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  • BIOETHICS FORUM ESSAY

Disobedience

Okay, the large signs in bars telling pregnant women not to drink alcohol were bad enough, especially when you consider that there is no medical evidence whatsoever that one or even two glasses of wine or beer a day does the fetus any harm. The woman would have to be falling-off-the-barstool drunk, repeatedly, in the earliest stages of her pregnancy for the alcohol that crosses the placental barrier to have teratogenic effects, yet there are bartenders who refuse to serve women who are visibly pregnant, and I know of at least one instance in which a patron sitting at another table walked over to a pregnant woman and took the glass out of her hand. It’s probably no coincidence that the rise in the 1970s of fetal imaging technologies, which allow us to imagine the existence of a little curled-up baby living independently against a maternal background, was attended by a heightened public scrutiny of its future birthgiver’s behavior: for the past twenty-five years or thereabouts, pregnant women have been monitored and admonished as never before.

So, as a matter of fact, have nonpregnant women. New federal guidelines issued on May 16 by the Centers for Disease Control and Prevention are merely the latest in a series of campaigns over the last two decades to get any human female who could conceivably conceive to act as though – and be medically treated as though – she were about to start a baby. It makes no difference if you weren’t intending to get pregnant, as about half of pregnancies are unplanned and “during the first few weeks (before 52 days’ gestation) of pregnancy, exposure to alcohol, tobacco and other drugs; lack of essential vitamins (e.g., folic acid); and workplace hazards can adversely affect fetal development,” says the report. That means no more cleaning out the cat’s litter box or working around lead-based paint after the onset of menstruation. It means keeping all vaccinations up to date and taking your vitamins until menopause is well and truly launched. It means keeping your weight down and your diabetes under control, putting out that cigarette, and talking with the doctor about the effect on the little curled-up baby of drugs and alcohol.

The U.S. infant mortality rate is higher than that of almost all other industrialized nations (three times higher than Japan and 2.5 higher than Finland, Iceland, and Norway). Within the United States, babies born to black women die at the rate of 13.5 per 1,000 live births, while infants born to white women die at a rate of 5.7 per 1,000. But the reason for these shameful statistics isn’t that 17 million U.S. women lack health insurance altogether while another 25 million are badly underinsured (statistics that are also contained in the report). And it certainly isn’t that no serious research has been done to date on the disparity between black and white infant mortality. No, the reason is that U.S. women just haven’t been behaving as if they’re permanently pregnant. Which is surely what Japanese, Finnish, Icelandic, and Norwegian women . . . oh, never mind. And if U.S. women don’t do what those little curled-up future babies need them to do, well, they aren’t very good mothers, is all the CDC has to say.

Remember the little boy with the disobedient mother in A. A. Milne’s poem?

James James
Morrison Morrison
Weatherby George Dupree
Took great
Care of his Mother,
Though he was only three.
James James said to his Mother,
“Mother,” he said, said he;
“You must never go down
to the end of the town,
if you don’t go down with me.”
You’ll recall that James James Morrison’s mother put on a golden gown. And then James James Morrison’s mother went to the end of the town. King John put up a notice, “LOST or STOLEN or STRAYED!/ James James Morrison’s mother seems to have been mislaid.” She was last seen wandering vaguely, quite of her own accord, and nothing further has been heard of her from that day to this.

In Milne’s cautionary poem the trouble comes because Mummy simply wouldn’t do what her three-year-old said. But that’s just Milne’s fun. The CDC has gone him one better. Now everybody from Mummy to the eleven-year-old girl who just got her period has to obey, not a three-year-old, but a little curled-up baby that doesn’t even exist.

 

Readers respond

While I agree that there are more serious risks to not-yet-born children from the lack of prenatal care than from maternal behavior during pregnancy, it is surely too strong to say, as Hilde Lindemann does, “that there is no medical evidence whatsoever that one or even two glasses of wine or beer a day does the fetus any harm.” It is more accurate to say, as I did inLife Before Birth: The Moral and Legal Status of Embryos and Fetuses in 1992, “there is no consensus regarding the amount of alcohol intake by the pregnant woman and the likelihood of adverse effects on the fetus.” Some studies found a relationship between alcohol consumption in early gestation and reduction in IQ; others did not. However, precisely because so much is happening developmentally in early gestation, the risks of drinking early in pregnancy are probably greater than later on (when the pregnancy is apparent). This makes refusing to serve visibly pregnant women alcohol rather beside the point.

Recognition that there are risks does not imply that women are morally obligated to avoid any and all risks during pregnancy, much less that the state is entitled to make decisions for women about what risks they may take. That normative issue is quite separate from the medical facts. What I said in Life Before Birth remain the consensus today: “Experts agree that there is no known minimum “safe” level of alcohol consumption. It is possible that any consumption of alcohol produces some risk to the fetus.” It is reasonable to provide women with this information so that they can make an informed decision whether or not to drink during pregnancy.

– Bonnie Steinbock
Department of Philosophy
University at Albany/SUNY

 

I agree with everything you had to say, but to fully advance your argument, I would at least acknowledge what the pro-lifers will say in response to your section on “specific performance” – that a woman can always give the child up for adoption. I would start by pointing out that doing such – the answer that these folks have – is pretty un-motherly… and seemingly counterintuitive to their argument.

– Thomas Lange
Lodi, WI

Published on: May 31, 2006
Published in: Children and Families, Health Care Reform & Policy, Human Reproduction

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