Productive but not constructive: The work of shame in the affective governance of fat Pregnancy

Abstract

The productivity of shame as an affective-discursive practice implicated in the neoliberal governance of “healthy pregnancy” is examined in the narratives of 27 ethnically diverse, cis-gendered, self-identified fat pregnant people in Aotearoa New Zealand. Shame is identified as a dominant affective-discursive practice produced in response to the problematising medical discourses surrounding the fat pregnant body, leading to the constitution of shamed maternal subjectivities. Seeking reparation in order to restore their maternal identities, participants adopted a range of self-governance strategies. However, fat shaming, while productive in constituting self-governed maternal subjects, was not constructive. We demonstrate how shame induced self-governed action, rather than improving maternal and infant health, instead led to a range of unhealthful behaviours and negatively impacted how participants experienced their pregnancies, emerging maternal selves, and newly born children. We call for attention to affect in feminist governmentality studies of reproduction and fatness.

Keywords

shame pregnancy fatness biopolitics self-governance maternal health affective-discursive practice

[a]ffectivity is not a counter force to the discursive. Rather, affectivity is one of the precise mechanical parts that … makes governmentality work. (Bjerg & Staunæs, 2011, p. 140)

Recent developments in governmentality studies point to the role of affective intensities – disgust, fear, anticipation, shame – as key strategies through which the neoliberal subject becomes engaged in the task of its own self-governance (e.g. Anderson, 2012; Bjerg & Staunæs, 2011; Isin, 2004; Leahy, 2014). Drawing on empirical qualitative research undertaken in Auckland, New Zealand, this paper interrogates the role of shame in the biopolitics of pregnancy fatness. We identify the ways in which shame is mobilised in the contemporary neoliberal governance of “healthy pregnancy”. In particular we demonstrate how fat shaming is embedded in the discourses and practices of contemporary pregnancy-related health care, and its role in constituting a responsibilised and (de)moralised fat maternal subject tasked with reparating the health of her child and salvaging her maternal identity from the “shame” of her fat body. While productive in engaging fat pregnant people in the self-governing practices of “healthy pregnancy”, we ask whether shame is constructive. In other words, is the maternal subject able to be shamed into health? We find quite the contrary to be true. Shame and maternal health emerge as antithetical in our study. We demonstrate the role of shame in constructing oppressive maternal subjectivities that embed our participants in a vicious cycle of struggle and negative affect, consolidating rather than transforming a failed fat maternal identity. The resulting real harms for mothers and their babies leads us to question current approaches to pregnancy fatness in maternal health care that elevate weight as a health issue. We conclude by calling for more compassionate and just approaches to maternal health promotion. We also argue for attention to the work of affect in feminist governmentality studies that focus on fatness, reproduction, and mothering.

The biopolitics of fat pregnancy

The fat maternal body has recently emerged as the new frontline of the “war on obesity” (Evans, 2010). As obesity science has sought the origins and causes of the so-called “epidemic of obesity” in Western nations, the womb has increasingly taken centre stage. Fatness before and during pregnancy, termed “maternal obesity”, has been associated with a wide range of adverse reproductive outcomes, from infertility to growing caesarean rates, stillbirth, and congenital abnormalities (e.g. Poston et al., 2016). Further, through the technological advances of epigenetics, maternal fatness and diet has been claimed to have an in-utero influence, programming the foetus for future obesity and other related chronic lifestyle conditions (e.g. Low, Gluckman, & Hanson, 2015). In other words, fat maternal bodies have been problematised, not simply as a particular manifestation of the obesity epidemic, but – more so – its cause.

The maternal turn in obesity science has placed pregnant people,¹ and new mothers and their babies, at the epicentre of obesity prevention strategies leading to troubling new opportunities for the vilification and governance of gendered (and raced and classed) fat bodies (e.g. Parker, 2014). Sensationalist news media stories have declared maternal fatness a “scary problem” that will harm the future health of children and will “cost the health system a fortune” (APNZ, 2012). Public health policy-makers have responded with a raft of measures intended to regulate risky fat pregnant people's bodies and behaviour, while public health education campaigns aimed at addressing obesity at a population level have homed in on the new priority area of pregnant people, new mothers, and young children (Ministry of Health, 2014; Office of the Controller and Auditor General, 2013). Both media framing and public health policy responses have located the causes of, and solutions to, the problem of fat pregnancy in individual behaviour and choices. Pregnant people have been implored to implement the necessary lifestyle changes needed to regulate their weight for the sake of their babies. As Browne (2011) reported in The Sydney Morning Herald:

A woman's weight does not have to be a life sentence for her baby … The message has to be that they have to be close to a healthy weight when they go into pregnancy, they have to control their diets when they are pregnant, then they need to be encouraged and supported with breastfeeding once their baby is born.

