Reproducing Pregnancy: Risk and Responsibility in Research During Pregnancy

Abstract

This dissertation explores the bioethical construction of pregnancy as site of risk and argues that pregnancy is best characterised as sitting in a constant state of tension, as simultaneously healthy-normal-natural and risky. This tension and how it is acknowledged or ignored is a significant factor in many ethical issues centered upon pregnancy. Using a genealogical analysis, this study identifies features of the social discourse around pregnancy that impede clinical research during pregnancy despite both policy changes and educational campaigns emphasising the benefits and importance of such research. The first major finding of the project is the identification of stigma about pregnancy and pharmaceuticals arising out of the mid twentieth century pharmaceutical scandals. This stigma continues to distort the perception of risk during pregnancy, such that the risk of inaction during pregnancy is significantly undervalued and the risk of actions—particularly pharmaceutical interventions—is overestimated. This is related to both the exclusion of pregnant women from pharmaceutical research, and an accompanying tendency towards medical over-intervention in childbirth. The second major finding is how narratives of health and risk construct pregnancy as women’s initiation into ‘responsible motherhood’ and the corresponding surveillance, pressures and expectations that align with the narrative. Pregnant women’s desire to act in their child’s best interest and the knowledge that not only acting or choosing ‘wrong’ may harm their child, make women less inclined to both take risks and/or act outside of conventional norm. This thesis recommends that successful, stakeholder education needs to widen to include a broader range of issues including the effect of stigma upon risk perception, the broader bias towards inaction, and the normative strength of social narratives of good mothering and maternal responsibility.