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[Qualitative Research in Medicine & Healthcare 2017; 1:6791] [page 93]
Introduction
The Amazing You (TAY) is a permanent exhibition at
the Tampa Museum of Science and Industry (MOSI) that
takes visitors through each stage of life, from conception
to death. It contains 400 different health exhibits, each
sponsored by Florida medical practices, device manufac-
turers, health insurance companies and government agen-
cies. These sponsors sometimes influenced the content of
the exhibits. For example, an ophthalmology practice pro-
vided videos of eye surgery, and a prosthetics manufac-
turer provided artificial limbs and organs. At the
Beginning of Life (BOL) area of TAY, the topic is women
as carriers and caretakers of fetuses. These 7 exhibits,
placed at the start of the exhibition have a strong prescrip-
tive, even moralistic underpinning, because they insist on
healthy choices made by mothers during gestation. I am
interested in the ways that motherhood as a subject posi-
tion1-4 is constituted by this multimedia health campaign.
In the ethnographic descriptions included in this paper I
argue that the exhibits encourage women visitors to iden-
tify themselves as candidates for a medicalized pregnancy,
and visitor responses show how they interpret and resist
these mandates. This project is at the intersection of health
communication and science center studies. It is derived
from a larger, doctoral study of how health instructions
are communicated to science museum visitors. The year
this study was conducted, 73 million people visited sci-
ence museums,5 and health exhibits are a common feature
of these museums, yet there is not much health commu-
nication scholarship about them. While science center
studies appear in a major communication journal, Public
Understanding of Science,6-9 they are not specifically
about health exhibits intended to change behaviors.
The key argument of this paper is that health exhibits
issue directives in addition to informing visitors, an argu-
ment presented through a case study of the pregnancy ex-
hibits at TAY. This research contributes to the literature
by focusing on a kind of speech act, the directive, encom-
passing requests, suggestions and commands.10 Directives
can be contrasted with assertives (or informational, de-
scriptive statements) because rather than just describing,
they seek to affect change in the addressee. In order to
hide the explicit exercise of medical authority, medical di-
rectives can be embedded within statements of fact. For
example, the message Quitting smoking now reduces se-
rious risks to your health is a factual assertion, syntacti-
cally, but functions pragmatically as an indirect directive11
to quit smoking. Characterizing messages as directives
helps surface power differentials in medical discourse, be-
Mandates of maternity at a science museum, from should to must
David Haldane Lee
NYC College of Technology, New York, USA
ABSTRACT
A pregnancy exhibit at a science museum is an opportunity to research how medical advice is communicated and interpreted. This
paper is about the Beginning of Life area of an exhibition called The Amazing You at the Tampa Museum of Science and Industry, where
exhibits are prescriptive as well as descriptive. Expectant women are urged to deliver full-term, normal birthweight babies, by behaving
according to prescribed medical norms. This study provides ethnographic descriptions of the exhibits, as well as insights from museum
visitors who were interviewed. The exhibits, which emphasize fetal rights and maternal duties, are interpreted and critiqued by women
visitors. As the exhibits climb towards greater realism (from euphemistic computer graphics to actual fetal specimens) visitors encounter
assertions of fact that precede sometimes tacit directives to undergo a medicalized pregnancy. Exhibits are viewed from the perspective
of speech act theory, presenting a new approach to health communication research. I argue that this science center exhibit tells people
what to do, in addition to passing on information.
Correspondence: David H. Lee, NYC College of Technology, De-
partment of Humanities, 300 Jay Street, Room A630, Brooklyn,
NY, 11201.
Tel.: +1.813.313.6888.
E-mail: dlee@citytech.cuny.edu
Key words: maternal health, science museums, framing, position-
ing, speech acts.
Conflict of interest: the author declares no potential conflict of in-
terest.
Received for publication: 13 May 2017.
Revision received: 28 July 2017.
Accepted for publication: 3 August 2017.
This work is licensed under a Creative Commons Attribution Non-
Commercial 4.0 License (CC BY-NC 4.0).
©Copyright D.H. Lee, 2017
Licensee PAGEPress, Italy
Qualitative Research in Medicine & Healthcare 2017; 1:93-102
doi:10.4081/qrmh.2017.6791
Qualitative Research in Medicine & Healthcare 2017; volume 1:93-102
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cause the issuer of a directive presupposes their own au-
thority and the obedience of the addressee. This is a power
dynamic that is not addressed in most health communica-
tion research which privileges information-transfer. Look-
ing at analogous developments in health education and
museum studies provides an entry-point for investigating
understudied health exhibits such as TAY, as well as the
limitations of viewing communication exclusively as the
transmission of facts.
Health education, science centers,
and behavior change
Information-transfer approaches to health education
are based on notions of passive individuals acquiring
facts.12-14 The limited effectiveness of health campaigns
based on information-transfer prompted more focus on
changing behaviors in health promotion efforts, beginning
in the 1980s.15 The shift from health education to health
promotion14,16,17 can be characterized as a rejection of ed-
ucation for education’s sake. Instead of simply describing
anatomical processes, individuals are instructed to prevent
disease by eating better, exercising, losing weight, reduc-
ing stress and quitting bad habits like smoking. Given its
preventative focus, health promotion messages have a
wider audience beyond people with medical problems.
They also address presymptomatic persons deemed at-risk
because of lifestyle factors predicting disease. Because
health promotion is also multisectorial14 it reaches beyond
medical settings and into workplaces, schools and other
public spaces such as science museums.
In ways analogous to health promotion, Hooper-
Greenhill18 sees museums moving away from the infor-
mation-transfer model and towards a conception of
visitors as active participants. Similarly, Leinhardt and
Knutson19 reject the osmotic perspective of museum
learning, where people learn simply by being in the pres-
ence of important objects. Instead, they see museum
learning as a participatory and interactive process.19 Tra-
ditionally, the purpose of health exhibitions is to inform,20
but during our interviews, MOSI executives rejected the
strictly informative approach, describing TAY as a kind
of public health intervention. Unlike human anatomy ex-
hibitions presented according to a systems framework (i.e.
skeletal, circulatory, etc.), TAY confronts visitors with ac-
tion steps at each life stage, urging behavior changes. The
exhibition is unique because it straddles these shifts from
health education to health promotion, and from passive to
active museum audiences.