With its causes and solutions grounded firmly in individual responsibility and self-management, governmentality scholars have critiqued “maternal obesity” as a biopolitical project in service to neoliberalism (e.g. McPhail, Bombak, Ward, & Allison, 2016; Parker, 2014; Parker & Pausé, 2018b; Warin, Zivkovic, Moore, & Davies, 2012). Biopolitics describes the ways in which rule in the contemporary neoliberal state is rationalised and rendered effective through the production of professional knowledges and practices about risky or problem bodies, leading to strategies for intervention in the population that emphasise individual responsibility and independence (Rabinow & Rose, 2006). Within biopolitics, individuals are responsibilised for the management of social or health risks such that they engage in ‘technologies of the self’ – the practices and behaviours of subjects tasked with their own self-management and transformation (Foucault, 1988; Harjunen, 2016; Murray, 2012). The health and wellbeing of children, representing future potentiality, has been described as a special project of biopolitics under neoliberalism (Evans, 2010; Lupton, 2012). Feminist analyses have demonstrated how mothers carry the burden of responsibility for child health and wellbeing in neoliberal states and are blamed for a failure of care in the face of child ill-health or harm (e.g. Boero, 2009; Harrison, 2012; Salmon, 2011). Maternal responsibilisation has been progressively extended to pregnancy in recent decades, aided by technological developments in reproductive visualising technologies that have collapsed the distinction between foetus and child (e.g. Lupton, 2012; Ruddick, 2007; Wigginton & Lafrance, 2016). As a result, pregnant people have been positioned as prime targets for neoliberal governmental strategies directed at the care of the “valuable potential child” and a self-managing citizenry, termed pre-emptive biopolitics (Lupton, 2012, p. 8). Under these strategies of pre-emption the pregnant person is implored to assume sole responsibility for the potentiality of her foetus (or even embryo and ovum) as both beloved child and healthy future citizen, subverting her own needs and desires, and engaging in a rigorous regime of self-surveillance and management to achieve a “healthy pregnancy” regardless of her social or material circumstances.

Governmentality, as a critical tool, is used to excavate the “technologies of the self” that draw us into the task of our own self-governance (Bacchi, 2012, p. 4). The central figure of much governmentality scholarship is the risk calculating and reflexive neoliberal citizen who assesses information and develops her own personal strategy for self-management to minimise her exposure to harm (O'Malley in Isin, 2004, p. 221). However, this account of the subject does not attend to the role of affect in energising governmental strategies, particularly in relation to mothering and maternal identity (Isin, 2004). Turning attention to affect, we can see how governmental strategies aimed at pregnant people and new mothers are awash in attempts to make maternal subjects feel deficient and at risk, and the use of these bad feelings to drive an intensity of engagement with governmental “technologies of self”. As a result, the drive for pre-emptive action by the governed pregnant subject is grounded not so much in “scientific facts” but in “affective facts”, making potential futures felt in the present (Massumi, 2007). Indeed, the problematising discourses and practices associated with maternal obesity are awash in affect. Considering the breadth of literature that has pointed to the central role of shame in public health campaigns and health-care discourses targeted at the fat body, we ask what role shame might play in the affectively driven biopolitics of fat pregnancy.

Constructing shamed subjectivities

Shame has been shown to be a powerful affective force in the constitution of the governed neoliberal subject (Bryant & Garnham, 2015). Shame emerges in situations or moments in which the self is made visible to others in acutely embarrassing or humiliating ways such that the shamed person feels negatively evaluated (by self or other) (Fullagar, 2003, p. 297). Shame is therefore an inherently social, cultural, and political phenomenon (Bryant & Garnham, 2015, p. 72). Munt (2008, p. 2) argues that sites of shame, such as the abject body, are “only brought into being because of the cultural, because of what dominant ideas of health and physical wellbeing dictate, through the idealisation of norms”. Shame performs politically through normative ideals to mark out, or stigmatise, certain groups (Munt, 2008). The shaming moment occurs from the feeling of being negatively evaluated (by self or other) because one has failed to meet social standards and norms regarding what is good, right, appropriate, or desirable (Wong & Tsai, 2007).

Shame is a potent accompaniment to expert problematising and risk discourses in governmental strategies seeking to engage the subject in “technologies of the self” (Murray, 2012). “Problem individuals” who fail to achieve the standards of good and proper citizenship “internalise the stigma of shame”, producing “shamed subjectivities” as outcast others who must struggle for reparation (Munt, 2008, p. 3). In other words, shame brings the “failing subject” to a felt awareness of her deficiencies, inciting the subject to corrective action so that she may return to the collective. This is not to assume, however, that the governed subject is cognisant of her subjectification through shame. Bryant and Garnham (2015, p. 72) note that in Western cultures,² “shame often lacks a discursive framework through which to be rendered intelligible”. Rather, shame is “sticky” and may attach to other more easily intelligible affects, such as mortification, fear, guilt, or disgust, or go “unrecognisable by the subject to be merely experienced as a diffuse unyielding sadness” (Munt, 2008, p. 3). However, while shame is ascribed a largely negative valence in Western cultural contexts, Tomkins (in Bjerg & Staunæs, 2011, p. 145) suggests that for shame to take hold, and to powerfully constitute shamed subjectivities, the more positively valenced affects of investment, interest, and attachment must also be present. The relationship between shame and attachment/interest constitutes a paradox for the subject because to disengage from its shame the subject must also disengage from the object or relation in which she has invested herself (Berg & Staunæs, 2011, p. 146). The impossibility of this task for the pregnant subject, whose investment lies in her child-to-be and forms the very basis of her emergent identity as mother, has led to the articulation of shame as particularly salient during the development of maternal identity (Thomson, Ebisch-Burton, & Flacking, 2015).

The concept of fat shame has been well established by Fat Studies scholars who have explored the role of shame in the identity, embodiment, and agency of fat people (e.g. Farrell, 2011). Fat shame is understood to be a result of internalised fat stigma, the negative stereotypes and discrimination that fat people experience in their everyday lives. The way fat individuals experience fat shame is heavily influenced by many factors, including class, ethnicity, and gender. For fat women, fat stigma is constructed at the intersection of patriarchy, neoliberalism, and biopolitics (Harjunen, 2016). For the purposes of this piece, we have focused on the role of fat shame in the spheres of public health and health-care providers. Shame has been used in public health campaigns against fatness for decades (Vartanian & Smyth, 2013; Wimalawansa, 2014). Positioning fat bodies as bodies that are both disgusting and harmful to others/society, public health campaigns rely on the shame these localities engender to prompt behavioural change (believed to address the cause of fatness) in fat individuals (believed to be the solution to fatness). There is no evidence to suggest that shame produces either weight loss or improved health in fat people; in fact, there is strong evidence that shame is harmful to the health of fat people (Salas, 2015). Nevertheless, public health continues to employ it as a tool in their “war on obesity”, increasing fat stigma and, in turn, further harming the health of fat people (Pausé, 2017; Puhl & Heuer, 2010). Nowhere is this better illustrated than in the experience of fat pregnant people.

