There’s a swirl of media and pithy opinions that pertain to women of child-bearing age this week that have come off as fairly oppressive. You’ve heard the news — this is about Zika and this is also about alcohol. First, there’s a new report out of the Centers for Disease Control (CDC) that stitches truths about unplanned pregnancy, alcohol use in child-bearing years and offers advice that has lit women and the blogosphere aflame. The CDC’s goal is valiant: inform women about risks alcohol has on developing fetuses, remind the public that nearly 1/2 pregnancies are unplanned and remind women to make “good choices.” On top of this, women of child-bearing age have been told that not only can we not take a trip to Mexico or Central America while pregnant because of risks from Zika, we learned earlier this week that we can’t have unprotected sex with our partners while pregnant if there is any chance of an exposure to the virus. Women planning on getting pregnant should also take precautions. As a reminder, Zika is a somewhat silent infection (only 1 in 5 who get it have symptoms) so the risk criteria is just based on where you go and where you’re exposed. If we women get the Zika virus while we’re pregnant or at the time of delivery, our babies can have devastating side effects. So the threat can feel very real.
Something that has to be said: public health recommendations in keeping families healthy will at times differ for men and women. It’s just the way it’s gonna be because of our differing roles in making and raising children. Nonetheless, I’m here to say I think the advice and the news this past week has felt like a big ton of bricks. Advice has felt unrealistic, sexist, and oppressive by many even though it’s based in smart public health data. For the first time in my life I’m relieved that I’m not thinking about having another baby. I mean it’s just a lot to toss around. That being said: IT’S A WONDERFUL TIME to have a baby. Let me do my best to frame up the alcohol conversation as a mom, feminist, pediatrician and health advocate. The updated recommendations/precautions on Zika will be in my next post:
Pregnancy, Women Who Can Get Pregnant, And Alcohol:
In the report’s summation, it advises women who 1) ARE pregnant or who 2) are TRYING to become pregnant to refrain from drinking. Pretty standard. It’s group #3, the group that MIGHT become pregnant causing a bit of unease. The report recommends that women who MIGHT become pregnant (capable of becoming pregnant) unintentionally & who consume alcohol, to either refrain from drinking altogether or use contraception. This includes women of child-bearing age (15 to 44) who are drinking, having sex, and not using birth control – roughly 3.3 million based on the CDC report. According to a study in 2011, we learned that about half of all US pregnancies are unplanned and, even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy.
The strong recommendation is a little like the theorems we solved in our logic classes in high school. A is true (50% of pregnancies are unplanned) and B (alcohol can severely impact fetal development, the dose causing harm across the board is unknown) that therefore C (women who drink should ensure they don’t get pregnant). True. Fetal Alcohol Spectrum Disorder (FASD) has lasting detrimental effects so this is high-stakes.
The CDC’s advice was clearly a forceful and somewhat impractical recommendation in a culture that endorses alcohol consumption like ours. Lifestyle restriction recommendations for women may be a sensible approach, but have to come in concert with acknowledging need for rapid improvement in education, access, and affordability to birth control for women of all ages. The fact that 50% of pregnancies are unplanned proves we must improve efforts. We’re making inroads with emergency contraception being available over-the-counter, with ACA covering birth control for all women, highly effective long-acting options for teens (IUDs, implants), and inventive ongoing efforts around the country to decrease unplanned teen pregnancy.
When it comes to alcohol, most physicians provide conservative advice — say no to alcohol all together if a baby is involved. No data that alcohol is safe when growing a baby.
Trusted sources like the American Academy of Pediatrics have long advised no alcohol during pregnancy, reaffirming this position in 2015. This is based on evidence that alcohol can harm your baby even before you know you are pregnant and drinking during any trimester increases odds of having a baby with FASD. Your OB will likely tell you to abstain from drinking while trying to get pregnant and while pregnant, too.
But knowledge around risks of alcohol on fetus may be poorly understood by the public and incompletely understood by scientists. The data that came out this week fueling the recommendation from the CDC confused some. Pediatrician and health economist researcher, Dr. Aaron Carroll, wrote a fantastic blog post on this topic and found some interesting data discrepancies:
You need to weigh risks and benefits. What is the prevalence of FADS? Even the CDC can’t decide. In their Data & Statistics section, they say that some records can identify 0.2 to 1.5 infants with FADS for every 1000 births. A more recent study found 0.3 out of 1000 kids 7-9 years of age has FADS. Other in-person assessments found that 6-9 per 1000 kids might have a FADS. But their new infographic proclaims that “Up to 1 in 20 US school children may have FADS.” Huh?
Yes, we want women who are trying to get pregnant or pregnant to avoid alcohol so as not to harm their infant. Yet how you interpret this week’s news if you’re just of child-bearing age might vary — it’s hard for women to feel they are being told to either abstain from alcohol or take singular responsibility for family planning. Men were unfortunately left out of the statement. Irregardless, the intention behind this recommendation is safety, architected to prevent birth defects caused by fetal alcohol spectrum disorders (FASDs).
FASDs can cause serious physical, behavioral & intellectual disabilities. Women drinking during the 1st trimester, compared with women who abstain, have a 12-fold increase in having a baby with side effects (FASD).
No question CDC got our attention this week on the risks of alcohol on developing babies. Although the package may have been imperfect by coming off as oppressive, I’m thinking we (as a public) walk away a little bit smarter. I mean, holy moly it’s amazing to think about having a baby. Even way before it happens. This advice just designed for a happier, healthier outcome.