‘I think he is immune to all the smoke I gave him’: how women account for the harm of smoking during pregnancy

Abstract

Despite women’s awareness of the risks of smoking in pregnancy to the developing foetus, a significant minority continue to smoke during pregnancy. In this article, we use a discourse analytic approach to analyse interviews with 12 Australian women who smoked during a recent pregnancy. We used these data to examine how women accounted for their smoking and identities in the light of the implicit but ever-present discourse that smoking in pregnancy harms babies. We found that the women in our study deployed two rhetorical devices in their talk, ‘stacking the facts’ and ‘smoking for health’, allowing them to situate their smoking within a discourse of risk or as a potential benefit to their health. Women ‘stacked the facts’ by citing personal observable evidence (such as birthweight) to draw conclusions about the risks of smoking in pregnancy to the baby. ‘Stacking the facts’ allowed women to show how they had evaded the risks and their babies were healthy. This device also allowed women to deny or cast doubt over the risks of smoking in pregnancy. Women’s accounts of ‘smoking for health’ involved positioning quitting as stressful and, as a result, more harmful than continuing to smoke a reduced amount. We found complex and counter-intuitive ways in which women dealt with the discourse that smoking in pregnancy harms babies and how these ways of accounting served to protect their identities. We argue that health promotion messages conveying the risks of smoking in pregnancy would benefit from contextualising these messages within women’s personal accounts (e.g. by ‘stacking the facts’ or ‘smoking for health’) and hence providing more ‘realistic’ health risk messages.