Table 2 Competing discourses in in defining problematic substance use during pregnancy and early parenting
Parallel/competing discourses | |
|---|---|
Abstinence (as the ideal) | Autonomy (of individuals to make different choices based on their knowledge and experiences) |
Characteristics | |
● ‘Obvious’ | ● Complex |
● Normative | ● Nuanced |
● Deontological/absolutist | ● Pluralistic |
Informed/reinforced by… | |
● Moral conviction | ● Relative and contextualized harms |
● Traumatic/negative personal experience | ● Personal and anecdotal experience |
● Ministry policies/legal structures | ● Ambiguity of evidence |
Sub-themes | |
Internalizing a moralized motherhood | A broader view of what influences health |
● Delimits the ‘bad mother’ and the ‘good mother’ by substance use and child removal | ● ‘Problematic’ determined according to substance type and frequency of use |
● Neoliberal view of choice over life circumstances (choice for both substance use and pregnancy) | ● Harms mediated by social determinants of health associated with substance use and dependency |
● Harm reduction as morally inadequate | ● More holistic view of health: personal care, agency, and emotional health |
● Mother and infant health as inseparable | |
● Disruption of family as problematic | |
Results in… | |
● Irreconcilable shame and guilt | ● Richer discussion of what influences health and child development |
● Stigmatization | ● Contestation of judgment and stigmatization |