The NHS have recently set guidelines in which pregnant women will be asked to take breath tests to prove if they smoke. This family wellness move has been backed by the Royal College of Midwives, but at what cost? We can all agree that the effects of smoking while pregnant can be devastating for the wellbeing of the mother and foetus, and education and quitting services should be readily available to pregnant smokers, but will the introduction of breath tests feed into a culture that fails to respect the autonomy of pregnant bodies?
If we merely test pregnant women to see if they smoke, this is a near-sighted solution to a wider social problem; cycles of addiction tied up in class and family structures. Framing wider social and economic problems in terms of individual choice makes them tidier, simpler, and easier to relinquish responsibility for. A pregnant woman who smokes of her own silly choice may have nothing to do with you, but a cycle of addiction may require your help – and who would want that?
According to Emer O’Toole, a researcher and visiting lecturer at Royal Holloway, University of London, ‘Something strange happens to social perceptions of women’s bodily integrity when they become pregnant. I have a friend who couldn’t believe the licence that people – sometimes even complete strangers – took with touching her when she started to show. She recalls thinking: “Hello! I’m still in here! It’s still weird for you to randomly start rubbing my tummy.”’
Yes, pregnancy does complicate the autonomy of pregnant – but no more and no less so than the autonomy of any parent is complicated by having children. O’Toole points out, ‘We all have the legal rights to smoke our lungs out and drink gin until our oesophagi bleed. These rights don’t disappear during pregnancy, but a moral imperative should take precedence. If you’re smoking and drinking, you’re smoking and drinking for two, and that’s not cool.’
O’Toole calls for a different approach for reducing smoking behaviours in pregnant women. ‘Instead of setting pregnant women tests they won’t pass, tests designed to make them feel guilty, we need to look at the reasons – economic, social and individual – that they started smoking in the first place,’ she says. ‘This involves examining class and family structures and finding ways to change entrenched attitudes to tobacco…It’s a harder task than breathalysing people, but you’re not going to change a society’s smoking habits by heaping shame on the pregnant minority.’
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