How Well-Intentioned Public Health Campaigns Can Wind Up Shaming Women

handmaid's tale

In sci-fi classic The Handmaid’s Tale, women’s bodies are controlled and seriously policied by society. 

We can all agree that fetal alcohol syndrome is a tragedy. But although American public awareness campaigns about the dangers of drinking while pregnant have good intentions at heart, recent media initiatives have deployed tactics that shame moms while ignoring bigger issues. Instead of helping improve the lives of women and kids, these public action campaigns veer into borderline Handmaid’s Tale territory.

Because addressing each and every fetal alcohol syndrome awareness organization state by state would be a book-length endeavor, for the purposes of this article I’m going to focus on a nationwide group, the National Organization on Fetal Alcohol Syndrome, and the organization in my own state, the Minnesota Organization on Fetal Alcohol Syndrome.

For a good example of these campaigns’ paternalistic rhetoric, there is this post from the Minnesota Organization on Fetal Alcohol Syndrome. which repeatedly refers to “women of child-bearing age,” be they “pregnant or not-yet-pregnant.” Being not and never-will-be is not an option, apparently. The organization advises healthcare providers to ask “all women of childbearing age… every woman, every time” about their drinking habits. This is the type of attitude that leads to the sorry scenario in which a non-pregnant patient goes to the doctor for an issue concerning her own health and ends up getting grilled about her lifestyle over the prospective well-being of a hypothetical fetus, regardless of how likely or willing she would be to conceive one and carry it to term. (It has happened to me, and I wouldn’t be surprised if it has happened to you, too.)

In 2011, Minnesota Organization on Fetal Alcohol Syndrome staged an educational stunt at the Minnesota State Fair, where they had an employee pose as a pregnant woman and drink beer at the State Fair. In case you were wondering, no, nobody stopped to publicly scold the grown-up woman about her beer. Where I see that as a respect for a pregnant woman’s choices and agency, the organization saw the lack of outrage as a major problem.

a still from a fox and friends segment

Of course, it’s an entirely laudable goal to aim to create a world in which no one is born with fetal alcohol syndrome, but I find that awareness campaigns often put the sole blame for the problem on the shoulders of pregnant women—making the issue one of personal morality, stripping out any political context. Not only do these public awareness efforts often fail to discuss reproductive rights, they largely don’t consider systemic issues at all, even though factors such as poverty, race, and mental illness have a tangible effect on a baby’s chances of being born with fetal alcohol syndrome. They also frequently imply that even non-pregnant women should make choices around a potential future fetus. The resulting public awareness campaigns are not only obnoxious, they’re ineffective.

Fetal alcohol syndrome prevention organizations do some good work, like running support groups for parents and children dealing with the disorder. However, these groups also expend a lot of money and energy on awareness-related advertising campaigns and outreach. For example, the National Organization on Fetal Alcohol Syndrome dedicates 28 percent of its budget to public awareness, media, and video, in addition to a lot of space on their site and various social media outlets. Similarly, the Minnesota Organization on Fetal Alcohol Syndrome dedicates a great deal of its website and almost a quarter of its budget to public awareness.

Browsing the social media pages of either of these organizations, you’ll find the recurring motif of the disembodied pregnant torso—incidentally, one that is also beloved by the anti-choice movement. While these images may not have been crafted with the intent of tapping into the woman-as-vessel idea, they tend to come off that way. The idea that pregnant women’s bodies belong to the community is well documented, even outside of the realm of reproductive rights.

