Tuesday, October 17, 2006

New Zealand Health Group Calls Smoking By or Around Pregnant Women Child Abuse

A New Zealand health group - the Maori Heart Foundation - is arguing that smoking by or around a pregnant woman is child abuse.

The Foundation issued a press release yesterday which stated:

"Smoking during pregnancy, or smoking around a pregnant women is yet another form of child abuse, the Maori Heart Foundation Te Hotu Manawa Maori (THMM) said today. ... As an organisation, we'’ve looked at the definitions of child abuse, and there'’s no doubt in our mind that smoking during pregnancy, and smoking around your children constitutes physical abuse. When we look at legal and policy guidelines, it'’s very clear that smoking during pregnancy is abusive to children. Child Abuse means the harming (whether physically, emotionally or sexually) ill-treatment, abuse, neglect or deprivation of any child or young person. Physical Abuse is any act or acts that result in inflicted injury to a child or young person."

The Rest of the Story

There are a number of severe problems with this argument. First, it confuses the concepts of injury (harm) and risk. There is little doubt that smoking during pregnancy increases the risk of a number of adverse health conditions. But it doesn't necessarily cause harm. As the Foundation itself admits, physical abuse is an act that results in inflicted injury. Since smoking during pregnancy or around a pregnant woman does not usually inflict injury, it is not physical abuse.

It is important to recognize that by the Foundation's definition of child abuse, any woman who takes a drink of alcohol during pregnancy is a child abuser. There is strong evidence that alcohol use during pregnancy increases the risk of adverse health outcomes. Any woman who drives in a car during pregnancy is also a child abuser. Riding in a car increases the risk of injury and death. So does changing cat litter while pregnant, another form of child abuse according to the Maori Heart Foundation's definition. And I don't even want to talk about pregnant women who eat raw fish. That increases the risk of intestinal infection, which could cause adverse consequences that harm the fetus, and represents child abuse, according to the Foundation's definition.

You can see how dangerous this type of argument is. If we adopted such a definition here, as suggested by Action on Smoking and Health, Smokefree Pennsylvania, and a number of other anti-smoking groups and advocates (they have argued that smoking around a child is a form of child abuse), then any parent who allows their child to ride on a roller coaster is a child abuser. Letting your child play hockey is a serious form of child abuse. Parents of children who are allowed to play football are also child abusers, according to this argument.

A second problem with the argument is that it would treat people who smoke around children, or pregnant women who smoke, in the same way as people who beat their children. If we are unable to see a world of difference between these, then we have some serious problems that could truly put our children at risk. Ultimately, society addresses child abuse by removing children from the custody of their parents. Resorting to such an approach to deal with smoking would be a tragedy and would cause every bit as much harm to children as is being caused by tobacco smoke.

Third, the argument that smoking during pregnancy is child abuse rests on making and enforcing a societal decision, that must be accepted by all, that life begins at conception. This is the ultimate infringement upon personal freedoms and rights. It essentially destroys the autonomy of women, and ends the concept of abortion rights. It is a particularly dangerous and alarming sequela of the kind of argument that the Maori Heart Foundation is making.

A fourth flaw in the Foundation's argument is that child abuse and physical abuse are terms that generally imply an intent to cause harm. The action that causes the harm is the primary intention of the perpetrator.

For example, when someone beats a child, the primary intent of the action was to beat the child. It is not the case that hitting the child was a secondary, unfortunate side effect of some other primary action.

But in the case of smoking around a child or a fetus, it is not the primary intent of the alleged perpetrator of the "child abuse" to injure the child or fetus. The injury, if it does occur, happens as an unfortunate, unintended secondary consequence of the primary action, which was simply to smoke.

This is also why driving with kids in a car at 60 miles an hour on a crowded Los Angeles freeway is not child abuse, nor is changing a cat litter and getting toxoplasmosis, which can result in severe neonatal injury or death. The primary intention of the act of driving was not to injure a child, it was to get somewhere. Similarly, the primary intention of changing the cat litter was not to harm the neonate; it was to change the cat litter.

This is not the case with beating or sexually abusing a child, where the beating or the forced sex is the primary intent of the action, not a secondary, unintended consequence.

Apparently, those of us in tobacco control are unable to make these important distinctions. But we had better learn, and pretty quickly.

I hope that other anti-smoking groups will condemn this approach to the problem of smoking during pregnancy and exposure of children to secondhand smoke. But as I said earlier today, I'm not holding my breath.

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