19 July 2010

Motherhood, abortion and parenting culture

At a recent conference, academics from the UK and USA came together to discuss new challenges to women’s autonomy. Jennie Bristow reports.

The seminar ‘Pregnancy and pregnancy planning in the new parenting culture’, hosted by the University of Kent in June 2010, provoked a number of stimulating discussions on the following themes:

—Abortion and reproductive decision-making in a culture of ‘intensive parenting’;
—Assisted conception and the limits of choice;
—The pregnant woman’s autonomy in an era of increasing lifestyle surveillance and sensitivity to fetal harm;
—Changing ideas about motherhood and fatherhood.

Dr Ellie Lee, convenor of Parenting Culture Studies and Pro-Choice Forum, opened the conference by welcoming the speakers to the event, many of whom had travelled from the USA and are at the forefront of groundbreaking research on pregnancy and abortion. This event sought to examine the way that contemporary assumptions about parenting shape the context of pregnancy and abortion, and how such assumptions give new grounds for the surveillance and regulation of individuals’ reproductive decisions.

Rachel Jones, Senior Research Associate at the Guttmacher Institute in New York, gave a presentation on abortion decision-making in a culture of ‘intensive motherhood’. Jones challenged the assumption that women have abortions because they don’t want children, and also the ‘pro-choice assumption’ that the woman having an abortion and the woman carrying a pregnancy to term is ‘the same woman at a different stage in her life’. In fact, 61 per cent of those having abortions in the USA already have at least one child. Twenty-three per cent of those under 20 years of age are mothers, and 10 per cent had a baby in the past 12 months. Jones cited research by some colleagues indicating that the most common reason given for abortion was that children ‘would dramatically change my life’.

The Guttmacher Institute study that Jones discussed was a qualitative study of 38 women at four different abortion providers in the USA. Three quarters were mothers, and about half were at or below the poverty line. When discussing their reasons for seeking abortion, women talked about a number of issues. Their ability to care for their other children emerged as a strong theme: one woman had severe morning sickness, which felt impeded her ability to play the mothering role she wanted to in relation to her other children; another young respondent already had three children and lacked the financial resources to have a fourth child.

Mothers discussed health – their own, and that of their children – and how this related to their maternal obligations. Jones remarked upon how, even when women talked about their own health problems, it was in the context of bringing up the children they already had. Women talked about the ideal conditions of motherhood as framing their decision. Jones noted that this included both the ‘real and perceived’ disadvantages of having a child in their situation. For example, one unmarried woman with no children said that she couldn’t give her child ‘everything in the world’ – expressing the idea that total devotion to motherhood is necessary before embarking on the process.

Respondents to the Guttmacher study also raised worries about maternal and fetal health – they talked about drugs, smoking, or failing to take prenatal vitamins to express concerns that they were not ideally positioned to carry this pregnancy to term. Adoption was an issue brought up, unprompted, by nearly one in four interviewees, but in the context that to adopt would be unrealistic. Jones suggested that this expressed the idea that if you have a child, it is your responsibility to take care of it – how would you know that somebody else could do that?

In conclusion, Jones noted that most women who have abortions are mothers, and that both ideas about, and the reality of, motherhood influences women’s abortion decisions. Some women used ‘anti-choice’ language to discuss their abortions, and were sad about the decision – but they nonetheless thought that they and their families would be better off as a result of the abortion. Jones suggested that pro-choice advocates need to work to achieve better social supports for motherhood, and for parents, and to use language that speaks to women’s experiences. She also suggested that attempts to increase adoption are not going to impact upon the abortion rate. 

Danielle Bessett PhD of Ibis Reproductive Health gave a paper on ‘Pregnancy after abortion: women’s experiences of a stigmatised reproductive career’. The context of Bessett’s research is one in which 52% of US women who have abortions plan to have children in the future, and one in three women have abortions. She noted that neither of the notation systems for recording women’s obstetric history - GPA (gravida/para/abortus), and TPAL (term births, preterm births, abortions, living children) – separates between the sequence of events. Past reproductive events often re-emerge in prenatal care, and Bessett argued for a more dynamic approach to understanding this. 

