a baby to women who were ‘naturally’ unable to conceive or maintain a pregnancy. These developments were intimately connected to the increase in sexual equality: in the political domain, in the workplace, and in society more widely. By having control over their fertility, women’s autonomy was no longer constrained by their biology: their decision to have children could be re-framed as a matter of choice. But these significant gains are limited by both old and new constraints on women’s reproductive autonomy. Women’s access to abortion is limited by law, and remains contingent on the prevailing political mood. Meanwhile, women who continue their pregnancies find themselves subject to increasing official and cultural surveillance about how that pregnancy should be conducted. The assumption appears to be that the choice to become a parent should bring with it the responsibility to create an ‘optimal womb environment’ for the developing fetus.
This paper will explore the extent to which contemporary parenting culture has come to frame the choice to have children as a risky, problematic endeavour, which demands that new mothers and fathers position themselves as receptive and obedient to expert advice and guidance. Long-standing tensions between the public and private domains of life are played out through debates about the conduct of pregnancy.
Jennie Bristow is Senior Lecturer in Sociology at Canterbury Christ Church University, and an Associate of the Centre for Parenting Culture Studies. Her research focuses on the problem of generations in contemporary cultural and policy discourses. She is author of ‘The Sociology of Generations: New directions and challenges’ (Palgrave Macmillan 2016), ‘Baby Boomers and Generational Conflict’ (Palgrave 2015), and ‘Standing Up to Supernanny’ (Imprint Academic 2009); and co-author of ‘Parenting Culture Studies’ (Palgrave Macmillan 2014) and ‘Licensed to Hug’ (2nd edn, Civitas 2010).
Session 2: Bad bodies, bad choices? Behavioural advice and the pregnant woman
Why take the risk? Governing pregnancy through maternal sacrifice
The idea of maternal sacrifice is central to the management of women’s reproductive bodies. Maternal sacrifice is both a symbolic and practical requirement of suffering and/or selflessness in which individual women ‘naturally’ put the needs and welfare of any existing or potential children first. During pregnancy, the cultural script of the vulnerable foetus combined with idealization of good motherhood means that women are expected to prioritize the welfare of the foetus over their own health, lives and desires. The development of risk consciousness, in which eliminating risk rather than assessing the balance of probabilities, means that the only ‘reasonable’ choice for women is to enact the precautionary principle.
Hence pregnant women, as mothers-to-be need to demonstrate their commitment to idealized motherhood by following biomedical regimes of advice and surveillance. Drawing of the examples of alcohol consumption and food ‘rules’ this paper will argue that women are instructed to make the right sacrifices to make to optimize foetal wellbeing, even if there is little evidence of harm. Moreover, risks that were once associated with particular social group can be democratized to the population more generally. Whilst women may adhere to or reject all or any of the health advice on food or other risks, they still have to engage with the normative gaze of surveillance from both the medical professionals and the public more generally. Visibly pregnant women who fail to display appropriate pregnant embodiment leave themselves open to public sanction. The individualization and responsibilization of pregnant women for the health and welfare of the developing foetus ignores both structural issues, such as poverty, and the idea that women have independent lives.
Obesity, pregnancy, and ‘fat-shaming’
Obesity is seen as one of the major public health issues of our time, and in recent years there has been increasing focus on women who enter pregnancy with a BMI of 30 or over. These women are seen not just as a risk to themselves in terms of health complications they may face while pregnant, but increasingly as posing a risk to the health of their foetus by the very environment of their own wombs. Indeed, a recent report from the UK’s Chief Medical Officer indicated that by damaging the germ line, obese women were pre-programming and condemning the offspring of their own offspring to a lifetime of obesity. What do we know about the science to substantiate these claims, and how is it conveyed to and interpreted by women themselves? My contribution will explore the communication of risk and the extent to which the ‘problem’ of obesity in pregnancy gives way to yet another example of ‘mother blaming’, in which issues with complex underpinnings are laid at the feet of pregnant women.
