advice or “who” gives it?
Of the participants who recalled receiving inconsistent messages around alcohol consumption during pregnancy, over half were critical of the messages given to them around alcohol consumption, revealing a lack of confidence in the medical profession. Are women therefore in Scotland becoming less accepting of the medical profession or health education efforts or is it that they do not see medical guidance as the be all and end all? The importance of lay knowledge and carrying out their own research was important to these women, as I have argued they resisted overarching simplistic messages and quite often did not feel that these messages were aimed at them, instead that they were targeting ‘other’ heavy drinkers. The inconsistency in message also led women to report having a lack of trust in the sources they are receiving messages from, therefore upholding the argument of Plant (2008, p.174) that ‘the UK appears to be in some confusion over the best advice to give’. As well as contesting the evidence, it is apparent that women furthermore contested and questioned ‘who’ is setting the advice. Although, receiving guidance from a midwife around the consumption of alcohol in pregnancy, Skyla described it as only ‘advice’, indicating that it was not a rule that should be followed:
At the time, I was aware of the advice, the advice that you were advised by the midwife was not to drink alcohol,
Skyla, 42, Inverness The guidance was therefore a suggestion, something which women were able to avoid if it wasn’t aimed at them and the common theme across some of the interviews was the way in which participants, made reference to an elusive “they” or “who” who gave the advice. This theme is strongly linked to the themes of power and surveillance as developed by Foucault (1979), as women appear to be more resistant to instruction when they do not know who is setting these messages. There are clearly different discourses of power that are evident linked to the theory of the medicalisation of pregnancy which sees the mother and child as two separate patients, additionally treating reproduction as a medical condition in need of management that views women as no more than foetal containers (Annas, 1986,
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Purdy, 1990, Ruddick, 2007a) and that these containers must be free from the pollution of alcohol (Ettorre and Kingdon, 2010, Murphy and Rosenbaum, 1994). Women actively question what power the bodies have to set this advice and this is also exacerbated by the way in which women question if they are they right in setting this advice. This reveals that women are unconvinced by these messages. Paige was also aware of the change in guidance but she does not indicate who in particular was setting or giving out this advice, instead she referred to the body as “they”:
In terms of current health campaigns I know that they're very keen to stress that no alcohol should be consumed during pregnancy
Paige, 28, Edinburgh The women in the study, who spoke about receiving messages around alcohol consumption during pregnancy, were often aware of a sense of authority in these messages but were often unsure as to who the body is that is setting it. This is evident as Catriona actively questions the authority that sets the advice:
Even the advice, I think that is set by, whoever gives out this kind of advice. I can’t remember who or what sort of authority says that you mustn’t drink in pregnancy anymore.
Catriona, 29, Edinburgh How women are resisting the power that is placed upon them through medical discourses and biopower is evident in Catriona’s interview which revealed the ways in which women challenge and dispute the authoritative recommendations set to pregnant women. The use of “authority” by Catriona infers that the advice has some power and influence behind it, contrastingly the use of “whoever” and because she couldn’t recall who gave her this message affected Catriona’s response to the messages around alcohol consumption during pregnancy. She not only questions the advice that women receive, but also questions what organisation sets the advice and the power/rights that they have to appoint it. It was clear therefore that women want to know who is setting the advice, and therefore who is telling them what to do. Women therefore rejected a disciplinarian message which did not take into account their discretion. Such comments reveal both their awareness of messages and a sense
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of responsibility but this questioning also indicates that women are suspicious of where messages come from, often resulting in their questioning the advice, and its credence. Contrastingly Paige revealed a consideration that perhaps some women need these strong messages, and likens this medical intervention during pregnancy to the messages around smoking:
I think related to kind of drinking in pregnancy, the government and kind of, medical profession is very keen to make you stop smoking during pregnancy as well... I think that’s probably the trouble with alcohol during pregnancy, that not enough is known about it, so people need to air on the side of caution an awful lot. I think maybe in America where my friend was coming from, I think maybe it’s more kind of highlighted there about the potential harm that alcohol, alcohol can do to your baby erm and we are only just starting to go that way ourselves
Paige, 28, Edinburgh Again there is an expectation that because “not enough” is known about alcohol in pregnancy risk is therefore unchartered, but that women should adhere to this policy. There was a general consensus that the advice on alcohol consumption during pregnancy should be better thought out. Women are less accepting of the medical profession as they do not see medical guidance as the be all and end all or ultimate importance. The health education efforts were linked with a lack of trust as there is no perceived benefit to them. However Paige recognises that not enough is currently known about the risks and claimed that the advice airs on the precautionary side. Paige also highlights an awareness of the cultural difference between Scotland and America in its stance towards alcohol consumption during pregnancy and the way in which pregnancy guidance is accepted by women. In America, women can be prosecuted for child harm when drinking or taking drugs during pregnancy (Campbell and Ettorre, 2011) (for a further discussion of the legal implications of drinking during pregnancy please see section 2.11.1) we could query if we actually want the health recommendations within the UK to go like this.
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