Materials and Methods
This qualitative, exploratory study uses ethnographic
observation and description,21 ethnographic interview-
ing,22,23 and multimodal methods24 suggested for the in-
terpretation of multimedia. Upon IRB approval in the
summer of 2012, data collection began by making refer-
ence videos of each exhibit, shot from the visitor perspec-
tive. I met 3 MOSI executives in the fall for unstructured
interviews, and that winter I collected 72 one-page exit
surveys from visitors. The survey posed open-ended,
undirected questions, including What brought you to
MOSI today?, What do you think about TAY? and Any-
thing you liked in particular? that elicited responses other
than yes/no. The last field in the survey invited the visitor
to be interviewed in exchange for tickets to MOSI’s
IMAX Theater. 22 visitors were interviewed for about 15
to 40 minutes each. After obtaining informed consent I
tried to ask undirected questions similar to those on the
survey that allowed informants to steer the topic of con-
versation. I spoke to volunteers, solo visitors, groups of
friends, couples and single or coupled parents. The con-
venience sample of mostly American visitors provided di-
verse responses in terms of age, groupings (dyad/triad),
occupation, gender and ethnicity.
Interviews were transcribed using Dragon Naturally
Speaking voice recognition software. Various descriptive
terms and phrases appearing on the transcripts that my in-
formants used to describe BOL were color-coded. I wrote
descriptions of each video, a transduction25 of televisual
data into descriptive text, and these fieldnotes were then
coded using the same descriptive language highlighted in
the transcripts. The approach was inductive, in that I did
not start out with a testable hypothesis or theoretical ori-
entation. It was inspired by grounded theory26-29 in that a
theoretical explanation emerged during the process of data
collection and analysis, rather than having been decided
on beforehand. Classic concepts from pragmatics and so-
ciolinguistics helped explain emerging themes.
Theories of frames and speech acts
As noted, MOSI executives stated that they set out to
create a different kind of human body exhibition that they
framed in interventionist terms. This helped me formulate
research questions about museum exhibits that, in addition
to passing on information, try to get the visitor to do some-
thing. I noticed that some exhibit titles contained com-
mands, worded in the imperative mood (for example,
“Stay Active”, “You Be The Doctor”, “Live Forever”, “Do
This, Not That” and “Use It Or Lose It”). Exhibits pre-
sented factual information, but apparently as a warrant for
a directive, and there were also directives performing dou-
ble-duty as assertions of fact. Codes from the transcripts
and fieldnotes variously identified exhibits in sequences
of descriptive and prescriptive messages. The museum
communication systems literature helped identify audio,
visual and tactile channels;30 components such as the ex-
hibitor, exhibition and visitor31 and the joint meaning-mak-
ing process of designers and visitors.32 But each of these
models failed to address the content of messages as either
descriptive or prescriptive. Seeking substantive theories to
explain this distinction, I began to consider exhibits as
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made up of speech acts, which presupposes that they need
not be vocal and verbal utterances. For example, hailing a
cab is a non-verbal directive. The Searle taxonomy of
speech acts10 provides a distinction between descriptive
(assertive) and prescriptive (directive) messages. His con-
cept of indirect directives11 describes commands or sug-
gestions phrased otherwise, as an assertion, for example.
Illocutionary force33 refers to the intended strength of a
speech act, as indicated by the difference between should
and must, for example.
The notion of “act sequence”34 describes speech acts
that are linked together, such as an assertion that precedes
a command.35-38 I was especially interested in the ways
that assertions of fact were building blocks of a directive,
because they provided the evidential warrant.39 Concepts
of framing,40-43 broadly conceived, helped to characterize
the selective presentations of facts, and what gets left out
when complex health problems are depicted in multime-
dia. Framing also describes the concealment of illocution-
ary point and the modification of the illocutionary force
of messages.
In the results section that follows, I present each exhibit
from TAY’s BOL area, including quotes from informants
and theoretical insights to illustrate themes that emerged. I
want to draw the reader’s attention to how health issues are
framed, and how directives are issued, sometimes tacitly.
Visitors encounter a mix of assertions and directives about
the duties of pregnancy and the rights of the fetus, while
representational strategies go from euphemism towards
graphic realism. Quotes show informants negotiating and
resisting these rhetorical appeals, pointing out what is ex-
cluded when an exhibit frames an issue.
Results
Introducing The Amazing You’s Beginning Of Life area
At the entrance to the TAY exhibition on MOSI’s third
floor there is a life-size plaster statue of a naked pregnant
woman, under spotlights, signaling the start of a human
lifespan. Her head bowed down, obscuring her face, she
clutches her swollen abdomen with both hands, drawing
attention to it. A text panel below reads:
YOU begin here. During our journey through life we
gradually begin to understand ourselves. In each life
phase there are new wonders to behold and new dis-
coveries to make. YOU are amazing. Welcome to the
AMAZING YOU!
The second-person, gender-neutral pronoun, YOU creates
a situation of address.44 At BOL you are a pregnant mother
learning about how to deliver a healthy baby. Elsewhere in
TAY, you are an adolescent learning how to resist peer pres-
sure. Still later in the exhibition, you are an elderly person
being told to complete crossword puzzles to postpone neu-
rodegenerative diseases. MOSI executives stated that the
exhibition is not about the body as some abstract object. In-
stead it is about you, and in addition to imparting informa-
tion it will enlist the visitor into a lifetime of biomedical in-
terventions. The epicene pronoun you is being used
deictically to hail various visitor demographics.
