Case Study of California’s Proposition 65 explores some serious questions

Since the widespread media attention given to the UK study on the relationship between light drinking and pregnancy outcomes in October (see my previous posts here and here), I’ve been having some interesting discussions with a number of people about why this study received so much attention. Why does it appear that the public is eager to find support for light drinking during pregnancy? Why do we, as a culture, resist the notion of abstinence from alcohol during pregnancy? Why does the precautionary principle in this particular area of public policy-making not receive widespread support?

One of the arguments that I’ve heard is that women are always making decisions about how to manage risk in their lives and that alcohol is just another risk to weigh in the grand scheme of things. I’ve also heard many women talk about “advice fatigue” and the pressures that pregnant women receive to modify their behaviour in all aspects of their lives.

These themes are taken up by Rebecca Kukla in her article on reproductive risk warnings published in Health, Risk, and Society in August 2010. She says that pregnant women “are encouraged to discipline virtually all dimensions of their bodies and behaviours (what they eat and drink, where they work and recreate, when and how they exercise, and so forth) in accordance with elaborate, ever-proliferating, ever-changing rules of risk minimisation. Pregnant women are in effect asked to imagine themselves as moving up and down various risk curves with each of their various activities and choices.” (p. 324)

Kukla’s article is not a study specifically on alcohol warnings during pregnancy which I think helps to think about the issues from a broader perspective and take a step away from the emotionally-charged terrain of FASD (in fact, most readers of this blog would disagree with her assessment of the actual risks of alcohol during pregnancy). The article takes a look at the implications of California’s Proposition 65 for pregnant women. Proposition 65 requires businesses to notify consumers that they may be exposed to one of over 800 chemicals that are known by the State of California to cause cancer and/or birth defects.

A Proposition 65 warning is a notice that warns the consumer of possible exposure to one of these chemicals. Kukla offers four arguments that demonstrate that these warnings are “ethically troubling” for pregnant women. She raises concerns with the “fetishizing of reproductive risk” and notes that when warnings become ubiquitous, individuals are unable to draw important distinctions between different kinds of risk. She also argues that warning signs provide too little information to enable any kind of rational risk reasoning. She says that “warned” consumers are not “informed” consumers and that decisions made under the threat of possible harm are not truly informed decisions.

Some of the issues that Kukla raises are relevant to those of us involved with FASD prevention. FASD prevention efforts occur within the context of a “risk society” and many issues related to possible reproductive harms have taken on a tone of moral outrage and sometimes emphasize maternal responsibility without enough emphasis on other determinants of possible reproductive harm. A better understanding of how FASD prevention activities connect to broader influences on pregnant women might be a good thing.

Reference:

Kukla, Rebecca. (2010). The ethics and cultural politics of reproductive risk warnings: A case study of California’s Proposition 65. Health, Risk, and Society, 12(4): 323-334.