Bessett discussed women’s reproductive careers in terms of the way that women’s relationship to reproductive experiences changes over time, and in relation to previous and anticipated reproductive events. She said she had been struck by the way that women talked about previous abortions while they were carrying a wanted pregnancy. One third of women interviewed reported having terminated a previous pregnancy, and women described their abortions differently at different stages.

Abortion emerged as quite distinct from the current pregnancy. Bessett noted that some of the women may have even forgotten about a previous abortion, and that it was sometimes thought of in terms of a lifestyle choice rather than a medical problem. Some women articulated feelings of regret and fear about the repercussions of abortion upon their current pregnancy – for example, illness or disability of the fetus – in terms that Bessett described as religious or ‘supernatural’. However, she stressed that these responses were not consistent with what has sometimes been described as ‘post abortion syndrome’ – the women weren’t exhibiting signs of mental illness, but they were describing their experiences in a discourse of religiosity.

Across both patterns of responses – those women who appeared to regret previous abortions, and those who did not – disclosure of a prior abortion was understood by women to affect their treatment in prenatal care and during the birth. Bessett concluded that women’s reproductive histories can shape their experiences and how they feel they are treated by others. It may be, she said, that women are not articulating a stigma attached to abortion but something else – but, she said, we don’t know what this ‘something else’ is until we interrogate it.

Evelyn Mahon, senior lecturer in sociology at Trinity College, Dublin, gave a presentation titled ‘Is there ever a good time to have a child?’ – a title which emerged from three different studies she has conducted over the past 20 years. Mahon discussed her research on women and ‘crisis pregnancy’ in Ireland, which examined factors that influenced women to have abortions. The data showed that a crisis pregnancy was socially constructed – that women who had abortions tended to be young, single and unemployed. Adoption was a major policy until the 1970s, she explained, and most illegitimate births were adopted. The sociological question this raised was, if everybody is doing one thing and abortion is seen as so awful, why do people do it?

The major findings of Mahon’s study included the experience and meaning of stigma. Stigma is about a lot of things, she explained: the negativity attached to premarital sex and single motherhood meant that the parent and child would be stigmatised. She noted that when women gave babies up for adoption, the effect was the same as that of abortion: namely, the idea that the baby was gone. In addition to stigma, Mahon talked about women’s unreadiness to have a child, which included not being able to cope financially.

Mahon went on to discuss some of the social shifts that have taken place over recent years, particularly in relation to Ireland’s economic development. Irish women have internalised ideas about the importance of education and work, and also certain ideas about the needs of the child. For example, the two-parent family has become an internalised model, and those women seeking abortion couldn’t conceive of adoption. There are new patterns of reproduction emerging, around ideas about the age at which women should have their first birth, the importance of first establishing a relationship with a sexual partner, and women’s attempts to define their own lives.

A presentation by Professor Kristin Luker, Elizabeth Josselyn Boalt Professor of Law and Professor of Sociology at the University of California, Berkeley, discussed ‘Abortion and the politics of motherhood revisited’. She began by examining the history behind abortion rights on the USA, arguing that abortion held together the gender and sexual regime – but since 1964 it changed dramatically.

The shift came about because of a combination of factors: technological change, with the Pill becoming the most popular contraceptive; ideological change, coming from the civil rights, women’s, and the student movement; and legal change. Luker highlighted the 1965 case Griswold v Connecticut, in which the Supreme Court ruled that a state’s ban on the use of contraceptives violated the right to marital privacy, as a key moment: while Roe v Wade in 1973 got all the publicity, argued Luker, Griswold had done much of the ‘heavy work’. Luker explained that Roe v Wade brought the birth of the pro-life movement: what mobilised people was not abortion, so much as the idea that the unborn child is not really a person. 

Luker discussed the dramatic changes to women’s lives brought about by the legalisation of abortion in Roe v Wade – illustrated by the increase of women into the professions. This changed the context in which decisions were made, and public opinion started to question the idea that women should leave running the country to men. However, while some women were positioned to take advantages of the changes, others were not. The option of abortion immiserated women for whom motherhood was the best job they could do. Luker suggested that women who were less educated or positioned to take advantage of equality are more likely to appreciate a gendered world, in which a housewife had a certain status.

