A recent Danish public health report classified being overweight during pregnancy as a chronic disease, marking a discursive shift from its previous classification as a risk factor for complications in maternal and foetal health. This discursive shift is considered a breach in the discursive field. Health care professionals’ approach to governing overweight pregnant women is affected by this breach in the discursive field. Thus, overweight pregnant women have become an issue for medical experts, who are encouraged to use stricter rhetoric when addressing them. This shift also renders pregnant women subject to interventions by medical experts. The aim of this article is to critically analyse recommendations for how health professionals should govern these high-risk individuals and to discuss the implications of such governance for overweight pregnant women. In this study, overweight is classified as BMI ≥ 30 and severe obesity is classified as BMI ≥ 35 on the basis of pre-pregnancy weight. The theory of social construction and the concept of governmentality are applied in a discourse analysis of the prevention of overweight among pregnant women in Denmark. Using a discursive approach, this study analyses central governmental documents that discuss obesity prevention. Three forms of freedom (as discipline, as solidarity and as autonomy) are transferred to three forms of governing and constitute the conceptual framework. The main finding is that public health programmes encourage governing through solidarity, including a palette of autonomy-making, responsibility-making and disciplinary technologies, to promote physical health. Public health programmes conjure an image of overweight individuals as strongly burdened subjectivities. The implications for overweight pregnant women are the formation of new subjectivities, engagement in patient associations, the threat of exclusion from communities and social citizenship and other forms of stigmatization.
KeywordsPublic Health PolicyOverweightPregnancyDiscourse AnalysisForms of Governing
Campbell, F., Johnson, M., Messina, J., Guillaume, L., & Goyder, E. (2011). Behavioural Interventions for Weight Management in Pregnancy: A Systematic Review of Quantitative and Qualitative Data. BMC Public Health, 11, 491. https://doi.org/10.1186/1471-2458-11-491
Danish Association of Obstetrics and Gynaecology (DSOG). (2012). Overweight Pregnant Woman. Sandbjerg: Obstetrical Guideline.
Dean, M. (1999). Governmentality. Power and Rule in Modern Society. London: Solid Action on Globalization and Environment.
Foucault, M. (1972a). Truth and Power. In C. Gordon (Ed.), Power/Knowledge (pp. 109-133). New York, NY: Pantheon Books.
Foucault, M. (1972b). The Archaeology of Knowledge (A. M. Sheridan Smith, Trans.). London: Tavistock Publications.
Foucault, M. (1982). The Subject and Power. Critical Inquiry, 8, 777-795. https://doi.org/10.1086/448181
Foucault, M. (1988). Technologies of the Self. In L. H. Martin, H. Gutman, & P. H. Hutton (Eds.), Technologies of the Self: A Seminar with Michel Foucault (pp. 16-49). Amherst, MA: University of Massachusetts Press.
Furber, C. M., McGowan, L., Bower, P., Kontopantelis, E., Quenby, S., & Lavender, T. (2013). Antenatal Interventions for Reducing Weight in Obese Women for Improving Pregnancy Outcome. Cochrane Database of Systematic Reviews, 1, CD009334. https://doi.org/10.1002/14651858.CD009334.pub2
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.
Gordon, C. (1991). Governmentality. In G. Burchell, C. Gordon, & P. Miller (Eds.), The Foucault Effect. Studies in Governmentality (pp. 87-104). Chicago, IL: Chicago University Press.
Government of Denmark (2000). Denmark as a Pioneering Country—A Sustainable System of Pensions. Copenhagen: The Ministry for Economic Affairs and the Interior.
Holen, M. (2015). Involving Patients as Politics: How Did It Become Possible and What about It? In Theme: Health and Health Politics in the Welfare State. Gjallerhorn (Vol. 20, pp. 37-48). Aarhus: VIA University College.
Holstein, J. A., & Gubrium, J. F. (2008). Handbook of Constructionist Research. London: Guilford Press.
Jorgensen, M. W., & Philips, L. J. (2002). Discourse Analysis as Theory and Method. Thousand Oaks, CA: SAGE Publications Ltd. https://doi.org/10.4135/9781849208871
Kamper-Jorgensen, F. (2004). National Public Health Programmes in the Nordic Countries. Journal of the Danish Medical Association, 166, 1301-1305.