Some museum exhibitions take place in an open space
in no particular order. By contrast, TAY is more rigidly
sequential, because visitors are guided from one exhibit
to the next by wall panels that form comb-like passages.
Entering the low-lit, noisy exhibition, visitors first en-
counter BOL, which contains the following exhibits: “In
My Womb”, “Welcome To Our World”, “Infant Roulette”,
“Early Arrival”, “Pregnancy”, “Biocontroversy” and
“Fetal Remains”.
In My Womb
Sponsored by the Morton Plant Hospital Bay Care
Health System, the “In My Womb” video booth has a
bench with seating for three. Each of these short videos
provides narration summarizing a period of gestation be-
tween conception and birth, stressing how formative it is
to the rest of human development. Computer animations
represent the fertilization of an ovum, cell division, and
organ development. Lupton14 notes the use of euphemism
in health promotion discourse. These colorful digital im-
ages are the first example of euphemism being employed
at TAY. Morgan45 argues that digital representations of em-
bryos indicate ambivalence towards actual fetal specimens.
After each video, the screen shows an image of what ap-
pears to be a woman’s hand, with a fetus between her
thumb and forefinger (Figure 1), as if holding the fate of
her offspring in her hands.This image suggests the precar-
ity of the fetus and the gravity of a mother’s responsibility.
WelcomeTo Our World
The title of the next exhibit switches from a first-per-
son singular pronoun (my) to a plural possessive (our).
“Welcome to Our World: Video Footage of Actual Human
Births” first shows 3D animations of a cervix dilating, a
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Figure 1. Feminine hand holding a fetus between thumb and
forefinger (“In My Womb” exhibit).
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uterus contracting, and an in-vitro fetus rotating in the
womb. Animations euphemistically show the birthing
process, the crowning of the baby’s head, and the delivery
of the placenta. The videos that follow show graphic doc-
umentary footage of solo birth, the birth of twins, and a
cesarean. They appear to take place in a hospital, indicated
by hospital gowns and gloves worn by obstetrical profes-
sionals. One of my informants, a mother pseudonymously
named Kay (who was visiting MOSI with her husband
and two children) disliked the exclusive portrayal of hos-
pital birth in these videos:
You walk in, and the first you see is the pregnancy and
birth part…It assumes “I’m going to go to the hospi-
tal”. There aren’t any other alternatives considered.
“I’m going to have an OB” and, really, that’s not the
way it really is in the world. They assume that every-
one has the money to go through this whole hospital
birth experience, and some people just choose not to.
You know, I had her [daughter] at home, and every-
thing was fine, and she turned out to be 10 pounds 6
oz., so she was really a big baby!
Based on her own experience, Kay notes that birth is
being framed selectively in a medical setting. Her objec-
tions to the biomedical hegemony of obstetrics are shown
in the following quote, where Kay describes the negative
aspects of hospital childbirth:
If you go to the hospital, the first thing they do is hook
you up to medical monitors, and they draw blood to
test you for herpes and strep, and even before they get
the results they start pumping you full of antibiotics…
As soon as you walk in the door you are automatically
put on a time limit, so if the labor isn’t progressing ac-
cording to their idea of the time limit they start with
the medical interventions, which could be IV medica-
tion, intra-vaginally, or even caesarian. Most women
end up on those medications, and then they tell the
woman she needs to have an epidural…before you
know it, you walk in the door and you are involved in
all these medical interventions in processes that will
occur naturally.
In this passage, Kay objects to the contrivance of a time
frame and she portrays hospital birth as involving proce-
dures beyond the mother’s control, mandated even when
medically unnecessary. Kay notes that women who decide
on hospital birth are subjected to medical interventions,
such as antibiotics and pain meds. The documentary
footage of hospital birth is notable because it initiates a
ramping up of realism as the exhibits move from away
from computer generated abstractions. The staging of
birth in a hospital setting appears to Kay as a tacit injunc-
tion to undergo a medicalized pregnancy.
Infant Roulette
At the next exhibit visitors spin a chrome steering
wheel that shows post-natal injuries resulting from a
mother’s diet, overweight/obesity, or use of tobacco, al-
cohol and drugs. For example, when the wheel stops on
“Drugs” there is a photograph of an underweight baby in
an incubator. A stanza of text explains that the consump-
tion of illegal drugs during pregnancy can “cause miscar-
riage, premature labor, placental abruption, fetal death,
birth defects and even maternal death”. The text asserts
that babies who are born addicted suffer “withdrawal
symptoms, such as tremors, sleeplessness, muscle spasms,
difficulties feeding, irritability, convulsions, diarrhea,
fever, sleep abnormalties, and joint stiffness”. The unspar-
ing listing of symptoms, combined with photorealistic vi-
suals, are an example of an indirect directive.11 It follows
from the assertions of negative consequences that women
should not use drugs while pregnant, but the directive is
not stated. The implication of the roulette wheel is “don’t
gamble with your child’s safety”, reiterating the frame of
maternal responsibility.
Paula, a health educator I interviewed (who was visit-
ing MOSI with her mom) noted that Neonatal Abstinence
Syndrome (NAS) was not mentioned, especially in the
case of women who already gave birth:
…and that’s actually probably the target demographic
that you have coming through here: women who have
children and may be getting pregnant for a second time.
Maybe they’re on some sort of opiate from a surgical
birth, or a follow-up complication, and now they’re
pregnant and their baby will be born addicted.
By drawing attention to what was omitted in “Infant
Roulette”, Paula suggests the possible health conse-
quences when an exhibit leaves out important informa-
tion. Over 20K U.S. infants a year are born with NAS, a
fivefold increase since 2000,46 corresponding to a national
opiate prescription crisis. Paula also said that the repre-
sentation of Fetal Alcohol Syndrome (FAS) at “Infant
Roulette” was missing some details:
…When you talk about the FAS it is really now like a
spectrum of disorders. It also doesn’t really say any-
thing – doesn’t really specify that a glass of wine a day
could be considered – [that] there’s no amount of al-
cohol that’s actually been proven safe.
