Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder

by Elizabeth M. Armstrong

In American society, the consumption of alcohol during pregnancy is considered dangerous, irresponsible, and in some cases illegal. Pregnant women who have even a single drink routinely face openly voiced reproach. Yet fetal alcohol syndrome (FAS) in infants and children is notoriously difficult to diagnose, and the relationship between alcohol and adverse birth outcomes is riddled with puzzles and paradoxes. Sociologist Elizabeth M. Armstrong uses fetal alcohol syndrome and the problem of drinking during pregnancy to examine the assumed relationship between somatic and social disorder, the ways in which social problems are individualized, and the intertwining of health and morality that characterizes American society. She traces the evolution of medical knowledge about the effects of alcohol on fetal development, from nineteenth-century debates about drinking and heredity to the modern diagnosis of FAS and its kindred syndromes. She argues that issues of race, class, and gender have influenced medical findings about alcohol and reproduction and that these findings have always reflected broader social and moral preoccupations and, in particular, concerns about women's roles and place in society, as well as the fitness of future generations. Medical beliefs about drinking during pregnancy have often ignored the poverty, chaos, and insufficiency of some women's lives―factors that may be more responsible than alcohol for adverse outcomes in babies and children. Using primary sources and interviews to explore relationships between doctors and patients and women and their unborn children, Armstrong offers a provocative and detailed analysis of how drinking during pregnancy came to be considered a pervasive social problem, despite the uncertainties surrounding the epidemiology and etiology of fetal alcohol syndrome.

Genres: Nonfiction, School, Feminism

296 pages, Hardcover

First published January 1, 2003

Reviews

[Kate Lansky · Rating 4 out of 5]

This is such a controversial topic and something tells me this is an equally controversial book. But having been pregnant in this country, and having had my eating, drinking, and general lifestyle monitored by complete strangers, having seen the fear mongering in pregnancy on all the above, I've come to a new understanding of what exactly acceptable risk is. Honestly, being unable to understand all the 'rules' of pregnancy, I began to do my own research - and that is how I found this book.

It's no secret that in America today, drinking alcohol during pregnancy is one of THE biggest pregnancy taboos around - but the research just doesn't support the extreme views we have on the topic. Recent studies have shown that moderate drinking likely poses no risk and, to go one step further, might even have a few benefits. If you go to Europe, you'll find pregnant women happily consuming a glass of wine with dinner. So, that being said, how did we come to this view that one single drop of alcohol during pregnancy could irreversibly harm your unborn child? Where did this come from? Elizabeth Armstrong tries to answer that question in Conceiving Risk, Bearing Responsibility. What emerges from this is a downright fascinating read. I really enjoyed the walk through the history of alcohol and pregnancy, with discussions of racial preservation, eugenics, the influence of abolition (and its repeal), and the development of drinking during pregnancy being seen as a moral disorder... the whole thing was intriguing from start to finish. It was downright odd reading medical advice from the 1950s stating that there was no problem at all with any level of drinking during pregnancy except for the high caloric intake and the lack of nutrients. It was even odder reading similar statements from the 1970s. Some of the anecdotes she provides (such as doctors advising a glass of wine after an amnio) are things that still happen today. Some (such as doctors giving ethanol intravenously to women to stop preterm labor), I am not sad to have missed.

Armstrong goes on to discuss exactly how FAS became a diagnosable syndrome in the US (it actually reminds me rather strongly of an article published in the New Yorker last year on flaws in the current system of the scientific process and the publication of research - also an interesting read, which also discusses the bias against the null hypothesis in scientific publication mentioned by Armstrong). She does use slightly stronger language than that, though - she says it was 'constructed', by 'moral entrepreneurs' (I will have to use that descriptor. I'm kind of a fan), and follows the development of FAS as it transitions from something caused by alcoholics to something caused by alcohol use and 'social drinking'. Morality and social control of alcohol clearly steps back into the spotlight at this point ("failure to thrive"? how do you even define that? Or prove it was caused by alcohol?). Armstrong even continues, taking on the surgeon general's warning on bottles of alcohol, arguing that these warnings turn our society's eyes away from the social inequalities that contribute to birth defects by placing blame on pregnant women rather than our culture. She mentions another study among women who had at least 3 drinks a day, the rate of Fetal Alcohol Syndrome varied immensely, based largely on socio-economic background (74% rate among lower income groups, 4.5% rate of occurrence in higher income groups) - the authors of this study theorized that the variable here was not just alcohol, but nutrition. It is, Armstrong hints, far easier to blame the individual, the other, than it is to accept part of the responsibility, or to take steps to repair the underlying cause.