Luker has famously argued that abortion divided women along lines of the meaning of motherhood. In recent years, she has also noticed the significance of postponing of motherhood, and changes in the status of marriage, which, she suggested, is now becoming ‘a luxury good’. Luker discussed what has been termed the ‘second demographic revolution’, with the decoupling of marriage and motherhood – the two are no longer seen as sequential.

In a session on ‘reproductive technology in an age of intensive parenthood’, Martin Richards, Emeritus Professor of Family Research at Cambridge University, discussed the question of ‘Choice or eugenics?’ Richards described the history of antenatal screening, noting that the first genetic clinic was established in 1946, for couples who had a child with a genetic disorder – the main issue was ‘recurrence’, and couples would often decide to have no further children. Richards argued that the culture in which the clinic operated was one of reform eugenics, and its aims were not controversial at the time.

Richards went on to explain that with the end of eugenics in the 1970s, such ideas became ‘unmentionable’. There was a shift from the belief in self-sacrifice for the common reproductive good to individualistic reproductive autonomy. Health professionals stopped giving advice in this area and instead provided information and ‘non-directive counselling’. He posed the question of whether this represented an end of the genetic clinic, or its rebirth in a culture of choice?

Moving on to antenatal screening today, Richards discussed the recent attempt to repeat Ann Oakley’s study of maternity care in the mid-1970s, when two-thirds of scans were dating scans. The 2009 study found that all women had scans at 11 weeks and an anomaly scan at 22 weeks. One third of women also had private scans, for a variety of reasons – both medical and to gain a clear image of the fetus. He pointed out that women are seeking antenatal scans – they are not being imposed upon them.

Richards discussed other screening programmes that are available today, including those which are directed towards specific groups at particular risk of certain disorders, and new diagnostic tests, including non-invasive tests that use blood samples to look at Free Fetal DNA. The lesson from history, Richards argued, is that ‘people do what they can do’ in utilising such technologies. He concluded by noting that there are more and more opportunities for testing, and only four possible ways to exercise choice: choice of sexual partner, termination of pregnancy, IVF and embryo selection, or gene therapy.

Julie McCandless, lecturer in law at Oxford Brookes University, discussed ‘What is “supportive parenting”? The new “Welfare of the Child” clauses in the Human Fertilisation and Embryology Act (2008)’. This was based on work she has conducted with Professor Sally Sheldon on the legislative backdrop to the HFE Act 2008 – a flagship piece of legislation passed by the New Labour government. McCandless noted that this legislation raised a number of controversial issues, the foremost of which was the removal of the ‘need for a father’ in the provision of fertility treatment, and the replacement of this clause with the need for ‘supportive parenting’.

McCandless discussed the media reportage of this shift, which focused on the idea that ‘no fathers are required’, and asked why it excited so much attention. Although this was represented as a major change, it was not necessarily so significant in terms of clinical practice – the Human Fertilisation and Embryology Authority (HFEA)’s code of practice has been interpreted increasingly liberally. ‘All the fuss’ can be explained, argued McCandless, through ‘a number of conflations’.

This is a clause with a long history, and the ‘need for a father’ initially represented a compromise with Conservative MPs who wanted to restrict ARTs to married couples. Also significant was how agendas were set in the process of legal reform. McCandless noted that the House of Commons Science and Technology Committee had recommended the removal of the ‘welfare of the child’ clause – initially, the issue was the clause itself. By the time the debate came to Parliament, some compromise was needed again. The simplicity of the phrase, and the way the deletion of the ‘need for a father’ clause became the focus of societal anxieties was another issue – the discussion of the need to have an explicit mention of fatherhood relates to broader anxieties around fatherhood, and the family.

In a session titled ‘Extending parenting backwards? Pregnancy and pre-pregnancy in contemporary context’, Elizabeth Mitchell Armstrong, Associate Professor of Sociology and Public Affairs, Princeton University, posed the question: ‘Do happier pregnancies make healthier babies? Stress and the medicalisation of maternal emotion’. Armstrong listed the wide range of adverse effects associated in contemporary discourse with stress in the mother, from pre-term birth to excessive crying and even schizophrenia.