Linders, A. (2008). Documents, Texts, and Archives in Constructionist Research. In J. A. Holstein, & J. F. Gubrium (Eds.), Handbook of Constructionist Research (pp. 467-490). London: Guilford Press.
Lindhardt, C. L., Rubak, S., Mogensen, O., Lamont, R. F., & Joergensen, J. S. (2013). The Experience of Pregnant Women with a Body Mass Index >30 kg/m2 of Their Encounters with Healthcare Professionals. Acta Obstetricia et Gynecologica Scandinavica, 92, 1101-1107. https://doi.org/10.1111/aogs.12186
Malterud, K., & Ulriksen, K. (2011). Obesity, Stigma, and Responsibility in Health Care: A Synthesis of Qualitative Studies. International Journal of Qualitative Studies on Health and Well-Being, 6. https://doi.org/10.3402/qhw.v6i4.8404
Ministry of Health (1999). The Governmental Public Health Programme 1999-2008. Copenhagen: Ministry of Health.
Ministry of Interior (2002). Affairs and Health. In Healthy throughout Life—National Aims and Strategies of Public Health 2002-10. Copenhagen: Ministry of Interior Affairs and Health.
National Board of Health (2006). Methods and Means to Prevent Overweight. Experience from 26 Projects Illustrated from Different Perspectives. Copenhagen: National Board of Health.
National Board of Health (2013). Recommendations Concerning Antenatal Care. Copenhagen: Committee of Health Information.
National Institute for Public Health (2007). The Report of Public Health (Denmark): 2007. Copenhagen: University of Southern Denmark.
Perron, A., Rudge, T., & Holmes, D. (2010). Citizen Minds, Citizen Bodies: The Citizenship Experience and the Government of Mentally Ill Persons. Nursing Philosophy, 11, 100-111. https://doi.org/10.1111/j.1466-769X.2010.00437.x
Prior, L. (2004). Following in Foucault’s Footsteps. Text and Context in Qualitative Research. In S. Hesse-Biber, & P. Leary (Eds.), Approaches to Qualitative Research: A Reader on Theory and Practice (pp. 317-333). New York, NY: Oxford University Press.
Rahman, M. M., Abe, S. K., Kanda, M., Narita, S., Rahman, M. S., Bilano, V., Ota, E., Gilmour, S., & Shibuya, K. (2015). Maternal Body Mass Index and Risk of Birth and Maternal Health Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Obesity Reviews, 16, 758-770. https://doi.org/10.1111/obr.12293
Rose, N. (1998). Inventing Ourselves. Psychology, Power and Personhood. Cambridge: Cambridge University Press.
Rose, N. (1999). Powers of Freedom. Reframing Political Thought. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511488856
Rose, N. (2003). Governing Freedom—An Analysis of Political Power in Advanced Liberal Democracies. In C. Borch, & L. L. Larsen (Eds.), Power: Perspective and Government. Luhmann and Foucault at Discussion (pp. 180-199). Copenhagen: Hans Reitzel.
Rudkjobing, A., Strandberg-Larsen, M., Vrangbaek, K., Andersen, J. S., & Krasnik, A. (2014). Health Care Agreements as a Tool for Coordinating Health and Social Services. International Journal of Integrated Care, 14, e036. https://doi.org/10.5334/ijic.1452
Schneider, A. L., & Ingram, H. (2008). Social Constructions in the Study of Public Policy. In J. A. Holstein, & J. F. Gubrium (Eds.), Handbook of Constructionist Research (pp. 189-211). London: Guilford Press.
Silverman, D. (2014). Interpreting Qualitative Data. Methods for Analyzing Talk, Text and Interaction. London: SAGE Publications.
Vallgarda, S. (2003a). Public Health as Policy. Denmark and Sweden from 1930 until Today. Aarhus: Aarhus University Press.
Vallgarda, S. (2003b). Studies of Exercise of Power. Contribution to an Operationalization of Michel Foucault’s Concept of Governmentality. In P. M. Christiansen, & L. Togeby (Eds.), Traces of Power (pp. 117-131). Aarhus: Aarhus University Press.
Villadsen, K. (2007). Power and Self-Technology. Foucault’s Relevance for Current Welfare Studies? Journal of Research in Welfare, 10, 156-167.