It’s not risky for me

A recent scientific paper reported that aficionados justify the increased risk in five ways:

1. risk perspective
2. reasonable use is not harmful
3. counter-evidence
4. compensatory behavior
5. as the lesser evil

In accordance with these strategies, they generally claim that 1. they are low risk; 2. reasonable precautions minimize harm; 3. they or their friends have already done it already and they’re fine; 4. they are very careful about nutrition and exercise, which lowers their risk; and 5. if the choice is taken away, they will replace it with other, riskier choices.

Homebirth advocates? No, tobacco smokers.

You may have been confused, though. That’s because homebirth advocates justify their risky behavior in the exact same way that smokers justify theirs. Looking at these tactics through the prism of smokers’ behavior makes it clear that they are nothing more than psychological defense mechanisms, and have no basis in science.

The paper is Smokers’ accounts on the health risks of smoking: Why is smoking not dangerous for me? by Heikkinen et al. The authors ask:

[O]n what grounds is it possible to continue a habit that is widely presented as detrimental to health?

In contrast to smokers, homebirth advocates are far more willing to contest the scientific evidence or to make up “facts” to support their belief that homebirth is safe. But even those who acknowledge that homebirth increases the risk of neonatal death are still willing to take that risk.

How do they justify themselves? They mobilize the same strategies that smokers use and for the same reasons. These strategies:

… served to protect [them] from self-blame as well as blame from others. [They] presented themselves as risk-aware and calculating actors, who have nevertheless made their choice … Second, [they] tried to convince the interviewers and themselves of the harmlessness and acceptability of their own [choice].

Sound familiar? It should. Consider the following quotes:

When talking about their own smoking, participants tended to deny or disprove the possible health risks by expressing a view that their own smoking was actually not that risky to them. In the accounts the health harms of smoking were accepted as a risk on a population level, but not individually.

When talking about their choice of homebirth, advocates tend to deny the possible health risks by expressing the view that the risk does not really apply to them. In their accounts, the risks might be accepted on the population level, but not individually.

Regardless of the amount of cigarettes the participants smoked, many participants stated that a small number of cigarettes does not pose serious health risks, or at least reduces the harm.

Similarly, homebirth advocates insist that homebirth is not risky for them because they are “low risk,” have chosen a qualified attendant or live near a hospital.

… [T]he participants’ own observations and experiences served as a source of health information and as opposing evidence of the claimed health hazards. This counter-evidence could be divided into two sub-types: either the participants referred to their own experiences, or to the experiences of their
peers or public figures.

When it came to their own experiences, the participants most frequently referred to their current good state of health … The absence of current health problems actually seems to act for some as an enabling force …

Homebirth advocates love the anecdote, preferably the celebrity anecdote. Ricki Lake had a homebirth and her baby is fine. My neighbor had a homebirth and nothing went wrong. And most powerful of all, I’ve already had a homebirth and it was glorious.

The impression of being healthy and immune to tobacco-related diseases was often underpinned with preventive measures or harm-reduction techniques. Many of the participants reported leading an otherwise healthy lifestyle e except for the smoking. It was clearly expected that the risks of smoking can be reduced or avoided through such preventive measures as sports or exercising …

For homebirth advocates, it is axiomatic that good nutrition and exercise reduce the risks of homebirth, even though, as in the case of smoking, there is no evidence to support the claim.


… [S]moking was quite often compared or contrasted to other habits, such as … alcohol consumption… Contrasted to these other risks, smoking was presented as a very small health risk – almost nil …

Homebirth advocates like to claim that the risks of hospital birth are higher than homebirth, even though that is a bald-faced lie. They also insist that if the choice of midwives is restricted, they will petulantly resort to unassisted childbirth, therefore increasing the risk that their babies will die.

In reviewing these strategies, the Heikkinen et al. point out:

Three of the account types – moderation, lesser evil and compensatory behaviour e draw from an overall view that lifestyle is composed of many healthy and unhealthy components and the end-result is a calculus of these components…

Another way of downplaying the risk of smoking on an individual level entailed referring to personal experiences … and using these as counter-evidence to the
medical view … These accounts resembled the I-know-many-old-people-who-smoke arguments..

In light of these strategies, the authors recommend:

… [A]nti-smoking advocates and health promotion specialists should consider the following questions arising from smoker’ own perceptions and argumentation: is there such a thing as moderate smoking and, if so, why is it not recommended? Why should smoking not be seen as a lesser evil and compared to other vices? Is it possible to compensate for the consequences of smoking with physical activity or the eating of healthy food? Why is a currently good health status or lack of illness symptoms not a guarantee of future good health? Why there are individuals who have smoked for decades but who don’t get lung cancer?

Answering these questions reveals that even moderate smoking is harmful, smoking is not the “less of two evils,” diet and exercise do not prevent lung cancer, and the fact that a celebrity or relative smoked and did not get lung cancer does not mean that smoking doesn’t cause lung cancer.

Homebirth advocates should not make the same mistakes that smokers do. ANY homebirth can lead to neonatal death regardless of risk status, homebirth is more risky than hospital birth, diet and exercise do not prevent neonatal death, and just because Ricki Lake had a successful homebirth does not change the fact that homebirth increases the risk of neonatal death.

Homebirth advocates would do well to consider that their “arguments” in favor of homebirth are strikingly similar to smokers’ arguments in favor of continued smoking. And as in the case of smokers, rather than conveying the impression that homebirth advocates are risk aware actors making choices that are the lesser of two evils, their arguments serve instead to highlight the fact that they are only kidding themselves.