The study

This paper describes our identification of fat shame as a dominant feature of the affective landscape fat pregnant people and new mothers navigate during their pregnancy-related health care.³ We describe the utility of shame in constructing a problematic subjectivity for maternal subjects driving pre-emptive action as self-governing citizens. However, describing the effects of self-governed action that is energised by shame, we question whether such action can fulfil the promise of improved health outcomes for mothers and their babies. In other words, we ask: can mothers-to-be be shamed into health?

Ethical approval for this study was obtained from the University of Auckland's Human Participants Research Committee (reference #9168). In-depth semi-structured interviews were undertaken with 27 ethnically diverse, self-identified fat pregnant people and new mothers in Auckland, New Zealand. Participants were recruited through maternity clinics, social media networks, and stories in local newspapers. Rejecting biomedical classifications of fat and reproductive bodies, participants were invited to self-identify as fat and to be at any point on their reproductive journey, from trying to conceive, currently pregnant, or within three years post-partum. Participants' written informed consent was obtained and they were asked to complete a brief demographic questionnaire that included ethnicity, occupation, number of children and type of births. The study included five Māori indigenous New Zealanders, five Pacific Island New Zealanders, eleven European New Zealanders, four other Europeans, and two Asian New Zealand participants. Because participants were asked to talk about their experiences of fertility and/or maternity care in relation to being large or fat, it is likely that there was some self-selection as participants needed to have already identified weight as a dynamic in the care they received and hold a desire to talk about it.

Interviews were conducted by the first author (New Zealand European), who herself was visibly pregnant at the time and has the lived, embodied experience of fatness, which together added an insider aspect to the research. Interviews were structured around an interview guide but were conversational in style, most participants requiring little prompting to narrate their experiences. Participants were not directed to explore shame or other specific affective responses resulting from their experiences but rather were asked to talk more generally about their fertility and/or maternity care experiences as large or fat women, how those experiences made them feel, and how this shaped their practices, choices, preparations, and self-perceptions as expectant parents. Interviews were transcribed, names were replaced with pseudonyms, and other identifying details were removed. Prepared transcripts were analysed using affective-discursive practice, an analytical approach that attends to the enmeshment of discourse and affect in accounts produced by the meaning-making subject (Wetherell, McCreanor, McConville, Barnes, & Le Grice, 2015). Affective-discursive practice is concerned with identifying the patterned, regular, and ordered “entanglements” of affect and discourse evident in participant accounts, those dominant discursive and emotional routines that are “established, immediately familiar and orthodox procedures for emoting and making sense” in a particular context (Wetherell et al., 2015, p. 59). Affective-discursive analysts also ask what affective-discursive subject positions are constructed in relation to dominant affective-discursive practices and how these are taken up and negotiated as beings and doings in the process of subjectification (Whetherell, McCreanor, McConville, Barnes, & Le Grice, 2015, p. 62). Whilst the goal is to identify the presence of dominant affective-discursive practices and subject positions in research data, accounts produced by research participants are also acknowledged as never singular and total. Affective-discursive analysts are therefore also alert to resistances and multiple versions and variations in the subject's negotiation of the affective-discursive (Wetherell et al., 2015, p. 60).

Analysis of our participants' meaning-making identified shame as a dominant affective-discursive practice produced in response to the problematising medical discourses and practices surrounding the fat pregnant body. This is not because shame was always explicitly referenced by our participants to describe their affective experience. As Bryant and Garnham (2015, p. 72) have observed, shame often lacks a discursive framework for its articulation, particularly in a Western cultural context. This was true for our participants, who were more likely to articulate feelings of anxious worry for their babies, guilt, and poor self-regard. Rather, we base our identification of shame as a dominant affective-discursive practice in our participants' accounts on theoretical understandings of shame as the predominant affect produced when the subject is negatively evaluated in relation to social standards and norms of acceptability (Fullagar, 2003; Wong & Tsai, 2007). Extensive research has demonstrated how body norms are policed in health-care encounters through the negative evaluation of the fat body as pathological and burdensome, leading to shamed responses in fat patients (e.g. Farrell, 2011). We therefore take it as given that shamed responses are an “established, immediately familiar and orthodox procedure” for emoting and making sense when patients' fat bodies are persistently negatively evaluated (fat shamed) during health care, as was the case for our participants (Wetherell et al., 2015). Below we trace how shame operates as a dominant affective-discursive routine produced in response to fat shaming in fertility and maternity care, describing the affective-discursive maternal subject position constructed in relation to it, and how shame is taken up and negotiated in ways that contribute to the affective governance of “healthy pregnancy”.