Clare Murphy is director of external affairs at the British Pregnancy Advisory Service, having joined the charity in 2010. Prior to that she worked as a health reporter for the BBC. Clare has an absolute commitment to campaigning for women’s access to the reproductive health services they need and the removal of legal and regulatory hurdles which serve no clinical purpose. She advocates for the ability of women to make their own reproductive decisions on the basis of evidence-based information and regularly speaks in the media on these issues. Clare is also a board member of the European Consortium for Emergency Contraception (ECEC).
Alcohol abstinence advice and the manipulation of evidence
In 2016, the Chief Medical Officers for the UK issued new guidance about drinking alcohol entitled, ‘Low Risk Drinking Guidelines’. One part of this guidance is about pregnancy and it states: ‘If you are pregnant or think you could become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.’ This was a modification of Guidance from 2007, the first to advocate alcohol abstinence, which stated: ‘Pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk’ (Department of Health, 26 May, 2007).
This change of ‘top line’ advice therefore removes any possibility that any drinking at all during or before pregnancy could be legitimised with reference to an official position. It does so on the basis of this view, taken by the Guidelines Development Group: ‘There is some evidence that the second part of the current English CMO guidance [the 2007 guidance] may have been read as implying a recommendation to drink alcohol at low levels during pregnancy which was not the intention.’
This paper will consider this effacing of any legitimation of the ‘knowing choice’ to drink before or during pregnancy at any level at all, against the evidence referred to in the footnotes of the guidelines that, at face, underpins their basis. It will suggest that what has happened in the selection and interpretation of evidence goes beyond what could be described as the application of the precautionary principle and constitutes, rather, a collapse into sheer irrationality. The conclusion will be drawn that women would do best to ignore what officialdom has to say about low levels of drinking, and relax.
Dr Ellie Lee is Reader in Social Policy at the University of Kent. Her research and teaching draws on sociological concepts such as risk consciousness and medicalisation to analyse the evolution of family policy and health policy. Her work explores why everyday issues – for example how women feel after abortion, what they eat, drink and feel when pregnant, or how mothers feed their babies – turn into major preoccupations for policy makers and become heated topics of wider public debate. She is the author of ‘Abortion, Motherhood and Mental Health: Medicalizing Reproduction in the United States and Great Britain’ (Aldine Transaction) and co-author of ‘Parenting Culture Studies’ (Palgrave). Her research papers include, ‘Under the Influence? The Construction of Foetal Alcohol Syndrome in UK Newspapers’. (Sociological Research Online) and ‘Advocating alcohol abstinence to pregnant women: Some observations about British policy’ (Health, Risk and Society), co-authored with Pam Lowe. She is the Director of the Centre for Parenting Culture Studies based in SSPSSR, and regularly discusses her research in the media and other public forums.
Supporting women who are pregnant and addicted to heroin: why specialist health and social care matters
Women who are simultaneously engaged in treatment for heroin addiction and who become mothers are likely to undergo a unique and complex psychosocial adjustment including transitioning social identities. There are clear advantages for the women and their children if this adjustment is successful. Best et al.’s (2016) Social Identity Model of Recovery (SIMOR) indicates that the social context is integral to this adjustment process, including encounters and interactions with health and social professionals involved in the women’s treatment for drug and maternity related issues. This paper is based on research carried out with 21 women who were engaged in treatment for heroin addiction. They were interviewed during pregnancy and again in the first year postpartum in order to elicit their accounts of their interactions and encounters with treatment professionals across this time and to understand how these impacted on the women’s transitioning identities. In accordance with the tenets of the SIMOR model, encounters across a range of professionals served largely to support the women’s transition of social identities though some interactions are hindering. Professionals who have specialist knowledge in the area of substance misuse are able to interact with the women in a way that is uniquely supportive of their psychosocial evolution.