Despite the playful frame provided by the roulette
wheel, “Infant Roulette” is a serious informational ex-
hibit describing the consequences of some risk behaviors.
Implicit, but going without saying, is an injunction to
avoid harming your fetus, although Paula implies that
women need the right kind of information to carry out
that injunction.
Early Arrival
Around the corner is an incubator with a realistic model
of a little baby inside (Figure 2). Preterm babies are defined
as being born any time before they reach 37 weeks old, and
text explains that one in nine (or half a million) children in
the U.S. are born premature each year. They struggle with
breathing, digestion, hearing and vision, and may face long
term learning and behavioral difficulties. Subheadings em-
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phasize the maternal role in preterm birth. “Mother’s Med-
ical Risk Factors” lists conditions, including high blood
pressure, diabetes, and being over or under weight.
“Mother’s Lifestyle and Environmental Risk Factors” lists
smoking, alcohol use, and illegal drug use (abuse of legal
drugs is not mentioned). Other risk factors on the list sug-
gest social determinants beyond a woman’s control, includ-
ing the lack of a social support system, working long hours,
and stress. Another stanza of text, entitled “A Growing
Problem?” notes that premature births increased 30% since
1983, but this may be partly an artifact of more stringent
diagnostic criteria. The last line of text reads “Statistics
clearly show that early and good prenatal care reduces your
chances of premature birth”. This sentence is a prototypical
indirect directive, phrased in the indicative mood but sug-
gesting an action to take.
While social determinants are acknowledged, “Early
Arrival” frames the responsibility for premature birth
mostly in terms of the mother’s behaviors. Paula, who
works as a smoking cessation specialist with expectant
mothers, told me that some women prefer to have a
smaller baby.
In certain populations, I mean, it’s desirable. Smoking
causes low birth weight babies, so they think of that
as a bonus-like, ‘Oh, the baby will weigh less. That’s
better for me’. They don’t want to have to carry or
have to push a heavier baby.
She described her clients as not being forthcoming about
their tobacco use:
Everybody thinks they’re different; everybody thinks
they’re especially unique and their actions are not going
to be the norm. The exception to the rule. Nobody’s
honest with me, especially when you meet women who
are pregnant and smoking; if they tell you they’re smok-
ing four cigarettes, they’re smoking twenty.
Rather than rushing to the defense of pregnant mothers,
Paula, above, portrays them as self-interested and duplici-
tous, as if agreeing with the victim-blaming frame of “Early
arrival”. While fact-checking the claims made in the ex-
hibit, I found a WHO fact sheet that framed premature birth
more broadly, listing as causal factors “multiple pregnan-
cies, infections and chronic conditions…however, often no
cause is identified”.47 Other causal factors not mentioned
in the either the exhibit or WHO fact sheet are environmen-
tal, such as air pollution,48,49 lead exposure,50 and household
chemicals.51 By selectively framing its etiology, “Early Ar-
rival” makes moms the primary culprits for premature birth,
while structural factors such as poverty, environment, and
access to prenatal care are downplayed.
Pregnancy
Harré2 describes positioning theory as the study of il-
locutionary force associated with shared assumptions
about rights and duties. Positions (similar to roles but
more fluid) are defined by rules that carry varying degrees
of urgency, from the merest suggestion to the compulsory.
At BOL, motherhood is a subject position with obliga-
tions, because women who conceive enter into a med-
ically predefined course of action. A maternal deontology
(meaning, duties and obligations) is emphasized where
the mother is responsible for post-natal injury. While the
eponymic you of TAY has so far been addressed to the
mother, the next exhibit tries to address a broader swath
of subject positions by way of pronoun disagreement.
The “Pregnancy” exhibit shows a cross section diagram
of an expectant woman’s torso, photos of swollen feet, and
two taut, distended abdomens of women close to delivery.
Text describes symptoms of pregnancy, including hormone
imbalance, pain, constipation, hemorrhoids, increased fre-
quency of urination and skin pigmentation. The last stanza
of text contains an array of addressees, which appear bolded
below to highlight typographical errors which arguably
have an unintended rhetorical effect.
The changes of pregnancy can be uncomfortable. But
if she is aware of the potential for pain and take ap-
propriate steps to avoid it or relieve it when it occurs,
you’ll go through the nine months in relative comfort.
Consulting with a health professional is the best way
to find out what is best for the mother and baby.
This stanza issues a directive to gravid women (and
others in her interpersonal orbit) to avoid and relieve pain
while consulting with health providers. Notice the pro-
noun shifts from third-person singular (she) to second-
person personal (you’ll), to definite articles (mother and
baby), addressing the variety of persons who will view
the exhibit. By switching identifiers mid-sentence, the
“Pregnancy” exhibit may unintentionally be heralding
other subject positions, such as the father, children, grand-
parents or others with a second-person relationship to the
pregnant woman. The shifts in addressee invite others to
consider pregnancy, helping prepare the visitor for the
next exhibit, where they are asked to consider criminaliz-
ing neglectful mothers.
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Figure 2. Realistic model of premie (“Early Arrival” exhibit).
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Bio-controversy
“Bio-controversy” is a video booth located toward the
end of BOL, tackling controversial issues, including irre-
sponsible mothers. Pro and con arguments are made by ac-
tors in minute long videos. After each video, both actors
ask, in unison, “What do you think?” letting visitors decide
who won the debate. However, instead of balancing both
sides of an issue, this exhibit contains hints to the viewer
as to which is the preferred argument. Medical authority,
played by a grey-haired male actor in a white coat, usually
makes a stronger case. In the video, Drugs, Smoking And
Drinking While Pregnant, a question appears onscreen:
“Should a mother who smokes, drinks alcohol, or does il-
licit drugs while pregnant be liable for criminal charges?”