Primed for shame

As Tomkins (in Berg & Staunæs, 2011) has argued, shame's power to take hold in constituting the subject is reliant on the investment, interest, and attachment of the person being shamed. This was certainly true for our participants, who described the care and preparation they had undertaken for their mostly planned pregnancies and their happiness, excitement, and anticipation when approaching pregnancy-related health-care services for the first time. As Stacey describes, “It was my first pregnancy and I was really excited about it, it was a planned thing and I couldn't wait to meet the midwife”. Feminist scholars have demonstrated how the splitting of pregnant embodiment from that of the foetus in the contemporary Western treatment of reproduction has led to the foetus being centred as the main subject of pregnancy (e.g. Lupton, 2012). In this dichotomous treatment of pregnancy, the pregnant person becomes responsibilised for the care and protection of the foetus within whilst her own material circumstances are disappeared (e.g. Lutpon, 2012). Our participants demonstrated their responsibilisation as mothers-to-be, describing the efforts they were undertaking to prepare their bodies for pregnancy. These actions included healthful eating, exercise, nutrient supplementation, and a range of other behaviours that are constructed as necessary for the achievement of a healthy pregnancy in the context of neoliberal mothering (Lupton, 2012). Participants viewed this preparation as a positive expression of their commitment to, and investment in, their pregnancies, indeed as acts of maternal care. As Lisa describes: “I knew that I was getting pregnant, you know I didn't smoke, I didn't drink, I lost weight, I was doing everything, I upped my exercise and I had all the supplements, you know, I was really healthy, I was feeling good”.

Alongside their demonstration of responsibility for, and investment in, their pregnancies through healthful preparation, participants also described a strong sense of emotional attachment to their babies-to-be and concern for their wellbeing. The ontological interembodiment between pregnant person and infant (or infant-to-be) has been observed by feminist scholars and is understood to form the very basis of emergent maternal identity (e.g. Lupton, 2012; Thomson et al., 2015). Zoe, for example, described: “When you're pregnant, everything suddenly becomes a focus on the baby, and you will do anything to keep your baby safe”. As we expected based on existing literature (e.g. Farrell, 2011), participants described histories of interpersonal and institutional fat shaming. However, most were not aware of the specific problematisation of pregnancy fatness as a health issue prior to becoming pregnant and did not anticipate negative responses to their fatness despite their previous experiences of health care. Rather, participants described approaching pregnancy-related health-care services with anticipation that they would receive affirmation from their pregnancy carers for their preparedness for their pregnancies. We suggest that this was consistent with the intense gaze on foetal wellbeing that occurs when the foetus is elevated to the central subject of pregnancy, resulting in the pregnant person's own health and wellbeing, and their own health histories, receding to secondary status. As Alison reflected, “You know, I didn't really think about my health, I just thought about my baby's health. My health was a little bit to the side, but yeah I was very concerned with the baby's health”. We argue that the maternal responsibilisation for healthy pregnancy combined with their emotional connection to the baby-to-be and almost singular focus on foetal wellbeing creates the conditions for shame in a way that is unique to the maternity care context. In other words, we argue that our participants were primed for shame through the amplification of investment, attachment, and interest that typifies contemporary affective-discursive practices surrounding reproduction and motherhood (Tomkins in Berg & Staunæs, 2011).

Shaming encounters

The positive feelings of preparedness and anticipation with which participants embarked on pregnancy were diminished as they encountered the negative evaluation of their bodies in the discourses and practices of pregnancy-related health care. Within these discourses and practices participants' bodies were constructed as a burden to care for and a risk to their babies' present and future health. This negative evaluation left participants feeling that they had transgressed the norms of healthy pregnancy and responsible motherhood. As Lisa reflects on her health-care experiences while pregnant, “I was made to feel so bad about it [my weight]. You know that I was going to be a bad mother because I was fat, or that I was a bad person because I was pregnant and fat. That was just the message I got”. The initial encounter with pregnancy-related health services was a powerful vector for the communication of the norms and standards of healthy pregnancy (including slimness). This was particularly the case because of the gulf that existed between the positively valenced feelings with which participants approached seeing a doctor or midwife for the first time, and the negative evaluation they received from their pregnancy-related health professionals.⁴ In these first encounters, participants' fatness was “made visible” through expert discourses of risk about pregnancy fatness combined with negative attitudes towards their fat bodies from their carers, in the form of annoyance, disgust and concern (Fullagar, 2003). As Nadine describes:

When I met her [midwife] I was really happy but I could tell immediately on her face that she was not happy … So she did the whole normal consultation and it wasn't until the end of the consultation that she said, “actually you're very overweight, and I'll take you, I'll take you on as a case but when I get closer to the time, when you're a bit further along I may have to assess the risk of you being a mother”. And then she said, “and if the risk is too high for me I'm sorry, I can't take you on, I'm going to have to give you to a specialist team”. And that's when I clicked, I'd never thought of my weight being a problem before, like I usually try to do things quite diligently, so when she said that, that automatically sparked fear, and then I was like in fear the whole way through my pregnancy.

Consistent with Bryant and Garnham's (2015) observation that shame often lacks a discursive framework for its articulation, Nadine did not articulate her emotional response to this initial encounter with her midwife specifically as shame. Rather, she describes how having her weight made visible as a problem against the norms and standards of healthy pregnancy precipitated feelings of fear and hypervigilance for her pregnancy and future child. Indeed, participants described a range of negatively valenced feelings in place of “shame” including “guilt”, “feeling bad”, “frustration”, “feeling horrible”, “defeat”, “worry”, and poor self-regard. For example, Jasmine described feeling “spoiled” after her first midwife appointment:

I'd felt so positive and that I was doing this amazing thing by having a baby, because it is amazing, but you know, it kind of took away that happy pregnant feeling, and it made me feel like, “oh, I'm just pregnant and fat,” you know not in a good way, like a round mama, I just felt frumpy and spoiled in a way.

However, while often not named as such, we contend that shame was the dominant affective-discursive practice underlying these more intelligible feelings. This is based on our theoretical assumption that shame was the likely dominant affective-discursive response that could be expected when participants' bodies were negatively evaluated in relation to the norms and standards of healthy pregnancy, and in the context of their investment in meeting those norms and standards. In other words, we argue that feeling shame can be assumed as the dominant affective-discursive response to being fat shamed, even if it was not as easily articulated by participants.

