A story of stigma: Australian women’s accounts of smoking during pregnancy

Abstract

A substantial minority of Western women smoke during pregnancy. Understanding smoking from these women’s point of view may provide a richer understanding of experiences that are very often silenced, and provide some explanation for why pregnant women smoke despite widely disseminated public health campaigns urging them to stop. Strong social pressures directed at women to stop, justified mainly by arguments of protecting the foetus, are reinforced through the policing of women’s bodies, which is particularly powerful during pregnancy. This emerges in the form of criticism, confrontation and judgement, irrespective of individual women’s contexts and social backgrounds. Interviews with 11 Australian women who had smoked during recent pregnancies were conducted to explore their smoking-related experience of stigma. Thematic analysis examined their perceptions of stigma and surveillance, in the strong anti-smoking climate of Australia. Women’s talk constructed medical and social pressures as two separate dimensions of stigma, which they accepted or resisted, or – at times – did both. They also used discursive strategies to negotiate their position as ‘good mothers’ despite stigma, and spoke about the need to manage the contexts in which they smoked. The women’s talk suggests that directive, critical public health campaigns, and the associated social stigma, may actually make it harder for some to stop smoking. More supportive approaches that move away from a focus on individual responsibility, and from the assumption that pregnant women need to be coerced into healthy decision-making, might better assist some pregnant smokers to seek cessation support.

Keywords:

• smoking
• pregnancy
• stigma
• Australia
• tobacco control
• qualitative

Acknowledgements

Thank you to Ms Alexandra Gibson, who helped as an independent coder in the initial phases of the analysis and provided continued guidance in the analysis. Also, thank you to our two reviewers and the Associate Editor for their useful input during the review process. Finally, we would like to thank and acknowledge the women who shared their experiences with us.