Background pictures show a pregnant woman holding a
cigarette and a beer bottle, and a woman behind bars. The
grey-haired actor who (according to scripts provided to me
by MOSI design staff) is portraying a “Medical Expert”,
says calmly:
The consumption of illicit drugs, alcohol and smoking
puts chemicals into the pregnant mother’s blood
stream, which cross the placenta and can affect the
fetus. Babies are more likely to be born prematurely,
have complications, be drug addicted themselves,
have mental retardation, have heart and face defects,
and much more. Some states have successfully pros-
ecuted the mother for child abuse.
The short argument above can be seen as a series of asser-
tions preceding a directive to criminalize pregnant women,
although it is never stated outright. In classical rhetoric, a
practical syllogism has as its conclusion the performance
of an action, following from a major and minor premise.52
Accordingly, the medical expert’s practical syllogism might
be restated as follows: Abuse is illegal; this is abuse. The
action step that follows is to support criminalization. The
medical expert could plausibly deny he is endorsing crim-
inalization, but is instead making mention of a possible pol-
icy response. With the action step unstated, but reasonably
following from the premises, the audience is enlisted to
come to the preferred conclusion.
The next half of the video shows a young actress por-
traying a “Female Rights Advocate” who provides a
rebuttal:
A woman has the right to do what she wants to her
body. It is not a crime to be pregnant, and it is not a
crime to be an addict. So why should it be a crime to be
a pregnant drug/smoking/alcohol addict? Making this
a legal matter would make substance abuse mothers less
likely to get pre-natal care, which puts the baby at far
greater risk. She needs help, not punishment.
The stanza uttered by the female rights advocate can be
also seen as a sequence of speech acts, in this case not all
assertions. The first two assert the rights of women and
the legality of pregnancy and addiction. These are fol-
lowed by a rhetorical question, and the last two sentences
are directives, because they take a stand and issue a policy
recommendation: help pregnant women rather than pun-
ishing them. Neither interlocutor says that drugs and
drinking during pregnancy is a good idea, but the female
rights advocate asserts that criminalizing behaviors will
result in women not getting needed medical help.
Viewers of the video are provided with some hints
about which side of this controversy is preferable. For
one, the woman carries the title of female rights advocate,
suggesting that her position is political rather than dispas-
sionately scientific. In fact, the move to criminalize ex-
pectant mothers has been characterized as ideologically
motivated, and opposed by obstetricians and addiction
specialists.53 Another clue undermining the credibility of
the female rights advocate is the equivalence fallacy “It
is not a crime to be pregnant, and it is not a crime to be an
addict. So why should it be a crime to be a pregnant
drug/smoking/alcohol addict?” For analogy, consider
“Drinking is legal, driving is legal, so why should drink-
ing and driving be illegal?” The visitor has been tacitly
steered towards the medical expert’s indirect directive to
criminalize, given the logical fallacy of his opponent.
Fetal Remains exhibit
Outside the last exhibit there is a large photo of a fetus
in vitro. Towards the entrance, a plaque announces that vis-
itors are about to see a collection of fetal specimens on loan
from the Human Development branch of the National Mu-
seum of Health and Medicine, a part of the Armed Forces
Institute of Pathology of the Walter Reed Army Medical
Center. Around a glass divider in a dimly lit area are 7 clear
cylinders, illuminated by floodlights, each containing a
fetus suspended in formalin. The collection includes a fetus
at 6 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and
the largest, a 27 weeks-old specimen. At the bottom of each
cylinder there is a plaque explaining what is happening at
each developmental stage. For example, “By 13 weeks the
sex of the embryo can be identified.”
Representational technologies at BOL have so far in-
cluded computer graphics, documentary videos, plastic
models and finally, the realism provided by human re-
mains. As the climactic exhibit, this was the one that sur-
vey respondents and interview participants most wanted
to talk about. They were concerned with the authenticity
of the fetuses, where they came from, and the exhibit’s
appropriateness for children. The plastic premie baby
from “Early Arrival” was perhaps realistic enough for vis-
itors to doubt the authenticity of these fetal specimens.
Coleen, visiting with her 8-year-old son (who was ex-
ploring the nearby exhibits as I spoke with his mom), was
surprised:
No way! I don’t think it actually registered just now
that they were really…real ones! [laughs] you know?
That might have flipped him out if he knew. But I did-
n’t mention it, he didn’t read it, I just kind of glossed
over it. He said “Oh yeah that’s neat!” I said “all
right!” I think in his mind, he is thinking they were
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models. It’s fine. Doesn’t bother me. If he had a ques-
tion about it, I would just explain.
An educated young woman without kids who worked in
marketing, Elizabeth was concerned about the origins of
the fetal specimens. I noted that the plaque said they were
on loan from Walter Reed, but she replied,
It just says that they are on loan, but they don’t say if
they are real or not. Like I know in the Bodies exhibit…
the bodies were real, and it was very controversial about
where the bodies came from. So I assume it was also
controversial here, and especially since there are issues
about pro-life and pro-choice. And you have people on
different sides, obviously, and they may be confused or
curious, and then maybe having to explain to their kids.
Elizabeth is referring to the museum exhibition Bodies,
which was shown at MOSI in 2005, featuring actual human
remains, preserved by a process called plastination. The ex-
hibitor, Premier Exhibitions, maintained that the corpses
used in the exhibition were obtained legally in China, but
details were scant, leading to a legal settlement with the
NYS Attorney General in 2008.54 The comments of Eliza-
beth, above, situate the fetal remains exhibit in social and
political context, which is left out when fetuses are used to
represent sui generis developmental stages.
Another woman named Alexis, also wondered about
their origins:
I think that they should have something clearly written
out that says these were babies that were unable to de-
velop any further and they weren’t killed to provide
this display. They aren’t like a real live person at all,
so that people, especially children, can understand.
“How did they get in the jar, Mommy?” I assume that
they were fetuses who were naturally aborted or mis-
carried and they were used for this purpose after their
lives had ended.