Shamed maternal subjectivities

The negative evaluation of our participants as failed mothers-to-be against the norms and standards of healthy (slender) pregnancy was not confined to their initial encounters with pregnancy-related health care but rather persisted throughout their pregnancies. Participants described how fat shaming pervaded every aspect of their routine pregnancy-related health care, from being weighed at pre-natal visits, to having ultrasound-scans and blood tests, and in the delivery of medical interventions during labour and birth. It presented in different guises and could arise at unexpected moments -- in dismissive comments from their carers about their bodies, gruff or rough handling, annoyance at their need for medical interventions or other forms of assistance, ill-fitting equipment and physical environments that made participants feel out of place, and a general absence of warm and respectful care. Zoe, for example, described her experience of being taken to theatre for a caesarean section after complications developed during her labour: “I felt like they were gruffer with me, like they were punishing me for being big. It's like you're automatically given a label “larger, difficult, this is just going to be a big hassle”, yeah I think it's definitely there”. Nadine similarly described her doctor's negative commentary when trying to insert an intravenous line during labour: “they tried to put me on a drip but no one could find my vein, and the doctor came in and said, “oh, I’m not very good at finding veins…” and then she paused and said, ‘in meaty arms’”.

Ultrasound scans were a potent site of fat shaming for participants, as excited anticipation of seeing their baby visualised on screen was dampened by the disdain of sonographers, particularly when they had trouble navigating participants' habitus to secure an image of the foetus. For example, Emma described the following:

Emma: I knew that it took them longer to do the scans and that it was quite hard and they sort of complained a bit, huffing and saying “oh I can't get the image” and you know, things like that.

Interviewer: How did that make you feel during the scan?

Emma: Oh well I felt uncomfortable, and I felt like an inconvenience, yeah and I felt like they just didn't want to deal with me, and you know just the comments they put on the report about my size and stuff, it was like, I kind of felt like a freak, yeah, I was quite upset.

As Munt (2008, p. 3) argues, “problem individuals” who fail to achieve the standards of good and proper citizenship, “internalise the stigma of shame”, producing “shamed subjectivities” as outcast others who must struggle for reparation. The persistent fat-shaming encounters described by our participants brought them into felt awareness of their deficiencies and undesirability both as mothers-to-be and as the recipients of pregnancy-related health care. The oppressiveness of this negative evaluation, combined with participants' investment in fulfilling the requirements of healthy pregnancy, was ultimately taken up as the shamed affective-discursive subject position of the “failed mother-to-be” who had wilfully put her baby at risk and unnecessarily burdened pregnancy-related health services.⁵ As Skye described:

I felt like I shouldn't have gotten pregnant, and that I'm not worthy of having a baby right then, like, you know, like being fat is going to affect everything, it just generally made me feel like I didn't deserve to be having a baby, that I was going to put everyone through so much hassle because of it.

The ways in which subjection as a “failed mother-to-be” was oppressive and constraining in the lives and pregnancy practices of our participants are described below. However, as we noted previously, subjection is never total. Wetherell et al., (2015) argue that the affective-discursive analyst should always be alert to resistances, fragmentations, and multiple versions in the subject's negotiation of the affective-discursive. This was certainly the case for our participants, who simultaneously took up their affective-discursive positioning as problematic and burdensome whilst also finding opportunities to negotiate with and resist these oppressive meanings. These resistances and their emancipatory potential are explored in much greater detail elsewhere (e.g. Parker & Pause, 2018a), but by way of note drew on counter discourses propagated in the fat acceptance movement, such as Health at Every Size (HAES) (Bacon, 2010). HAES asserts the potentiality for healthfulness, capacity, and enjoyment for all bodies regardless of their size. Echoing this, in the face of their negative evaluation, some participants still asserted their healthfulness despite their weight, and their bodies' strength and capacity to grow and birth their babies. For example, Talia described: “And it got to the point where my midwife was telling me that I am going to have a really difficult labour, that things will go wrong because of my weight, and I said look, my cholesterol's fine, my blood pressure's fine, I know my body can do this.”

The productivity of shame

Subjected as the “failed mother-to-be” who must do everything she can to protect her baby from the dangers of her own body and reduce her burden on limited health resources, participants described the drive with which they engaged in “technologies of the self”. Because fatness was problematised as antithetical to a healthy pregnancy, efforts at body management and transformation were directed at minimising weight gain or even achieving weight loss during pregnancy. This proved a source of anxiety and stress given that weight gain is an inevitable part of the physiology of pregnancy (e.g. Nash, 2012). Participants described how concern with their weight came to dominate their pregnancies, leading them to monitor what they ate and how much; restricting or denying foods they found pleasurable; and stress about family events such as Christmas or birthday celebrations where casual enjoyment of food would be expected. Participants also described how exercise during pregnancy was undertaken with the negative valance of weight management rather than fitness or enjoyment. As Nadine described:

Yeah, so I was really strict, I did everything she [midwife] said, I never ate at Christmas because I didn't want to put anything on, and I was just always very worried. So I didn't really relax throughout the whole pregnancy, my mum didn't know why I was going for walks every day, and she would be this is a time to enjoy the experience, to be glowing.

Participants' efforts at weight management only intensified as their pregnancies progressed and their bodies proved unruly, energised with the affective intensity of a mother who is failing to protect her child. Skye described the emotional impact of weight gain each time she was weighed by her midwife in prenatal appointments:

So I would just feel rubbish for days, and then it affects, you know, how much you eat, or whatever. Like for me I might not eat for a couple of days, because it makes me feel guilty every time I put something in my mouth. Guilt about having this baby when I'm so fat, guilt that it's going to make me more fat, or guilt that it's going to stop me losing weight.