The National Organization on Fetal Alcohol Syndrome’s website has a lot of content that implies that all women should be hesitant about drinking. Throughout their many factsheets, the statistic that “half of all pregnancies are unplanned” is frequently paired with the familiar phrase “women of childbearing age.” Although the group doesn’t come right out and say it, this repeated juxtaposition gives the reader the impression that women-of-a-certain-you-know-what shouldn’t drink at all. The factsheets, awareness materials, and social media of these organizations are also full of statistics whose relationship to FAS is tenuous, at best—nuggets of wisdom such as “60 percent of women over pour or overestimate the size of a drink” and  “52 percent of women of childbearing age consume alcohol.”

a psa says that 52 percent of "women of childbearing age" consume alcohol

FAS ad

It’s absurd to encourage women to make choices around a surprise baby regardless of their lifestyle, sexual proclivities, contraceptive use, or desire to conceive. It’s indicative of an enduring double standard: the concept that a man should do something similar is remote—that men shouldn’t drink because it impairs their ability to put on a condom correctly, for example. In a similar vein, when perusing the websites and awareness materials of these organizations, one finds nary a reference to contraceptives, reproductive rights, or healthy sexuality. In spite of the fact that the CDC explicitly promotes contraceptives as a means of preventing fetal alcohol syndrome , the only mention I found during an exhaustive search of the NOFAS and MOFAS sites was a single sentence at the bottom of a factsheet. The assumption that women are slaves to their uteri becomes more antiquated with every passing year, so why this silence on issues of reproductive rights? Surely if every baby were planned, it would dramatically decrease the incidence of the syndrome.

In addition, in these factsheets and awareness literature, there is also surprisingly little discussion of issues such as poverty and access to health care. This is not only disappointing in terms of a lack of analysis, examining confirmed cases of fetal alcohol syndrome  reveals that it’s also counterproductive. According to a study published in the medical journal Neurotoxicity and Teratology:

Mothers of children with fetal alcohol syndrome were significantly more likely to be older, American Indians/Alaska Natives, Black, not Hispanic, unmarried, unemployed, and without prenatal care, to smoke during pregnancy, to have a lower educational level, and to have more live born children … they were also significantly more likely to be on public assistance, to be on Medicaid at their child’s birth, to have received treatment for alcohol abuse, to have confirmed alcoholism, to have used marijuana or cocaine during pregnancy, to have their baby screen positive for alcohol or drugs at birth, to have had an induced abortion, to have had a history of mental illness, to have been involved in binge drinking during pregnancy, and to have drunk heavily (7 days/week) during pregnancy.

There is clearly a link between poverty, race, mental illness, and fetal alcohol syndrome. Therefore, instead of implying that the issue could be easily fixed if women would just avoid alcohol regardless of quantity or pregnancy, it would be more effective to integrate broader social advocacy into awareness literature. The fact that white women are more likely to drink while pregnant but minority women are more likely to have kids with fetal alcohol syndrome shows that this is NOT just a matter of habits or chance—outside circumstances determined by these systemic factors have a tangible influence. If fetal alcohol syndrome is as serious an issue as these organizations suggest, making blanket injunctions about the personal consumption habits of all women, regardless of amount, risk, or pregnancy is a waste of time. 

Moreover, if this is such an enduring, urgent issue, the idea that so many women Just! Didn’t! Know! is both improbable and condescending. When perusing fetal alcohol syndrome awareness material, one catches the distinct whiff of a musty scent. It’s eau de lady-blame: the rhetoric of protecting babies from pregnant women. The Reiterative Statistics of Doom and information sans broader analysis or discussion gives the reader the impression that maybe women are just too stupid to realize that booze is bad for their fetuses. Perhaps they just can’t read the labels that have been on their beer since 1988.

The fetal alcohol syndrome movement shares a lot of ground with other groups that focus on “awareness” in that it takes a political issue and frames it an individual failure. If FAS is indeed such a perennial problem, maybe its non-improvement is due in part to the tactics that are used to combat it. In order to effectively address the problem, we need to move aware from the “awareness model” and address issues like reproductive rights and access to healthcare, instead of depoliticizing the issue and putting the onus of responsibility solely on individuals. The decision to be sober is life-affirming, but it needs to be a positive choice that a person makes for herself, not a sacrifice on behalf of a prospective surprise fetus. The idea that women should arrange their lives around their reproductive capacity enables the type of climate in which lawmakers try to incarcerate pregnant women that use drugs. A world in which women have full reproductive control and unfettered sovereignty over their bodies will do far more for babies (and women!) than slogans and awareness.