According to MOSI staff, the Walter Reed Medical Center
didn’t provide details about the provenance of the speci-
mens, only that they may be over one hundred years old.
The initiative to collect and preserve fetal material is as-
sociated with the embryologist Franklin Paine Mall, di-
rector of the Carnegie Institution Department of
Embryology, founded at John Hopkins Medical School in
1913,45 who solicited human embryos from doctors whose
patients had miscarried. According to Morgan45 the im-
pulse to collect fetuses was in the interests of science, and
can be viewed as defensible in historical context. The fetal
remains may signify what Layne55 argues is a taboo topic
for American parents: the memory or mention of preg-
nancy loss. These relics of early 20th century scientific cu-
riosity have been supplanted by neater, more palatable
representation technologies such as computer graphics.
Discussion
Apart from some key studies56-58 the directive speech
act has not been a primary focus of communication in-
quiry, let alone the subfield of health communication. A
measure of successful public health interventions is the
degree to which target audiences submit to and comply
with prescribed regimens, and in order to comply they
first need to be asked. While directives are abundant in
public health messages that instruct and persuade, many
health communication studies don’t clearly distinguish re-
porting and ordering. No doubt, receiving and understand-
ing the right information improves outcomes, but in this
paper, I have suggested how assertions of fact can be used
to justify a directive that follows. Researching the as-
sertive-directive speech act sequence has the potential to
enlarge the discussion about health messages, adding to a
fuller understanding of what recipients are expected to do
with the information they receive.
BOL doesn’t just pass on information; it is full of
shoulds and musts, both overt and implicit, for expectant
mothers. Because choices made during pregnancy have such
formative effects, mothers are framed as vessels for human-
ity, foregrounding their duties and the rights of the fetus.59
Concepts of educational scaffolding60,61 describe how sup-
port systems that help introduce new ideas and procedures
can gradually be removed as learners progress. Arguably,
BOL eases visitors into difficult topics through a progressive
movement towards greater realism and urgency. As such,
the exhibits are climax-ordered,62 culminating in a macabre
directive for expectant women to walk the straight and nar-
row and opt for a medicalized pregnancy.
This analysis shows a ramping up of illocutionary force,
as exhibits become increasingly realistic and focused on
prenatal dangers. “In My Womb” has computer animations
focused on normal gestation, and “Welcome To Our World”
begins with animations, then shows actual birth videos.
“Early Arrival” presents a realistic 3D model of an under-
weight baby, and finally, actual aborted fetuses are shown.
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Figure 3. Representational staircase going from should to
must as the exhibits get more realistic.
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Depictions climb a representational staircase (Figure 3)
from euphemism to realism. The staircase diagram corre-
lates representational mode and illocutionary force. That is,
as depictions become more explicit, auxiliary verbs of ne-
cessity (must) supplant suggestions (should), heightening
urgency for the visitor. This is a hypothesis of BOL as a
multimodal argument using assertions to predicate moral
mandates about maternal responsibilities, as evidenced by
the exhibits and informant insights.
Paula noted what information was lost during a trans-
duction of medical expertise into multimodal exhibits, and
Kay noted the preferential portrayal of hospital birth, both
drawing attention to framing. Coleen, Elizabeth and Alexis
voiced a sense of shock about the fetal specimens and won-
dered about their authenticity and origins – their concerns
phrased in vocabularies of “real” and “actual”. The quotes
show them seeking “footing”63 as frames become more re-
alistic and subject positions shift. Positions are addressed
throughout BOL using pronouns or definite articles. Un-
named, unparented, the fetuses efface subjecthood and es-
tablish in its place the grand third-person, singular-neuter
pronoun, it. Their manifest function is to represent devel-
opmental stages, but is their latent function a warning? Can
the fetal remains be viewed as an indirect directive? Are
women being told to place the selfhood of their child over
their own, lest it be still born? An implicit object lesson
about miscarriage, warning women about what can happen
if they don’t behave? In posing these questions, I’m spec-
ulating less about the intentions of MOSI and the exhibit
designers, and more about a potential interpretation, al-
though unarticulated by my informants in such terms.
What makes the present study unique is the consid-
eration of speech acts other than assertions, which helps
surface assumptions about behavior change. The results
show how the illocutionary force of a directive can be
ambiguated by stating it indirectly, in the form of an as-
sertion. Health communication studies note the problem
of reactance to controlling language64-66 which helps ex-
plain motives behind the strategic attenuation of illocu-
tionary force. Questions for further research are related
to the attenuation and amplification of risk,67-69 except ap-
proached from the perspective of speech acts. Namely,
how can representational means (from euphemism to re-
alism) alter the illocutionary force of multimodal mes-
sages? Does explicit realism necessarily correspond with
stronger, more forceful health directives? While modali-
ties in language express possibility and necessity to vary-
ing degrees, can a defensible analogy be made with
multimodal health messages?
Limitations
Although presented under traditional subheadings, the
reader will note discussion and analysis throughout, in-
tended to show how existing theory was consulted in con-
cert with data analysis. This essay is not typical of visitor
studies that measure learning outcomes. Informants were
not asked directed questions, so they spoke only about ex-
hibits that interested or concerned them. Notice men
didn’t comment. A follow-up study will employ a more
directed survey instrument to investigate the hypothesis
that modes of representation correspond to perceived il-
locutionary force. There is also a reflexive dimension, un-
explored here, regarding how my own subject position
(male, childless, middle-aged, white, etc.) influenced the
research process. Despite these limitations, I believe a
fresh approach to the under-researched topic of medical
directives at science museums is presented here. Showing
how multimodal messages link together reports and com-
mands helps foreground what the messenger wants the re-
cipient to do with the information they get, clarifying the
intent of public health interventions. This offers health
communication and museum practitioners an opportunity
for clearer communication and more explicit agendas.
