Protect Your Womb From the Devil Drink

Julie: Olga, did you know that 3.3 million women in the U.S. are “at risk of exposing their developing baby to alcohol?” Well, their hypothetical babies at least. This number represents the women aged 15 to 44 who are “drinking, having sex, and not using birth control,” according to a report The Centers for Disease Control and Prevention released on Tuesday. In an effort to prevent fetal alcohol syndrome, the agency says doctors should “recommend birth control to women who are having sex (if appropriate), not planning to get pregnant, and drinking alcohol.”

This recommendation is just one part of a surely well-intentioned set of guidelines trying to combat what is a totally preventable birth defect. In the same report the CDC suggests being sure to screen women for alcohol use and referring them to treatment services if they're unable to stop drinking. These are good things to do for any patient.

Whether a woman should drink (small) amounts of alcohol during pregnancy is a fraught and much-discussed topic, but this report is stretching the responsibility of preventing fetal alcohol syndrome onto women who are not yet pregnant.

Olga: To be fair, it’s still not clear to us whether the CDC literally meant what the lead of this USA Today story says: “Women of childbearing age should avoid alcohol unless they're using contraception.” (We asked them for comment, and they redirected us to the original statement).

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.

Olga: Emily Oster, an economics professor and the quintessential rational voice in the pregnancy blogosphere, has analyzed studies showing that there is “no credible evidence that low levels of drinking (a glass of wine or so a day) have any impact on your baby's cognitive development.” One big Australian study of thousands of pregnant women found fewer instances of behavior problems among the children of women who were “light” drinkers during pregnancy than among those who abstained. A different study found the same results for IQ points: The children of occasional drinkers fared slightly better.

Of course there’s a risk to drinking alcohol if you might get pregnant. There’s a risk with nearly everything you do in life. Hormonal birth control, for that matter, has its own risks, like cervical cancer and, for some brands, blood clots. But it’s creepily natalist to suggest you should privilege a risk-free, hypothetical, future motherhood—especially if you don’t desire said motherhood—over one of life’s greatest pleasures.

Julie: I think what gets me is the tone. This report reads as though this is just another good preventative health practice for young women—eat your vegetables, get your pap smear every three years, and don't drink if you're fertile. Suddenly it's not enough that society expects pregnant women to be superhuman models of willpower and sacrifice. This report is holding all women to a higher standard. The language insinuates that your womb is a Schrodinger's box and you shouldn't pour alcohol into it unless you've peeked in there to be 100 percent sure the coast is clear.

Olga: Yeah, the CDC’s job is to promote public health, but an announcement that focuses solely on women smacks of the antiquated view that women shouldn’t drink, period. Men drink far more than women do. They are twice as likely to binge drink. They’re more than twice as likely to become alcoholics. They’re more likely to drink before being in a fatal car accident or before killing themselves. Of course we want to prevent developmental delays among newborns. But if you’re worried about health on a whole-population level, men’s drinking is at least as concerning as women’s, if not more so.

Julie: You're totally right. An infographic that comes along with the CDC report is headed “Drinking too much can have many risks for women.” Drinking too much can have many risks for everybody! (One thing the graphic lists is “injuries/violence” as one such risk “for any woman,” which is really toeing the line of the “women shouldn't drink so they don't get raped” argument.) This focus on women here is only because of their potential as babymakers. Just the potential, it seems, is too risky for the CDC.

Olga: Bottom line for me: It makes sense to, if not stop drinking entirely when pregnant or trying to get pregnant, at least cut way, way down. And of course people should be educated about the risks of heavy alcohol consumption, not just during pregnancy, but all the time. Female alcoholics who get pregnant and can’t quit need a special kind of help. (There are great international examples of home-visiting and other programs designed expressly for this purpose.)

But suggesting all women shouldn’t drink if there’s a chance they might conceive is way too broad. It implies women have no knowledge of or control over their own fertility. And that we don’t appreciate a good G&T on occasion.

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