Related Reading: The History of Temperance and Suffrage. 

Kelsey Irving Beson (@kirvingbeson) holds a Master of Library and Information Science and a BA in English. Among many other things, she is interested in intersections between feminist issues and sobriety. 

by Kelsey Irving Beson
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4 Comments Have Been Posted

Great article. I worked for

Great article. I worked for some time at a women's health nonprofit that helped women who wanted to quit smoking and drinking alcohol during pregnancy. We definitely used some of the phrases like "women of child-bearing age" and "50% of pregnancies are unplanned" in our literature to raise awareness around drinking/smoking, which did make me feel icky at the time.

It gets complicated, though, when looking at this stuff through "life course approach" and you start to get knee-deep in the medical studies that have shown that even if you smoked before you were pregnant and quit, it can still have detrimental effects on the fetus. And that if you were binge drinking in the first month and half before you even knew you were pregnant, this can be damaging to the fetus, and up the possibility of a premature birth. I think this is why those organizations phrase the outreach campaigns like they do. It can be scary to find out you are pregnant, decide to keep the baby, and realize you might have done some harm unknowingly to the fetus.

I agree that the answer is not shaming or paternalizing women who drink/smoke for the sake of their possible future babies. We women just don't see ourselves as vessels for fetuses--we think we're people, which is why this type of campaign doesn't work and doesn't appeal to us in any way. The answer is better reproductive health care (like you say), so that the 50% of unplanned pregnancy statistic drops. The answer is also about better general healthcare and opportunities for self-care for women, especially women in poverty.

Oh, here's another tidbit: there have been studies that have found that when men smoke cigarettes, it can genetically alter the DNA in their sperm, which can pass genetic damage onto their possible future children. What! Scientists suggested that men who are planning to conceive think about quitting smoking well ahead of time. Have you ever seen a public service announcement "educating" men about how their actions can affect their future babies? Umm, no. Just saying.

Thanks for this article!

Thanks for this article.

Thanks for this article. Perhaps this is a slightly different issue, but over the last few years, I have become increasingly irate at the way pregnant women are portrayed by alcohol and healthcare companies. I am British and, increasingly, wine bottles from [predominantly] US vineyards are carrying the symbol of a pregnant woman drinking inside a red circle with a line through it. The message to me reads, visually, that pregnant women are bad, a huge no-no, and is both simplistic and offensive. I now live in Canada, where most bars and pubs are now displaying a woman's headless torso with the standard message about birth defects. Holding on to the headless torso from behind are a pair of visibly male hands which, to me, is a reminder of the woman-as-vessel idea, controlled by the man's hands i.e. you are carrying this baby for someone else, so don't drink. However, reading articles such as this one has ignited my gut suspicion that these campaigns, while well-intended, work on the basis that pregnant women are not equipped to make choices over their bodies. My understanding based on the above article and some (admittedly outdated) anecdotal information on drinking while pregnant in other less puritanical cultures is that drinking small amounts is not a problem. I asked a doctor friend about this, and she said that the alcohol is harder to process while pregnant, so it's better not to do so. However, I would be keen to hear others' opinions on this (esp the commenter above) as my friend was trained in the British system and follows government recommendations. Obviously I am not recommending drinking if it truly is dangerous. However, I do question whether this is the case. It is something which is rarely discussed, as the person raising the topic has to undergo the ignominy of being branded too selfish to err on the side of caution, regardless of how factual that side may be. The problem also then becomes that alcohol manufacturers reproduce these symbols in their enthusiasm to please governments, and as the public mood changes accordingly women are shamed by other citizens who are following the advice. A new book called "Expecting Better" examines some of this advice in detail, however it is written by an economist rather than a medical professional. I'm linking to the review (by the same author as above) Thanks!

Sorry! I double-posted by

Sorry! I double-posted by accident

Really Interesting

Thanks for writing this article! You gave a really interesting commentary on an issue that I'd previously never been exposed to or given much thought towards. I look forward to reading any future work you might produce!

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