Faced with unruly pregnant bodies that continued to gain weight despite their efforts, participants also pursued opportunities to “balance the ledger” by managing other perceived risks to their baby. For Maia this meant declining pain-relief during labour so that her baby was not exposed to pharmaceuticals:

So everything that I could do that was best for my baby came before my own needs because I felt that by me being overweight I had been detrimental to her. So that meant that I had suggested during my birth plan that I don't want Pethidine because that's going to affect the baby and I don't want an epidural because that might affect the baby and, you know, I had an excruciating delivery because of it.

Talia described how her desire to offset the risk of her fat body manifested in a generalised anxiety about her pregnancy. She focused intensely on any number of potential risks to her baby posed by her everyday practices and behaviours, from the shoes she wore, to the position she slept in, and her exposure to chemicals: “my whole excitement went out the window. So, I started getting all anal and overthinking things and reading too much”. In their desire to do everything they could for their babies, participants also described governing themselves by accepting medical surveillance and management of their fat pregnancies even if this was counter to their own views about their bodies' healthfulness and capacity to grow and birth their babies. Acquiescence to medical management included ceding their preferences about where and how they would give birth and accepting increased prenatal screening such as additional ultrasound scans, even if this meant further exposure to fat shaming. As Lisa describes:

I wanted to make sure that I was doing the right thing, so that's why I went for the tests, and that's why I went to the hospital. And after all I went through, I think that even if I got pregnant again, that I'd still do it, because I would have hated something to have happened to my baby that could have been avoided if you'd had the scan, or had the blood test, so it was a guilt thing. I went because I felt guilty that if I didn't go, something would happen. You know, so I would put up with all of it, the shame and humiliation, all the tests, because yeah, I wanted to know that I had done the best for my baby.

Shamed into health?

While fat shaming was productive in intensifying our participants' engagement with the task of self-governance, we argue that because this action was energised through such negative self-evaluation, it was not constructive. Rather, shame energised self-governed action manifested in a state of being (physically, mentally, and spiritually) that was disruptive in the development of maternal identity and counterproductive to the goals of maternal and child health care. As their pregnant bodies proved impossible to control, participants described a descent into an unhealthful state of self-loathing and despair, resulting in a loss of enjoyment in their pregnancies, social isolation, eating difficulties, poor body image, mental distress, and a lack of confidence in their mothering abilities. As Maia discussed: “There was nothing pleasurable about it [my pregnancy]. I didn't proudly show off a baby bump because people would've just thought I was fat”. Skye described how her decline in self-worth led to her desire to avoid social situations during pregnancy that she previously would have enjoyed:

I don't want to leave the house. I don't want people to see me. I don't want to see anybody. I'm usually never at home, I'm always out doing something, seeing someone, but you know even friends arranged a get together and I haven't seen them for quite a while and I've put on all this weight and I'm just like too embarrassed to go.

Alice described how her negative self-evaluation led to a loss of motivation for self-care: “At the end of the day you can't fat shame someone and expect them to want to take care of themselves. You make them miserable, you make them unhappy and so you eat more, it's just not the right approach”. For Stacey, her sense of despair undermined her efforts to avoid alcohol while pregnant: “Well I felt bad about my body, which made me more like to go, oh well, I'm bad, and my body is bad, and I'll treat it badly because that's what I deserve”. Talia discussed how her drive to keep her pregnant body small triggered past eating issues: “and then my binge eating came in, because I was so depressed at it all I just gave up, so that's when I started self-medicating”.

This negative state of being endured beyond birth, impacting on participants' emerging parenting identities and practices with ongoing health consequences for themselves and their children. Participants described a range of ways in which their sense of having failed as mothers before they had even held their babies in their arms carried into their parenting experiences, resulting in postnatal depression and anxiety, health-care avoidance, and concern about their own and their children's weight. For example, Talia drew a strong connection between pregnancy fat shaming and her experience of postnatal distress, sharing an anecdote about her enduring sadness:

When I see skinny mums sitting with their babies it makes me sick because I feel like she would have had the best treatment, and she would have had her baby welcomed into the world with opened arms yet mine was not like that at all.

Participants also described the ongoing anxious management of both their own and their children's weight. As Skye described: “It's made me more conscious of what we feed the kids, not as many treats and healthier food, because I don't want the kids to have to go through what I have gone through”. Some participants described their loss of trust and faith in health services leading to their avoidance of health care services once their children were born. As Leilani reflected: “If you don't feel that they [health professionals] care about you, that's going to ripple on to your children, you're going to think it's a waste of time ringing them when something is wrong because they're not going to care about it”. Having taken up the subject position of the failed fat mum before they had even given birth, participants struggled to reconstitute their maternal identities in more affirming ways despite the raising of their children being a source of pride and affirmation. As Alice described: “I just don't like being the fat mum”. For some participants, their subjection as a failed fat mum felt so unviable that it led them to question the feasibility of having more children, and for others it consolidated their decision to pursue bariatric surgery prior to another pregnancy. Maia went for her first gastric by-pass appointment when her daughter was 11 months old and reflected, “all of these treatments led me to this decision, because you are treated like a leper”.

