Gestational Harm and Responsibility: A Vulnerability Framework Approach

Gestational harm occurs when exposures in‐utero, such as alcohol, lead to long‐lasting health effects in the child born of that pregnancy. Because the actions of pregnant people can bring about such harm, this has given rise to debate about whether pregnant people are morally obligated to prevent harm to their future children (call this ‘gestational responsibility’). The debate on gestational responsibility increasingly recognises the social context of gestational harm. To the extent that unequal structural conditions constrain pregnant people's ability to prevent harms to their future children, some scholars argue that collective agents, and not individual pregnant people, are primarily responsible for such harms. In this, the debate has neglected to seriously consider the question of individual gestational responsibility under conditions of structural inequality. To address this question, I develop a framework for gestational responsibility grounded in the concept of vulnerability. The concept of vulnerability has gained traction in feminist bioethics as a means of capturing relational autonomy and increased susceptibility to harm under unequal social conditions. Focusing on the context of foetal alcohol spectrum disorder, I argue that the metaphor of ‘layers’ of vulnerability can help to articulate the varying degrees of autonomy—and correspondingly responsibility—of pregnant people under conditions of structural inequality. The purpose of my argument is to demonstrate the differential degrees of responsibility that people (in this case, those who are pregnant) possess in contexts of inequality, and to show how inequality mitigates responsibility.