Armstrong noted that there many hypothesised mechanisms by which stress might affect the fetus. But there is remarkably little evidence that stress has any of the effects upon the fetus that dominate media discussion of this issue. In discussing why concerns about maternal stress this idea has taken hold of today’s imagination, Armstrong linked the ‘scientific’ maternal stress discussion with the historical (palpably unscientific) notion of maternal impressions: the idea that something the woman sees or tastes can leave a direct mark on the fetus, with the effect that ‘strawberry’ birthmarks were understood as a result of a mother’s craving, for example.

Armstrong argued that these beliefs continue today. Despite the pseudo-scientific character of the maternal stress discussion, the responsibility for reducing stress is placed squarely on women’s shoulders, contributing to the regulation of pregnant women’s bodies and behaviour.

Cynthia Daniels, Professor of Political Science at Rutgers University, gave a paper titled ‘Policing pregnancy: The politics of fetal risks’. Daniels argued that reproductive politics in the USA has traditionally focused on abortion, but in recent years this has shifted to the management and control of the pregnant body. The most visible campaigns around pregnancy have been around alcohol use, as in the slogan ‘a pregnant woman never drinks alone’. Yet what we are now seeing is how ‘information’ about fetal development extends is backwards to even the point where ‘sexually active women who are not using contraception’ need to be thinking about how their behaviour might affect potential children.

Daniels noted that there have been 200 prosecutions of pregnant women since 1980 in the USA. Fifteen US states, for example, consider substance abuse in pregnancy to be child abuse, and 33 require health care professionals to report to welfare authorities the suspected use of alcohol or drugs in pregnancy. In some cases where women have suffered stillbirth, they have been convicted of homicide for using cocaine in pregnancy. In conclusion, Daniels noted that there was a presumed exclusive responsibility of women for fetal health/harm: despite the sensitivity of the male reproductive system to environmental effects and toxins.

These presentations were followed by a panel discussion with Frank Furedi, Professor of Sociology at the University of Kent, and Janet Golden, Professor of History at Rutgers University. Furedi noted some distinctive new features of the moralising imperative towards pregnancy. One is an ambiguity in the discourse about pregnancy: it is both celebrated yet problematised, to the extent that it becomes a focus for ‘joined up fear-mongering’ and regarded as an opportunity for social intervention. He argued that when fetal rights are elevated, human subjectivity, in terms of consciousness and experience, is flattened out. Picking up on Daniels’s emphasis upon the sensitivity of the male reproductive system, Furedi cautioned that there was a danger in medicalising male reproduction in the same way as female reproduction.

Janet Golden provided a historical perspective on these debates. She noted that the idea that we want ‘happy babies’ is a very modern secular view – society used to want fearful babies, ‘trembling before God’. She pointed to the limits of the maternal stress discourse in relation to the anti-abortion literature: nobody says ‘okay, well, if you’re stressed by pregnancy, why don’t you have an abortion?’ Golden also cautioned about the tendency to rely upon animal studies to make claims about maternal behaviour, which can then become the basis for social policy.

The ensuing discussion raised issues to do with how new and culturally specific concerns about the fragility of the fetus are: a concern that did not exist until the 1960s, when the Thalidomide tragedy indicated the extent to which drugs could cross the placenta. The ‘duality of pregnancy’ was discussed, as something that is both sacred and profane, that we revere and are revolted by. A pregnancy is seen both as fragile and hard to achieve, and in other instances hard to get rid of. A key question was raised about how reproductive needs could be put on the agenda without extending the power of state surveillance, and the problems inherent in the idea of ‘the public pregnancy’, which now seems to dominate the debate.

A session examining ‘fatherhood and parenting culture’ began with a paper from Tina Miller, Reader in Sociology at Oxford Brookes University, on ‘Men and “bonding”: fathers’ expectations in the antenatal period’. Discussing findings from a recent study exploring fatherhood, Miller argued that there were clearly dominant discourses about ideal, ‘involved’ fathering, which include preparing appropriately for fatherhood by accessing information, attending antenatal classes, and so on - but that there remains a recognition amongst fathers that they don’t have the same emotional involvement as mothers.