Dr Sarah Christie is a Senior Research and Knowledge Exchange Fellow in the Research Centre for Children, Families and Communities at Canterbury Christ Church University. Her main area of research interest is the social psychology of women who are mothers, particularly in respect of identity and support needs. She has carried out several research projects involving women who are mothering amid unusual circumstances such as addiction and migrancy. Sarah works with quantitative and qualitative research methodologies and has a growing interest in exploring creative participatory approaches.
Session 3: Pregnancy surveillance and the medical profession
Capturing the womb: Pregnancy surveillance in early twentieth-century Britain
Amid wider efforts to improve healthcare provision for mothers and babies in Britain on the eve of the First World War, public health officials mooted the prospect of making pregnancy a notifiable condition, like some infectious diseases. Although officially frowned upon for both ethical and practical reasons, ‘notification of pregnancy’ schemes were introduced in various guises by a number of local authorities from around 1916. Examining the prominent, and hitherto overlooked, debates that these proposals generated reveals that controversies over notification were briefly the key battleground in negotiations over the meaning of ‘antenatal care’ at this formative moment in the development of maternity and child welfare services. They offer valuable evidence of how demarcation disputes between occupational groups of various degrees of authority, including midwives, general practitioners, health visitors and Medical Officers of Health, were folded into gendered and class-based concerns about state power, family privacy, and professional ethics.
Salim Al-Gailani is a Teaching and Research Associate at the Department of History and Philosophy of Science at the University of Cambridge. He is a social historian of medicine, with a focus on the history of pregnancy and childbirth in Britain since 1900. His first book, ‘Mothers and Monsters: Pregnancy in Britain since 1900’ will be coming out with the University of Rochester Press.
The social implications of epigenetics
The last decades have seen a profound shift in our understanding of biological processes and life itself. Where genetics has conventionally focused on examining the DNA sequence (the genotype), the burgeoning field of epigenetics examines additional mechanisms for modifying gene expression in manifest behaviours, physical features, health status and so on (the phenotype). It provides a conduit mediating the interaction of the environment on an otherwise immutable DNA blueprint, and invites a natural interest in the impact of adverse conditions, such as deprivation or ‘suboptimal’ parenting. The implications of this for social policy are far reaching. Gestation inevitably becomes the playground for epigenetic manipulations. Women are seen as responsible for optimizing good biological influences, making the right choices, consuming the remedies and therapies on offer to ‘optimise’ their uterine environments. ‘Optimisation’ of early life environments might make the case for benignly intended public health and parenting education approaches, but it also erodes the ‘normal’ and exposes sections of the population to increasing interference in the name of prevention and social progress.
Sue White is Professor of Social Work at the University of Sheffield. Her research has focused principally on the detailed sociological analysis of everyday professional decision-making in child health and welfare, particularly examining its moral aspects and the way evidence is perceived and used. She has completed a number of influential studies. Her recent research funded by the National Institute for Health Research, focused on designing safer systems for the detection of children at risk presenting in secondary health settings, based on a thorough understanding of human and social factors. Sue is currently conducting international research on social workers’ understandings of family complexity in a range of countries and also the impacts of technological biology on social policy and public discourse.
Rebecca is chief executive of the human rights in childbirth charity, Birthrights. When not working for Birthrights she writes freelance about reproductive rights, birth and parenting for The Pool, The Guardian and other publications. Her book on human rights in childbirth was published by Pinter and Martin in September 2016 and her new book, a comprehensive pregnancy and birth guide, will be published by Penguin Life in spring 2018. Before entering the childbirth world as a doula she completed a Masters degree in War Studies with a focus on human rights issues. She has worked in the charity and the NGO sector, most recently at Human Rights Watch.
