This document summarizes a study on pregnant women's perceptions of alcohol use during pregnancy. The study interviewed 50 pregnant women in Switzerland about their alcohol consumption. While all acknowledged risks to the fetus, some reported abstaining and some reported strong reduction but not total abstention. Women questioned the need for zero alcohol based on mode of consumption, personal experiences, norm perceptions, and values of autonomy and holistic pregnancy. They constructed their own understandings of responsible drinking during pregnancy amid scientific and social uncertainty about low to moderate alcohol effects. The cultural status of alcohol as normal influenced perceptions more than for smoking, seen as always dangerous.

1. Policing Pregnancy: A one-day conference on maternal
autonomy, risk, and responsibility
Autonomy, risk discourses and
pregnant women’s perception of the
abstinence principle
Raphaël Hammer
School of Health Sciences (HESAV), Institute of Health Research
Lausanne (Switzerland)
raphael.hammer@hesav.ch

2. Introduction
• “the pregnant woman is surrounded by a complex network
of discourses and practices directed at the surveillance and
regulation of her body” (Lupton 1999: 59-60)
• the “governmentality” perspective: a critical approach to the
pervasive risk-thinking
- pregnant women as encouraged to police themselves and to
abstain from drinking alcohol for the sake of their fœtus
- many pregnant women endorse the abstinence principle on
the basis of the “good mother” social norm (Jones and Telenta
2012)
 how do non-abstinent pregnant women understand and
give meaning to the recommendation of “zero alcohol”?

3. • abstinence policy (zero tolerance)
• 30% to 40% of the women consumed alcohol during
pregnancy (Meyer-Leu et al. 2011, Lemola and Grob 2007)
• 0.5-2‰ of children would suffer from FAS (Addiction Suisse
2015)
• 1% of newborns would suffer from FASD (Addiction Suisse
2015)
• maternal drinking is not (yet) a major public health
issue (Schnegg 2013)
Maternal drinking in Switzerland

4. The study
 50 pregnant women interviewed
 normal pregnancy
 between 24 and 41 y.o.
 most of participants were expecting their first child
 most of them were Swiss, married and in paid employment
 overrepresentation of well-educated women
 part of a larger study on women’s experiences of professional
follow-up and risks
 Hammer R. and Inglin S. (2014) ‘I don’t think it’s risky, but...’:
pregnant women’s risk perceptions of maternal drinking and smoking,
Health, Risk & Society, 16(1): 22-35.

5. • all of the participants acknowledged that consuming
alcohol during pregnancy may be harmful for the fœtus
• two profiles: abstinence and strong reduction of
consumption (“once in a while”)
- reported behaviours!
- “abstinence” ≠ zero alcohol!
Questioning the need for total abstinence

6. 1) Mode of consumption
- frequency, amount, type of alcohol, context...
 value of moderation
“I don’t think that drinking a beer for a few months may compromise
baby’s health, honestly... but your doctor will never tell you
that!” (Françoise)
“this is what stopped me sometimes when I offered myself a glass
and when I felt a bit of the drunk sensation” (Adeline)
Questioning the need for total abstinence

7. 1) Mode of consumption
“to clink glasses”
“If I have already eaten well and I drink a little glass of red
wine, I do not feel that I put my baby at risk” (Marie)
 importance of the cultural and social dimension of alcohol
in daily life (Gaussot 2004, Testa and Leonard 1995)
Questioning the need for total abstinence

8. 2) Personal experience
“I have seen a lot of women who have been drinking a bit… not
daily and they did not have horrific consequences”
(Françoise)
“Everyone drinks moderately while pregnant without anything
happening, so I think [avoiding alcohol entirely] is a bit
extremist” (Monica)
Questioning the need for total abstinence

9. 3) Perception of the normative environment
“I drink a little glass from time to time, and she [her midwife] told
me “ok” and that’s it… so for her, it was acceptable’ “ (Marie)
 scientific uncertainty
 social uncertainty:
“there truly are people who say and think that you definitely can
drink a glass of wine while eating, even every day, and others
who say “oh how horrible, we should never drink a glass of
alcohol while pregnant”, so I really hear both discourses’ (Marie)
“Women described feeling pressure to both have a drink, “not
to be paranoid,” and to abstain, “to be a good mother”
(Loxton et al. 2013: 527)
Questioning the need for total abstinence

10. 4) Social values
- logic of the body:
“the importance of listening to their own bodies and not denying
themselves certain cravings” (Holland et al. 2015: 40)
- holistic view of pregnancy
- “pregnancy is not an illness” (April et al. 2010: 33)
 claims of autonomy (making one’s decision, challenging
the context of risk discourses)
Questioning the need for total abstinence

11. Comparison alcohol – tobacco consumption
1) the uncertainty about harmful effects of smoking during
pregnancy was absent
2) smoking is dangerous in any case (irrespective of the
number of cigarettes, the circumstances and means of
consumption)
3) more evident moralisation of maternal smoking (personal
failure)
Questioning the need for total abstinence

12. Two main features shaping perception of alcohol use during
pregnancy:
• the uncertainty about the effects of low or moderate
consumption of alcohol
• the cultural status of alcohol use as a normal and
accepted behaviour
 pregnant women construct their own representations of
the riskiness of alcohol use during pregnancy, and their
own understanding of irresponsible/responsible drinking
Conclusion

13. Ha ut e Ec ol e de Sa nt é Va ud Ti t r e pr i nc i pa l
Addiction Suisse (2015) Alcool et grossesse : un défi pour la société, Communiqué de presse, septembre
2015.
April N. et al. (2010) Représentations sociales et consommation d'alcool pendant la grossesse, Drogues,
santé et société, 9(2): 17-48.
Gaussot L. (2004) Modération et sobriété. Etudes sur les usages sociaux de l’alcool, Paris, L’Harmattan
Holland K, McCallum K et Blood RW (2015) Conversations about alcohol and pregnancy, Canberra,
Foundation for Alcohol Research and Education.
Jones S.C. and Telenta J. (2012) What influences Australian women to not drink alcohol during pregnancy?,
Australian Journal of Primary Health, 18: 68-73.
Lemola S. and Grob A. (2007) Drinking and smoking in pregnancy: which questions do Swiss physicians ask?
Swiss Medical Weekly, 137: 66-69.
Loxton D. et al. (2013) Acquisition and Utilization of Information About Alcohol Use in Pregnancy Among
Australian Pregnant Women and Service Providers, Journal of Midwifery & Women’s Health, 58, 523-
530
Lupton D. (1999) Risk and the ontology of pregnant embodiment, in Lupton D (Ed) Risk and sociocultural
theory: New directions and perspectives, Cambridge, Cambridge University Press, 59-85
Meyer Y. et al. (2011) Association of moderate alcohol use and binge drinking during pregnancy with
neonatal health, Alcoholism: Clinical and Experimental Research, 35(9): 1-9.
Schnegg C. (2013) A la santé de qui ?, EspacesTemps.net, Travaux, [revue en ligne]
Testa M. and Leonard K.E. (1995) Social influences on drinking during pregnancy, Psychology of Addictive
Behaviors, 9(4), 258-268
References