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Confining Risk
Choice and responsibility in childbirth in a risk society
Alphia Possamai-Inesedy
University of Western Sydney
Abstract
The language of risk in relation to pregnancy practices is available to and invoked by not only women who are contemplating pregnancy, the currently pregnant, and mothers, but also the never to be pregnant.
Beyond the dozens of leaflets and posters which warn about all kinds of hazards that women face during their pregnancy and impending birth, there is a multitude of messages within the media where women are told about the inherent faultiness of their bodies. These women are told about invisible killers lurking in their ignorance. Yet, blame is allocated to those who fail to inform themselves about the risks that they face.
Risk, according to the works of Beck and Giddens, has become a force of social change. It can be seen to actively shape our concept of health, desire for perfection, and our relationship to technology and responsibility.
It is these themes which are noticeably absent from previous research in the area of sociology of childbirth and can capture more adequately the ideological shift which this article examines. It is argued, through the scrutinizing gaze of the public, that the pregnant woman is the least able to escape the consequences of risk society where changed notions of health and responsibility have created a cultural acceptance of medical intervention of childbirth.
Keywords
sociology, risk society, reproduction, medicalisation, responsibility, agency
Article Text
Risk society and childbirth
The world of risk for childbearing women in Western society, and also for the general population, is not as straightforward as previous generations. In theorising these changes, Beck (1996: 28) coined the term 'risk society' to refer to a new stage in the life of individuals residing within developed countries. 'Risk society' argues Beck (1996: 28) 'is not an option which could be chosen or rejected [...]'. Rather, it is an inescapable structural condition of advanced industrialization where the produced risks of that system 'undermine and/or cancel the established safety systems of the provident state's existing risk calculation' (Beck 1996: 31). Beck uses the examples of chemical pollution, genetic engineering and nuclear power to highlight this point. These contemporary risks cannot be limited in time and space, cannot be grasped through the rules of causality, and cannot be safeguarded, compensated or insured against. 'Industrial society, which has involuntarily mutated into risk society through its own systematically produced hazards, balances beyond the insurance limit' (Beck 1996: 28).
Because of this Beck et al (1994) argue that the central problem of Western societies is not the production and distribution of goods but the prevention or minimisation of risks. Individuals are daily bombarded with debates and conflicts which proliferate over these risks. Bauman (1998: 65) illustrates this point well when he states that:
[risk] is now dissolved in the minute, yet innumerable, traps and ambushes of daily life. One tends to hear it knocking now and again, daily, in fatty fast food, in listeria-infected eggs, in cholesterol rich temptations, in sex without condoms, in cigarette smoke, in asthma-inducing carpet mites, in the dirt you see and the germs you do not.
Accordingly individuals in these societies have moved towards a greater awareness of risks, deal with them on an everyday basis, and are far more sensitive to what they define as 'risks', or threats to their health, economic security or emotional wellbeing than they were in previous eras (Lupton 1999b). In such a context, risk has become a force of social change (Beck 1992, 1995, 1997, 2000a, 2000b; Giddens 1990, 1991). It can be seen to actively shape our concept of health, desire for perfection, and our relationship to technology and responsibility. Yet it is noticeably absent from previous sociological research into childbirth, especially that associated with medical intervention during pregnancy and childbirth.
The perception of risks faced by previous generations of childbearing women, as outlined above, entailed a relationship to an unknown future, the likelihood of which could be calculated on the basis of past occurrences. Risk assessment and behaviour of this kind was thus a question of measurement or quantification irrespective of whether it was explicitly or implicitly calculated (Adams 1995). We could say that this world of risk assessment belongs to the realm of rational action and scientific certainty, a realm where there are clear distinctions between danger and safety, falsity and truth. This article will argue that the world of risk for childbearing women, particularly of the Western world, is not of this kind. Rather, their world is full of hazards and risks that are not as clear-cut as was the case for previous generations. The invisibility of many of the risks as well as their insidious nature cannot be encompassed by traditional conceptions of risk.
Specifically for the conceiving or pregnant couple, these multifaceted risks are in a permanent state of virtuality and are actualized through anticipation. It makes no difference whether they are actually or objectively 'safe'; if the risks are anticipated then they call for the couple or the woman to respond. This 'becoming real' aspect of risks within high modernity may placate sentiments of absurdity relating to living in a risk society (Petersen 1997). After all, our world appears so much safer than that of previous times. We have learned to control most contingencies, for example relating to diseases, accidents or violence. As Van Loon (2002) suggests, even natural hazards appear less random than they used to be. Although we cannot stop the hurricane or earthquake we can reasonably predict it and, therefore, make the necessary structural arrangements for managing its impact as well as emergency planning. Further examples can obviously be cited here, however, it is safe to summarise that life in modern Western societies is now safer than ever. While this seems an obvious point to raise it does neglect the argument put forward by Beck. The risks of high modernity are not 'real', they are 'becoming real' (Beck 1992, 2000b; Van Loon 2000).
To adequately describe the 'risk society' environment that not only the expectant woman faces but indeed all of us within Westernised societies experience, we can turn to the creator of the thesis, Beck:
We no longer choose to take risks, we have them thrust upon us. We are living on a ledge - in a random risk society, from which nobody can escape. Our society has become riddled with random risks. Calculating and managing risks which nobody really knows has become one of our main preoccupations. That used to be a specialist job for actuaries, insurers and scientists. Now we all have to engage in it, with whatever rusty tools we can lay our hands on - sometimes the calculator, sometimes the astrology column. The basic question here is: how can we ignore it and possibly get hurt or killed? Or should we be alarmed and stop or exclude all likely causes? Which course of action is 'rational', the first or the second option? (Beck 1998: 12)
Indeed, what expectant mother disregards the possible threats, hazards and risks that are constantly highlighted as a threat not only to herself but to her unborn child? Recent examples include the media coverage on studies such as child cancer being linked to exposure to environmental pollution while in the womb (BBC News 2005) and separate research on the possibility of breast milk being toxic for newborn children because of exposure to various pollutants such as paint thinners, dry-cleaning fluids, wood preservatives, toilet deodorizers, cosmetic additives, gasoline by products, rocket fuel, termite poisons, fungicides and flame retardants (Williams 2005).
The hopes, anxieties, risks and uncertainties expressed by the woman of this research appear to be in stark contrast to our 17th century counterparts. These sentiments did not stem from the lived reality of the respondents but rather their constant speculation and negotiation of the potential risks they felt confronted with on practically an everyday basis. Accordingly, the social construction of pregnancy and childbirth as inherently risky has led many of the respondents to express fear and anxiety in relation to the event. On the one hand, this can be understood as being irrational as statistics reveal low morbidity and mortality rates for both the woman and her child. On the other, these responses are eminently rational given the risk discourse of both medicine as a social institution and broader society in general. The fears and anxieties expressed by all of the respondents of this study are only explicable and rational within this context.
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