The Starting Gate: Birth Weight and Life Chances, and: Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder (review)

Fetal Alcohol Syndrome (FAS) and low birth weight (LBW) are two health outcomes typically diagnosed at the outset of life and are intricately linked to maternal health, socioeconomic status and race. Not all babies are at equal risk of being born LBW and not all mothers are at equal risk of bearing children with FAS. The two books reviewed here, Conceiving Risk and The Starting Gate, examine FAS and LBW respectively, in an effort to disentangle the complex relationship between social and biological influences on health outcomes and life chances. The authors of these works utilize different theoretical and research frameworks in order to investigate the causes and consequences of their chosen health outcome. I will provide a brief overview of each work and conclude with a summary of the findings and implications.

The Starting Gate

About 7 percent of children born in the United States are labeled LBW at birth; these babies are more likely to be African American and poor. LBW babies, defined as any child weighing less than five and a half pounds at birth, are at an increased risk of infant mortality. Those who do survive are more likely to face a host of negative outcomes including poor health and chronic illness as well as physical, mental, and intellectual disabilities. Behavioral disorders, lower IQ scores, lower educational attainment, and chronic illness tend to persist into adulthood.

Conley, Strully, and Bennett use data from both the Panel Study of Income Dynamics (PSID) and the 1995–97 Matched Multiple Birth Data Set to investigate the biosocial interaction between economic resources and inherited risk. The data confirm a hereditary link between LBW parents and LBW offspring. However, there is a strong indication that higher family income may all but eradicate the hereditary consequences of LBW by providing additional resources pre- and postnatally. Resources may include better prenatal care, better nutrition, less exposure to a potentially harmful environment, and access to superior educational resources. The authors conclude that children predisposed to LBW are faced with either a "double advantage" or a "double disadvantage" dependent on the socio-economic state of the family into which they are born.

Conley, Strully, and Bennett follow their statement of findings by proposing public policy advocating for the label of LBW to be taken into account when families seek state or federal aid. They suggest that throughout their educational careers, children who are born LBW should have this status noted by their teachers. They write, "Attention to birth weight status may help parents, teachers and physicians recognize and refine treatments of disability and developmental delay" but do not explicate how such a policy would be effectively implemented.

Conceiving Risk, Bearing Responsibility

The slogan of the National Organization on Fetal Alcohol Syndrome (NOFAS) embodies, to a large extent, the attitudes commonly held in our society about the interaction between alcohol and pregnancy. "No safe time. No safe amount. No safe alcohol. Period." These beliefs are, Armstrong argues, social constructions that ignore the facts. In truth, FAS occurs in the children of only a small minority (5%) of women who are heavy drinkers — those who drink upwards of 14 drinks per week during pregnancy — and is highly correlated to race, smoking, advanced maternal age, malnutrition, and poverty. In the vein of Freidson and Zola, Armstrong asserts that medical authority has edged beyond its bounds of scientific expertise and applied diagnostic criteria to capture a socially deviant behavior — drinking alcohol during pregnancy.

Armstrong provides an historical overview of attitudes toward alcohol use and pregnancy as well as qualitative data highlighting the lack of cohesion...