Productive but not constructive

The work of shame in the governmental strategies described here highlights the importance of attention to affect in feminist governmentality studies. As we have demonstrated, in the governance of healthy pregnancy, fat pregnant people are incited to action not simply as rational and responsible neoliberal subjects who seek not to burden the state, but as affective subjects, whose feeling and emotional landscape as mothers-to-be is brought into the game. Taking the role of affect in governmental strategies seriously, Isin proposes that we substitute the construct of “neoliberal citizenship” with “neurotic citizenship”, illuminating the strength with which we are incited to calibrate our conduct on the basis of affective intensities (shame, anxiety, uncertainty) as much as, or more than, our rationalities. Shamed into subjection as failed mothers-to-be against the norms and standards of healthy pregnancy, our participants could be described as “neurotic citizens”, driven to engage with self-governing practices in their attempt to self-manage and transform their fat bodies. However, while fat pregnant subjects could be shamed into self-governed action, they could not, and were not, shamed into health. Rather, the task of self-managing their growing and morphing pregnant bodies proved impossible and futile, resulting in a perpetuating cycle of struggle and negative self-regard. The result was a state of unhealthfulness and diminished capacity for experiencing a healthy, happy pregnancy. For this reason, we have concluded that while shame is a productive force in the biopolitics of fat pregnancy, it is not constructive. Rather, shame and maternal health emerge as entirely antithetical in our study, persistent fat shaming resulting in the production of oppressive maternal subjectivities with real health implications for mothers and their children.

Taking seriously the role of affect in governmentalities, how might attention to shame shape critical feminist responses to the biopolitics of fat pregnancy? For a start, we might challenge the contemporary logics of public health policy and practice that justify fat stigma and shaming during pregnancy as an appropriate health-promoting intervention in response to the “problem” of pregnancy fatness. Rather, we can point to the ways in which contemporary approaches to fat pregnancy that energise shame are not producing healthy mothers and babies but rather are destructive to the psyche of fat pregnant people, robbing them of joy and happiness as they grow their babies, and triggering a downward spiral of negative self-evaluation and poor health (physical, mental and spiritual). We might also point to the work of shame in facilitating the “de-socialisation” of health, whereby we allow the burden of society's health (both now and in the future) to be shouldered by demoralised and dispossessed individuals (mothers) (Rail, 2012, p. 232). We might express our outrage that this works to mask the vast and persistent health inequities in neoliberal states and justify decreased state responsibility for population health. Finally, we might reject the neoliberal rationalities that underpin contemporary approaches to “healthy pregnancy” and demand more compassionate and liveable approaches to maternal and child health – approaches that insist on the substitution of stigma and shame with kindness, support, and positivity. Because in the words of Leilani, “You know, I think at the end of the day being a good mum is a state of mind, not a state of body”.

Footnotes

Acknowledgements

The authors would like to thank the School of Social Sciences at the University of Auckland, in particular Associate Professor Vivienne Elizabeth and Professor Nicola Gavey, and the Institute of Education at Massey University for their support in writing this paper.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biography

George Parker is a doctoral student in the School of Social Sciences and lectures in Medical Humanities at the University of Auckland. George’s research draws on feminist, intersectional, and governmentality theories to examine the construction of “maternal obesity” and foetal programming as significant new public health problems.

Cat Pausé, PhD, is a Senior Lecturer in Human Development at Massey University. She is lead editor of Queering Fat Embodiment (2014, Routledge), and has coordinated two international conferences: “Fat Studies: Reflective Intersections” (2012) and “Fat Studies: Identity, Agency, Embodiment” (2016). Her research is focused on the effects of fat stigma on health and well-being on fat individuals and how fat activists resist the “fatpocalypse”. Her work has appeared in journals such as Fat Studies, Feminist Review, and Narrative Inquiries in Bioethics, as well as online in the Huffington Post, The Conversation, and in her blog.

References

Anderson

(2012) Affect and biopower: Towards a politics of life. Transactions of the Institute of British Geographers 37(1): 28–43.

APNZ. (2012, May 15). Extremely obese mothers a “scary problem”. The New Zealand Herald. Retrieved from http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=10806075.

Bacchi

(2012) Why study problematisations? Making politics visible. Open Journal of Political Science 2(1): 1–8.

Bjerg

Staunæs

(2011) Self-management through shame: Uniting governmentality studies and the “affective turn”. Ephemera: Theory & Politics in Organization 11(2): 138–156.

Bacon

(2010) Health at every size: The surprising truth about your weight, Dallas, TX: BenBella Books.

Boero

(2009) Fat kids, working moms, and the “epidemic of obesity”: Race, class, and mother blame. In: Rothblum

Solovay

(eds) The fat studies reader, New York, NY: NYU Press, pp. 113–119.

Browne, R. (2011, December 1). Obesity starts in the womb. The Sydney Morning Herald. Retrieved from http://www.stuff.co.nz/life-style/wellbeing/6070724/Obesity-starts-in-the-womb.

Bryant

Garnham

(2015) The fallen hero: Masculinity, shame and farmer suicide in Australia. Gender, Place & Culture 22(1): 67–82.

Evans

(2010) Anticipating fatness: Childhood, affect and the pre-emptive “war on obesity”. Transactions of the Institute of British Geographers 35(1): 21–38.

10.

Farrell

A. E.

(2011) Fat shame: Stigma and the fat body in American culture, New York, NY: NYU Press.

11.

Foucault

(1988) Technologies of the self (A seminar with Michel Foucault at the University of Vermont, October 1982). In: Martin

L. H.

Gutman

Hutton

P. H.

(eds) Technologies of the self: A seminar with Michel Foucault, Amherst: University of Massachusetts Press.

12.

Fullagar, S. (2003). Wasted lives: The social dynamics of shame and youth suicide. Journal of Sociology, 39(3), 291–307.

13.

Harjunen

(2016) Neoliberal bodies and the gendered fat body, Abingdon, UK: Routledge.