Session 4: Breastfeeding, guilt, and ideals of good motherhood
Am I Harming My Baby? The significance of the default in representations of infant feeding
The phrase ‘breast is best’ is controversial for many reasons, but one perhaps surprising criticism comes from breastfeeding advocates. The claim is this way of talking mistakenly represents breastfeeding as a departure from the norm, when in fact breastfeeding should be treated as the default for infant feeding. Breastfeeding mothers have an interest in representing breastfeeding as the default, for example to counteract criticism of public breastfeeding. I connect this issue to an increasing trend for advice for new mothers to warn that formula feeding harms babies rather than stating that breastfeeding is beneficial. I argue (1) the harm/ benefit distinction is generally morally significant and thus (2) holding that those who decide to use formula harm their babies is likely to contribute to guilt associated with formula feeding and thus to undermine the wellbeing of vulnerable women. However, (3) the harm/ benefit distinction does not apply easily to infant feeding decisions, in part because of difficulties in determining whether we should treat breastfeeding as the default for infant feeding. I show that neither the descriptive ‘facts of the matter’ nor moral considerations provides an easy answer.
Fiona Woollard is an Associate Professor of Philosophy at the University of Southampton. Her current research focuses on Philosophy of Pregnancy, Birth and Early Motherhood with a special interest in infant feeding.
Breastfeeding across time and place: the construction of cultural norms
Drawing on ethnographic research with parents in London and Paris, this paper examines the narratives of women who breastfeed ‘to full term’ (typically for a period of several years) as part of a philosophy of ‘attachment parenting’ – an approach to childcare which validates long term proximity between child and care‐taker. As a non-conventional practice, examination of their accounts provides a vantage point by which to reflect on wider cultural norms surrounding infant feeding and care. Typically, women narrate their decision to breastfeed to ‘full term’ as ‘natural’: ‘evolutionarily appropriate,’ ‘scientifically best,’ and ‘what feels right’ in the heart. What follows in the presentation is a reflection on how these various ‘accountability strategies’ are given credence in narratives of mothering, how they might be understood as part of a wider shift towards a more ‘intensive’ parenting culture (Lee et al. 2014), and what the social implications of that might be. In parallel with other presentations during the day, the paper explores the issues of politicization in reproductive decision making, moralization and identity work, scientisation and changing meanings of choice.
Dr Charlotte Faircloth is a Senior Lecturer in the Department of Social Sciences at the University of Roehampton, London. She is also a Visiting Scholar and founding member of the Centre for Parenting Culture Studies (CPCS) at the University of Kent. She is author of ‘Militant Lactivism? Attachment Parenting and Intensive Motherhood in the UK and France’ and, with colleagues in CPCS, ‘Parenting Culture Studies’.
The emotional and practical experiences of formula-feeding mothers
Dr Victoria Fallon, School of Psychology, University of Liverpool
The majority of infant feeding research is focused on identifying mother’s reasons for the cessation of breastfeeding. The experience of mothers who choose to use formula is largely overlooked in quantitative designs. This study aimed to describe the emotional and practical experiences of mothers who formula feed in any quantity, and examine whether these experiences would vary among different cohorts of formula feeding mothers according to prenatal feeding intention and postnatal feeding method. A total of 890 mothers of infants up to 26 weeks of age, who were currently formula feeding in any quantity, were recruited through relevant international social media sites via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant feeding choices. Practical predictor variables included support received from health professionals, respect displayed by their everyday environment, and main sources of infant feeding information. Descriptive findings from the overall sample highlighted a worryingly high percentage of mother’s experienced negative emotions as a result of their decision to use formula. Multinomial logit models revealed that negative emotions such as guilt, dissatisfaction, and stigma were directly associated with feeding intention and method. The evidence suggests that the current approach to infant feeding promotion and support may be paradoxically related to significant issues with emotional well-being. These findings support criticisms of how infant feeding recommendations are framed by health care professionals and policy makers, and highlight a need to address formula feeding in a more balanced, woman-centred manner.
Vicky Fallon is a Lecturer in the School of Psychology at the University of Liverpool. She is affiliated with the Appetite and Obesity research group in the Department of Psychological Sciences. Her research interests concern perinatal mental health and early infant development, in particular infant nutrition. Her PhD examined maternal anxiety and infant feeding from pregnancy to parenthood.