The ethics and cultural politics of reproductive risk warnings: A case study of California's Proposition 65

Abstract

Public space is filled with reproductive risk warnings, from labels on bottles of alcohol and cigarette packs, to disclaimers on drugs, signs posted in front of amusement park rides, and public health campaigns and advisories aimed at modifying pregnant women's behaviour. California's Proposition 65 requires that businesses post signs warning of the presence of chemicals that cause cancer, birth defects, or other reproductive harm. In this paper I examine the history of Proposition 65, and demonstrate the gap between its intended and actual effects. I explore the practical and symbolic implications of this law for women who are or think they might be pregnant, and argues that the Proposition 65 risk warnings have ethically troubling consequences for pregnant women. The warnings imply that reproductive risks are more important than other health risks, thereby singling out pregnant women as having a unique responsibility to make choices that minimise risk for others. They locate responsibility for foetal risk management in pregnant ‘consumers’, construed as agents who are free to make the correct choices on behalf of their future children, rather than on those responsible for creating safe public spaces. They offer pregnant women a choice between excluding themselves from public spaces and forgoing basic services, or taking on the identity of the reckless mother willing to ‘voluntarily’ impose ‘unnecessary risks’ on her child. And despite being justified via the rhetoric of informed consumer choice, they impede and distort rather than enable rational, informed decision-making.

Keywords:

• parenting
• risk communication
• risk perception
• public health
• uncertainty

Acknowledgements

This research was supported by a grant from the Social Sciences and Humanities Research Council of Canada. Many thanks are due to the other members of the Obstetrics and Gynecology Risk Research Group (Elizabeth Armstrong, Lisa Harris, Miriam Kuppermann, Margaret Little, Anne Drapkin Lyerly, and Lisa Mitchell) for their large role in helping shape my thinking about reproductive risk.

Notes

1. This fact itself deserves, and is starting to receive, close ethical analysis. Regulatory and perceived ethical barriers to running clinical trials involving pregnant women have left an epistemic void that makes informed treatment and decision-making about treatment impossible for pregnant women. For an excellent analysis of this problem see Lyerly et al. 2008.

2. As we often forget, it typically benefits foetuses to develop inside a healthy mother. Asthma drugs, antidepressants, etc. taken during pregnancy are likely to provide benefits to foetuses and not just to their mothers, although we don't have any better evidence about these than about the risks they pose.