14.

Harrison

(2012) The body economic: The case of “childhood obesity”. Feminism & Psychology 22(3): 324–343.

15.

Isin

E. F.

(2004) The neurotic citizen. Citizenship Studies 8(3): 217–235.

16.

Leahy

(2014) Assembling a health[y] subject: Risky and shameful pedagogies in health education. Critical Public Health 24(2): 171–181.

17.

Low

F. M.

Gluckman

P. D.

Hanson

M. A.

(2015) Evolutionary and developmental origins of chronic disease. In: Muehlenbein

(eds) Basics in human evolution, London, UK: Academic Press, pp. 369–381.

18.

Lupton

(2012) Configuring maternal, preborn and infant embodiment, Sydney Health and Society Working Group Paper No. 2. Sydney, AU: Sydney Health & Society Group.

19.

McPhail

Bombak

Ward

Allison

(2016) Wombs at risk, wombs as risk: Fat women's experiences of reproductive care. Fat Studies 5(2): 98–115.

20.

Massumi

(2007) Potential politics and the primacy of preemption. Theory & Event 10(2): Retrieved from Project MUSE database.

21.

Ministry of Health (2014) Guidance for healthy weight gain in pregnancy, Wellington, NZ: Ministry of Health Retrieved from https://www.health.govt.nz/publication/guidance-healthy-weight-gain-pregnancy.

22.

Munt

(2008) Queer attachments: The cultural politics of shame, Aldershot, UK: Ashgate Publishing.

23.

Murray

(2012) “Fat” bodies as virtual confessors. In: Wright

Harwood

(eds) Biopolitics and the “obesity epidemic”: Governing bodies, New York, NY: Routledge, pp. 78–90.

24.

Nash

(2012) Weighty matters: Negotiating “fatness” and “in-betweenness” in early pregnancy. Feminism & Psychology 22(3): 307–323.

25.

Office of the Controller and Auditor General. (2013). Evolving approach to combating child obesity (No. 978-0-478-41025-9). Retrieved from: https://www.oag.govt.nz/2013/child-obesity.

26.

Parker

(2014) Mothers at large: Responsibilizing the pregnant self for the “obesity epidemic”. Fat Studies 3(2): 101–118.

27.

Parker

G. C.

Pausé

(2018a) “I'm just a woman having a baby”: Negotiating and resisting the problematisation of pregnancy fatness. Frontiers in Sociology 3: 5.

28.

Parker

Pausé

(2018b) Pregnant with possibility: Negotiating fat maternal subjectivity in the “war on obesity”. Fat Studies 7(2): 124–134.

29.

Parker, G., Pausé, C., & Le Grice, J. (2018). “You're just another friggin number to add to the problem”: Constructing the racialized (m)other in contemporary discourses of pregnancy fatness. Manuscript submitted for publication.

30.

Pausé

(2017) Borderline: The ethics of fat stigma in public health. The Journal of Law, Medicine & Ethics 45(4): 510–517.

31.

Poston

Caleyachetty

Cnattingius

Corvalán

Uauy

Herring

Gillman

M. W.

(2016) Preconceptional and maternal obesity: Epidemiology and health consequences. The Lancet Diabetes & Endocrinology 4(12): 1025–1036.

32.

Puhl

R. M.

Heuer

C. A.

(2010) Obesity stigma: Important considerations for public health. American Journal of Public Health 100(6): 1019–1028.

33.

Rabinow

Rose

(2006) Biopower today. BioSocieties 1(2): 195–217.

34.

Rail, G. (2012). The birth of the obesity clinic: Confessions of the flesh, biopedagogies and physical culture. Sociology of Sport Journal, 29(2), 227–253.

35.

Ruddick

(2007) At the horizons of the subject: Neo-liberalism, neo-conservatism and the rights of the child, part one: From “knowing” fetus to “confused” child. Gender, Place and Culture 14(5): 513–527.

36.

Salas

X. R.

(2015) The ineffectiveness and unintended consequences of the public health war on obesity. Canadian Journal of Public Health 106(2): e79–e81.

37.

Salmon

(2011) Aboriginal mothering, FASD prevention and the contestations of neoliberal citizenship. Critical Public Health 21(2): 165–178.

38.

Thomson

Ebisch-Burton

Flacking

(2015) Shame if you do – shame if you don't: Women's experiences of infant feeding. Maternal & Child Nutrition 11(1): 33–46.

39.

Vartanian

L. R.

Smyth

J. M.

(2013) Primum non nocere: Obesity stigma and public health. Journal of Bioethical Inquiry 10(1): 49–57.

40.

Warin

Zivkovic

Moore

Davies

(2012) Mothers as smoking guns: Fetal overnutrition and the reproduction of obesity. Feminism & Psychology 22(3): 360–375.

41.

Wetherell

McCreanor

McConville

Barnes

H. M.

Le Grice

(2015) Settling space and covering the nation: Some conceptual considerations in analysing affect and discourse. Emotion, Space and Society 16: 56–64.

42.

Wigginton

Lafrance

M. N.

(2016) How do women manage the spoiled identity of a “pregnant smoker”? An analysis of discursive silencing in women's accounts. Feminism & Psychology 26(1): 30–51.

43.

Wimalawansa

S. J.

(2014) Stigma of obesity: A major barrier to overcome. Journal of Clinical & Translational Endocrinology 1(3): 73–76.

44.

Wong

Tsai

(2007) Cultural models of shame and guilt. In: Tracy

J. L.

Robins

R. W.

Tangney

J. P.

(eds) The self-conscious emotions: Theory and research, New York, NY: Guilford Press, pp. 209–223.