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Table 2 Competing discourses in in defining problematic substance use during pregnancy and early parenting

From: Complicating the dominant morality discourse: mothers and fathers’ constructions of substance use during pregnancy and early parenthood

Parallel/competing discourses
Abstinence (as the ideal) Autonomy (of individuals to make different choices based on their knowledge and experiences)
‘Obvious’ Complex
Normative Nuanced
Deontological/absolutist Pluralistic
Informed/reinforced by…
Moral conviction Relative and contextualized harms
Traumatic/negative personal experience Personal and anecdotal experience
Ministry policies/legal structures Ambiguity of evidence
Internalizing a moralized motherhood A broader view of what influences health
Delimits the ‘bad mother’ and the ‘good mother’ by substance use and child removal ‘Problematic’ determined according to substance type and frequency of use
Neoliberal view of choice over life circumstances (choice for both substance use and pregnancy) Harms mediated by social determinants of health associated with substance use and dependency
Harm reduction as morally inadequate More holistic view of health: personal care, agency, and emotional health
Mother and infant health as inseparable
Disruption of family as problematic
Results in…
Irreconcilable shame and guilt Richer discussion of what influences health and child development
Stigmatization Contestation of judgment and stigmatization