Julie: Using birth control if you're drinking and fertile was just something the agency told doctors to “recommend.” The only category of women to whom they straight up said, “Don't drink,” was women who are "trying to get pregnant or could get pregnant." But the phrase “could get pregnant” could apply to an awful lot of women.
As of this writing, the CDC homepage blares “Alcohol and Pregnancy: Why Take the Risk?” but what the report is really asking is “Alcohol and the Ability to Get Pregnant: Why Take the Risk?”
Won't somebody think of the hypothetical children?
Olga: The fact that the headlines coming out of the announcement fall along the lines of, “Young women should avoid alcohol unless using birth control” speaks to the lack of finesse in this statement. Consider, for example, this quote:
“Alcohol can permanently harm a developing baby before a woman knows she is pregnant,” Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, told reporters yesterday. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking.”
"The risk is real,” she added. “Why take the chance?”
Why do it? Why is it that whenever public-health officials talk about alcohol, they act like they’re Puritan robots from outer space who could never understand earthlings’ love of distilled spirits. “Why take the risk?” is a naive question. Both men and women drink alcohol because it is extremely fun.
The debate over the risk of drinking while actually pregnant, meanwhile, is as old as time. In recent decades, medical science has taken a much more conservative stance on this issue. Alcohol is considered by most doctors to be a leading cause of preventable birth defects and developmental disorders in the U.S. As one pediatrician put it to me last year, “the very worst thing that a mom could do during pregnancy is drink alcohol.” And women are drinking more in general, so it’s logical that this issue would be on the CDC’s radar.
Julie: The American Academy of Pediatrics has taken a hard line on this, saying in October 2015 that “no amount of alcohol intake should be considered safe” at any point in a woman's pregnancy. Fine. The science of drinking during pregnancy is contradictory and confusing and a “better safe than sorry” approach to official policy is reasonable until the research is clearer. On a policy level.
On an individual level, pregnancy is an exercise in abstinence. Women are told to give up not just alcohol, but caffeine, too. And seafood and lunch meat and soft cheeses. And sometimes, things that are much harder to go without. Jane Marie wrote a heartbreaking essay in Cosmopolitan about going off her depression and anxiety medication while pregnant.
Why? Mainly because we can't do controlled drug studies on pregnant women and babies, duh. Therefore, we don't know what happens to a developing fetus when, say, the mother needs to take 300 milligrams of Wellbutrin every morning, 25 milligrams of Trazodone at night, and 5 milligrams of Valium as needed for fear of flying and wide open spaces and heights. Your guess is as good as mine, literally, and guessing and mothering don't mix well.
But when a doctor says “it's safer for you to go off your antidepressants,” that is a guess. “It is not safe for you to have one glass of wine for nine months” is a guess. Plenty of women have weighed the risks for themselves, made an (informed) guess in the other direction, and turned out just fine.