Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome & the Diagnosis of Moral Disorder

In American society, the consumption of alcohol during pregnancy is considered dangerous, irresponsible, and in some cases illegal. Pregnant women who have even a single drink routinely face openly voiced reproach. Yet fetal alcohol syndrome (FAS) in infants and children is notoriously difficult to diagnose, and the relationship between alcohol and adverse birth outcomes is riddled with puzzles and paradoxes.

Sociologist Elizabeth M. Armstrong uses fetal alcohol syndrome and the problem of drinking during pregnancy to examine the assumed relationship between somatic and social disorder, the ways in which social problems are individualized, and the intertwining of health and morality that characterizes American society. She traces the evolution of medical knowledge about the effects of alcohol on fetal development, from nineteenth-century debates about drinking and heredity to the modern diagnosis of FAS and its kindred syndromes. She argues that issues of race, class, and gender have influenced medical findings about alcohol and reproduction and that these findings have always reflected broader social and moral preoccupations and, in particular, concerns about women’s roles and place in society, as well as the fitness of future generations. Medical beliefs about drinking during pregnancy have often ignored the poverty, chaos, and insufficiency of some women’s lives--factors that may be more responsible than alcohol for adverse outcomes in babies and children.

Using primary sources and interviews to explore relationships between doctors and patients and women and their unborn children, Armstrong offers a provocative and detailed analysis of how drinking during pregnancy came to be considered a pervasive social problem, despite the uncertainties surrounding the epidemiology and etiology of fetal alcohol syndrome.

Elizabeth M. Armstrong is an assistant professor of sociology and public affairs at Princeton University.