Jonathan Ives, Lecturer in Behavioural Science and Heather Draper, Reader in Biomedical Ethics, from the Centre for Biomedical Ethics at the University of Birmingham, presented a paper titled: ‘Should we strive to involve men in a meaningful way during pregnancy? Rethinking men’s involvement in antenatal care’. They noted that men’s involvement in antenatal care is part of a wider narrative around the modern father, demanding physical and emotional presence overlying an economic and social responsibility. There are tensions here: the implicit breadwinner role is always the bottom line.

In examining the ways in which the involvement of fathers in antenatal care could be justified in ethical terms, Ives and Draper suggested that it is not clear that this is the best way of fostering fathers’ engagement. Furthermore, overt attempts to ‘involve’ men may run risk of creating the father as a passive bystander, and may make women feel obliged to engage a partner, even if they don’t want to.

In response to these papers, Mary Ann Kanieski, Assistant Professor of Sociology at Saint Mary’s College, Notre Dame, Indiana, argued that in terms of medicalised parenting, one of the most pervasive trends is the intensification of fatherhood. She asked why fatherhood should today be constructed in relation to child well-being, rather than as something enjoyable, and suggested that the discussion of mothers’, fathers’, or children’s interests misses the concept of family, in which the interests of all members must be balanced.

The third session examined the current advice to abstain from alcohol during pregnancy, offering perspectives from the USA and from Britain. Janet Golden, Professor of History at Rutgers University and author of the book Message in a Bottle: The Making of Fetal Alcohol Syndrome, focused on the construction of Fetal Alcohol Syndrome (FAS), from the emergence of this as a concern in the USA in the early 1970s. Golden described the process of the politicisation of drinking in pregnancy, and questioned the extent to which scientific evidence about the teratological effects of alcohol on the fetus could explain the ‘crusade to warn’ all pregnant women, but with a particular focus on ethnic minorities, about their drinking behaviour.

A presentation by Pam Lowe, Lecturer in Sociology at Aston University, discussed the ‘migration’ of the Fetal Alcohol Syndrome problem from the USA to the UK, in the form of a much broader range of disorders grouped as Fetal Alcohol Spectrum Disorder (FASD). Until 2000, very little attention was paid to FAS in the UK, but it emerged as a problem around the activities of particular claims-makers and lobby groups.

Interest in this issue peaked in 2007, when the Department of Health and the National Institute of Clinical Excellence produced slightly different recommendations on alcohol consumption during pregnancy. The recommendations were later brought in line with one another: advising no alcohol consumption at all for pregnant women or those trying to conceive, despite an official recognition that this warning was not based on scientific evidence. Lowe argued that in the UK, the message straightaway took the form of a ‘democratised threat’, presenting all women who as ‘at risk’. This is another example of the trend towards the ‘public fetus’ – broader aspects of motherhood are screened out.

The panel discussants were Elizabeth Armstrong of Princeton University and Pat O’Brien, Consultant and Honorary Senior Lecturer in Obstetrics and Gynaecology at University College Hospital London, and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG). Armstrong talked about the ‘globalisation of public health policy, especially around drinking during pregnancy’, and saw this within a trend towards the individualisation of responsibility: abstinence messages are not about providing community level solutions, but about convincing individuals to act in a particular way. She pointed to the paradox that a woman is constructed as the ultimate protector of the fetus, yet she and her body are also constructed as the greatest threat to fetal well-being

Pat O’Brien noted that FAS and FASD are not the same thing: FAS is a definite diagnosis, while FASD is so uncertain that ‘people who are searching for reasons for misfortune can use FASD, as it fits the bill with a range of symptoms’. He questioned whether abstinence guidelines would reduce the incidence of FAS and argued that abstinence messages can actively cause harm: by ‘crying wolf’, based on unsound evidence; and by making good mothers who have drunk in previous pregnancies according to previous guidelines ‘feel terrible’.

Additional reporting by Charlotte Faircloth.

This two day seminar was organised by Parenting Culture Studies and the Kent Centre for Law Gender and Sexuality, and supported by BPAS and the Economic and Social Research Council. The full programme is available here.

The abstracts for the seminar are available here, and the slides can be viewed here.