Conclusions
This study presents four different findings about BOL
that can be itemized as follows: i) The selective framing of
pregnancy, emphasizing women’s individual behaviors
over structural determinants. ii) Techniques of subjectifying
women as candidates for a medicalized pregnancy, such as
euphemism, pronouns, logical flaws and indirect directives.
iii) Foregrounding the rights and personhood of the fetus,
provoking questions about the authenticity and origins of
the fetal remains. iv) A ramping up of realism correspon-
ding with increased urgency or illocutionary force.
BOL hails women into a deontology of medicalized
pregnancy, contrasting normal pregnancy with patholog-
ical scenarios of premature birth and miscarriage, which
serve as warnings. The dominant frame of BOL is that
women are responsible for post-natal harm resulting from
their behaviors, while the structural determinants of health
are underexplored. While empowerment is unobjection-
able, there is a risk of victim-blaming when the mother’s
agency is overstated. Women’s responses show strategies
for interpreting and resisting biomedical onuses.
This paper views science center exhibits as speech acts
in sequence, with the directive sometimes unstated, but fol-
lowing assertions as a matter of course. The implication for
further research is that speech acts need to be considered
multi-modally (not only in their paradigmatic verbal form),
and in sequence instead of as stand-alone units of analysis.
This approach can help further health communication be-
yond a narrow focus on information transmission.
References
1. Davies B, Harré R. Positioning: the discursive production
of selves. J Theory Soc Behav 1990;20:20.
2. Harré R. Positioning theory. Self-Care Dependent-Care
Nursing 2008;16:28-32.
3. Kerr A, Cunningham-Burley S, Tutton R. Shifting subject
[page 100] [Qualitative Research in Medicine & Healthcare 2017; 1:6791]
Article
No
n-
co
mm
er
cia
l u
se
on
ly
positions: experts and lay people in public dialogue. Soc
Stud Sci 2007;37:385-411.
4. Braun K, Schultz S. “… a certain amount of engineering in-
volved”: constructing the public in participatory governance
arrangements. Public Underst Sci 2010;19:403-19.
5. ATSC. 2011 Science center and museum statistics. 2014:
Available from: http://www.astc.org/wp-content/uploads/
2014/10/2011-Science-Center-Statistics.pdf.
6. Macdonald S, Silverstone R. Science on display: the repre-
sentation of scientific controversy in museum exhibitions.
Public Underst Sci 1992;1:68-87.
7. Henriksen EKF, Frøyland, M. The contribution of museums
to scientific literacy: views from audience and museum pro-
fessionals. Public Underst Sci 2000;9:393-415.
8. Bud R. Science, meaning and myth in the museum. Public
Underst Sci 1995;4:1-16.
9. Yaneva AR, Rabesandratana TM, Greiner B. Staging scien-
tific controversies: a gallery test on science museums’ inter-
activity. Public Underst Sci 2009;18:79-90.
10. Searle JR. A classification of illocutionary acts. Lang Soc
1976;5:1-23.
11. Searle JR. Indirect speech acts. In: Cole P, Morgan JL, eds.
Syntax and semantics, vol. 3: Speech acts. New York: Aca-
demic Press; 1975. pp 59-82.
12. Beattie A. Knowledge and control in health promotion: a
test case for social policy and social theory. In: Gabe J, Cal-
nan M, Bury M, eds. The sociology of the health service.
London: Routledge; 1991. pp 162-202.
13. Weare K. The contribution of education to health promotion.
In: Bunton R, Macdonald G, eds. Health promotion: disci-
plines, diversity and developments. 2nd ed. New York:
Routledge; 1992. pp 102-25.
14. Lupton D. The imperative of health: public health and the
regulated body. Thousand Oaks: Sage; 1995.
15. Nutbeam D. Health literacy as a public health goal: a chal-
lenge for contemporary health education and communica-
tion strategies into the 21st century. Health Promot Int
2000;15:259-67.
16. Tulchinsky TH, Varavikova E, Bickford JD. The new public
health. 3rd ed. Cambridge: Academic Press; 2014.
17. Petersen AR, Lupton D. The new public health: health and
self in the age of risk. St. Leonards, NSW, Australia: Allen
& Unwin; 1996.
18. Hooper-Greenhill E. The educational role of the museum.
2nd ed. New York: Routledge; 1999.
19. Leinhardt G, Knutson K. Listening in on museum conver-
sations. Walnut Creek: Altamira Press; 2004.
20. Danilov VJ. Science and technology centers. Cambridge:
MIT Press; 1982.
21. Agar M. The professional stranger: an informal introduction
to ethnography. New York: Academic Press; 1980.
22. Spradley JP. The ethnographic interview. New York: Holt,
Rinehart and Winston; 1979.
23. Atkinson P. Handbook of ethnography. London: Sage; 2001.
24. Bezemer J, Jewitt C. Multimodal analysis: key issues (pre-
print version). In: Litosseliti L, ed. Research methods in lin-
guistics. London: Continuum; 2010. pp 180-97.
25. Kress G. Multimodality: a social semiotic approach to con-
temporary communication. Abringdon, UK: Routledge;
2010.
26. Glaser BG, Strauss AL. The discovery of grounded theory:
strategies for qualitative research. Chicago: Aldine Publish-
ing Company; 1967.
27. Charmaz K. Constructing grounded theory. Thousand Oaks:
Sage; 2006.
28. Corbin JM, Strauss AL. Basics of qualitative research: tech-
niques and procedures for developing grounded theory. 3rd
ed. Los Angeles: Sage; 2008.
29. Lindlof TR, Taylor BC. Qualitative communication research
methods. 3rd ed. Thousand Oaks: Sage; 2011.
30. De Borhegyi S. Visual communication in the science mu-
seum. Curator 1963;6:45-57.
31. Cameron D. A viewpoint: the museum as a communications
system and implications for museum education. Curator
1968;11:33-40.
32. Hooper-Greenhill E. A new communication model for mu-
seums. Curator 1991;6:45-57.
33. Searle JR. Speech acts: an essay in the philosophy of lan-
guage. London: Cambridge University Press; 1969.