I remember the whole big to-do about crack babies years ago. And I remember when, fairly recently, researchers came forward to say that it turns out crack wasn't all that harmful to the fetus after all. But alcohol remains hugely taboo, in spite of the fact that, even among heavy drinkers, rates of fetal alcohol syndrome are less than 5 percent. Can alcohol in pregnancy cause severe problems? yes. Does our country deal with this risk (or for that matter, with alcohol in general) in the best way? Undoubtedly no. Armstrong provides here a critique of our current path and offers a new focus - societal, rather than individual, reform.

[Allyson · Rating 4 out of 5]

Yes, I read this book for a college class. No, I would not read this on my own for fun. Was it interesting and shocking? Absolutely. First off, before I start this review and go on a long rant, I want to state that I DO NOT mean or intend to downplay Fetal Alcohol Syndrome. It is and can be very serious and I have a lot of sympathy for families who have babies and children with that diagnosis. To those that have been impacted by FAS, I am deeply sorry and I hope you are getting the support you deserve.

As a young woman, one of the main things you know about pregnancy is that you should not drink. And while Armstrong is not at all encouraging women to drink during their pregnancies, she puts an emphasis on understanding where FAS comes from and why we care about it so much. The main takeaway I got from this book is that not every baby who had a mother that drank alcohol during her pregnancy is born with FAS. Yet, we have formed this societal stigma about drinking while pregnant - about how dangerous it is and have formed this impression that only terrible mothers drink while pregnant. Our government’s solution? Slap minimalistic warnings on all alcohol bottles sold in the US - these warnings to nothing to deter drinking habits AND often appear before the warnings of drinking and driving, which is ROYALLY f***** up considering how many people die annually due to drunk drinking (but I digress). Something Armstrong talks about is that most babies diagnosed with FAS are born to alcoholic mothers. Yet, as a country we do basically nothing to help struggling alcoholics. Social programs in this country are SEVERELY underfunded and these women receive no outside help other than their doctor advising they don’t drink. Not to mention, in the book Armstrong mentions that most mothers with children diagnosed with FAS felt like their physician diagnosed their child just to diagnose them - they often weren’t given any support or resources they could reach out to get adequate information and support for their child. This begs the question: why do we care so much about FAS and why are we warned about it from an early age as young women?? Essentially it’s just another form of control. As a society we force women to harness their maternal instincts, even when they don’t want to be mothers. We question what pregnant women put into their bodies and we judge them for it.

Basically, this book just showed me how badly society wants to control women’s bodies and how many believe that pregnant women are directly responsible for the upcoming generation’s success when in reality their success is solely dependent on their upbringing and their environment. Yet, we only care about the baby when it is in the womb. As soon as it’s born, who cares. What about foster children? What about orphaned children? What about children growing up in lower socio-economic statuses? Why don’t we care about them? Why aren’t we adequately funding our social programs??

Anyway, I’ll get off my soapbox now. Compelling read.

[Mary · Rating 4 out of 5]

This book deserves 4 stars for what it is: an academic text. It’s not really written for the lay person (not would I think of this as a really “fun” read) but I think that the information presented was well researched and supported. This brought up many issues that I had yet to consider and I like that the author went about investigating the topic of FAS in a systematic and logical way.

[Caitlin Killian · Rating 5 out of 5]

One of my favorites. I've been thinking about and teaching this book for years.

[Roxy · Rating 4 out of 5]

a fascinating look at the construction of the fetal alcohol syndrome diagnosis