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What's Wrong With Suggesting Women Who Drink Use Birth Control?

Forty percent of births in America are unintended, which can lead to unhealthier babies and kids. But is treating every woman as "pre-pregnant" the answer?
(Photo: H. William Tetlow/Fox Photos/Getty Images)

(Photo: H. William Tetlow/Fox Photos/Getty Images)

Well, that's certainly one way to think of it.

On Tuesday, the Centers for Disease Control and Prevention (CDC) published a joint report and press release about the dangers of drinking and not using birth control. Startlingly, instead of noting that such habits could result in an unintended pregnancy—and all the stress that entails for the mother—the CDC chose to focus on the fact that girls and women who drink and don't use birth control could accidentally conceive a baby with fetal alcohol syndrome. "Alcohol can permanently harm a developing baby before a woman knows she is pregnant," CDC Principal Deputy Director Anne Schuchat said in the release. "The risk is real. Why take the chance?"

The report has garnered a lot of protest. Why? On the one hand, the CDC's recommendation is sound. Drinking, being sexually active with an opposite-sex partner, and not using contraception is a risky mix for anybody who is fertile, regardless of gender. But to frame the message as the CDC has can be dangerous. It harkens to an idea in public health that's faced a lot of criticism: treating childbearing-age girls and women as "pre-conception," regardless of whether or not they actually intend to conceive. Doctors are supposed to encourage female patients to adopt wholesome habits in order to ensure any babies they happen to have are healthy. While some doctors may apply it to all of their female patients, "pre-conception care" most often targets young, low-income, minority women, which is the demographic that's most likely to have unintended children. While it takes aim at a real public health need, the "pre-conception" paradigm is condescending and insulting—and it may not even be very effective, because many girls and women dislike the message.

Let's start by looking at the scope of the problem pre-conception care proponents hope to solve. It's big. In 2008, 40 percent of births in America were reported as unintended. Unintended babies are more likely to be born too early, and their mothers are less likely to get prenatal care. There's evidence having unintended children is bad for the whole family.

But is approaching every young lady of color as "pre-conception" the right way to reduce the ill effects of unintended pregnancies? There are several problems with the notion:

  • It prioritizes hypothetical fetuses over real women. This "baby first" attitude—remember, we're talking about unwanted, hypothetical babies—can be deeply insulting. It suggests women's health and bodies are not important, except as a conduit for offspring. In addition, should a clinic become overly focused on pre-conception care for all women, it may unfairly ignore unrelated or conflicting aspects of women's health, such as that of lesbian, transgender, and post-menopausal women, and women undergoing cancer treatment, philosopher Rebecca Kukla argues.
  • It assumes all pregnancies, even unwanted ones, will be carried to delivery. Not only is this idea untrue, but together with a "baby first" attitude, it may erode support for easily obtainable emergency contraception and abortions.
  • It's alienating. We were not able to find any scientific surveys about how women feel about being considered constantly on the brink of having an unwanted child, but news reports suggest they don't like it, which may mean they won't listen.

There are better ways to achieve the healthier numbers that pre-conception care proponents want. Re-focusing health care to better focus on the young women themselves is a start. After all, the healthy behaviors doctors want to encourage "for the babies" are also good for women, including eating healthy, not smoking, and getting screened for sexually transmitted infections. Even the idea of not drinking while not using birth control can be oriented as benefiting women. You don't want to have an unintended pregnancy, especially one that may be complicated by fetal alcohol syndrome.

The proven way to reduce the sad consequences of unintended births is to support free and low-cost family planning services for women who need them. "In 2013, publicly funded family planning services helped women prevent two million unintended pregnancies; of those, one million would have resulted in an unplanned birth and 693,000 in an abortion," the Guttmacher Institute reported last year. An ounce of prevention is worth a pound of cure, and when it comes to unintended pregnancies, prevention should start with family planning—not with weird protections for babies who haven't even been born yet.