34. Hymes DH. Foundations in sociolinguistics: an ethno-
graphic approach. Philadelphia: University of Pennsylvania
Press; 1974.
35. Frentz TS, Farrell TB. Language-action: a paradigm for
communication. Q J Speech 1976; 62:333-49.
36. Van Dijk TA. Pragmatic connectives. J Prag 1979;3:447-56.
37. Wunderlich D. Methodological remarks on speech act the-
ory. In: Searle JR, Kiefer F, Bierwisch M, eds. Speech Act
Theory and Pragmatics. Amsterdam: Springer; 1980. pp
291-312.
38. Cooren F. The contribution of speech act theory to the analy-
sis of conversation. In: Fitch KL, Sanders RE, eds. The
handbook of language and social interaction. New York:
Psychology Press; 2005. pp 21-40.
39. Toulmin S. The uses of argument. Cambridge: Cambridge
University Press; 1958.
40. Goffman E. Frame analysis: an essay on the organization of
experience. Cambridge, MA: Harvard University Press; 1974.
41. Tannen D. Framing in discourse. New York: Oxford Uni-
versity Press; 1993.
42. Hom AG, Plaza RM, Palmén R. The framing of risk and im-
plications for policy and governance: the case of emf. Public
Underst Sci 2011; 20:319-33.
43. Steier F, Jorgenson J. Ethics and aesthetics of observing
frames. Cybern Human Knowing 2003;10,124-36.
44. Benveniste E. Problems in general linguistics. Coral Gables:
University of Miami Press; 1971.
45. Morgan LM. The rise and demise of a collection of human
fetuses at mount holyoke college. Perspect Biol Med
2006;49:435-51.
46. NIDA. Dramatic increases in maternal opioid use and
neonatal abstinence syndrome. Bethesda: National Institute
of Health, National Institute on Drug Abuse; 2015; Available
from: https://www.drugabuse.gov/related-topics/trends-sta-
tistics/infographics/dramatic-increases-in-maternal-opioid-
use-neonatal-abstinence-syndrome.
47. WHO. Preterm birth fact sheet: World health organization.
Regional office for europe. Geneva 2013. Available
from: http://www.who.int/mediacentre/factsheets/fs363/en/
index.html.
48. Stieb DM, Chen L, Eshoul M, et al. Ambient air pollution,
birth weight and preterm birth: a systematic review and
meta-analysis. Environ Res 2012;117:100-11.
49. Darrow LA, Klein M, Flanders WD, et al. Ambient air pol-
lution and preterm birth: a time-series analysis. Epidemiol-
ogy 2009;20:689-98.
50. Torres-Sanchez LE, Berkowitz G, Lopez-Carrillo L, et al.
[Qualitative Research in Medicine & Healthcare 2017; 1:6791] [page 101]
Article
No
n-
co
mm
er
cia
l u
se
on
ly
Intrauterine lead exposure and preterm birth. Environ Res
1999;81:297-301.
51. Fei C, McLaughlin JK, Tarone RE, et al. Fetal growth in-
dicators and perfluorinated chemicals: a study in the dan-
ish national birth cohort. Am J Epidemiol 2008;168:
66-72.
52. Gottlieb P. The practical syllogism. In: Kraut R, ed. The
blackwell guide to Aristotle’s nicomachean ethics. Oxford,
UK: Blackwell Publishing Ltd; 2006.
53. Eckholm E. Specialists join call for veto of drug bill. New
York Times. 04/15/14.
54. Wilson M. ‘Bodies’ exhibitors admit corpse origins are
murky. New York Times. 05/30/2008.
55. Layne LL. Motherhood lost: a feminist account of preg-
nancy loss in America. New York: Routledge; 2003.
56. Ehninger D. Towards a taxonomy of prescriptive discourse.
In: White EE, ed. Rhetoric in transition: studies in the nature
and uses of rhetoric. University Park, PA: Pennsylvania
State University Press; 1980. pp 89-100.
57. Fitch KL. A cross cultural study of directive sequences and
some implications for compliance gaining research. ComM
1994;61:185-209.
58. Labov W, Fanshel D. Therapeutic discourse: psychotherapy
as conversation. New York, NY: Academic Press; 1977.
59. Oaks L. Smoking and pregnancy: the politics of fetal pro-
tection. New Brunswick: Rutgers University Press; 2001.
60. Pea R. The social and technological dimensions of scaffold-
ing and related theoretical concepts for learning, education,
and human activity. J Learn Sci 2004;13:423-51.
61. Puntambekar S, Hübscher R. Tools for scaffolding students
in a complex learning environment: what have we gained
and what have we missed? Educ Psychol 2005;40:1-12.
62. Hovland CI. The order of presentation in persuasion. New
Haven, CT: Yale University Press; 1957.
63. Goffman E. Footing. Forms of talk. Philadelphia: University
of Pennsylvania Press; 1981. pp 124-59.
64. Shen L. Antecedents to psychological reactance: the impact
of threat, message frame, and choice. Health Commun
2014;30:975-85.
65. Richards AS, Banas JA, Magid Y. More on inoculating
against reactance to persuasive health messages: the paradox
of threat. Health Commun 2016:1-13.
66. Xu J. The impact of locus of control and controlling lan-
guage on psychological reactance and ad effectiveness in
health communication. Health Commun 2016:1-9.
67. Kasperson RE, Kasperson JX. The social amplification and at-
tenuation of risk. Ann Am Acad Pol Soc Sci 1996;545:95-105.
68. Schütz H, Wiedemann PM. Framing effects on risk percep-
tion of nanotechnology. Public Underst Sci 2008;17:369-79.
69. Goodman JR, Goodman BP. Beneficial or biohazard? How the
media frame biosolids. Public Underst Sci 2006;15:359-75.
[page 102] [Qualitative Research in Medicine & Healthcare 2017; 1:6791]
Article
No
n-
co
mm
er
cia
l u
se
on
ly