The CDC has a new message for women: stop drinking alcohol unless you’re on birth control.
Fetal Alcohol Spectrum Disorders (FASD) are birth defects that can occur when women drink during pregnancy, and may include physical, psychosocial, and intellectual disabilities. There’s no disagreement in the health care community that FASD are a tragedy, all the worse because they are 100% preventable. However, the amount of alcohol consumption that is considered safe for pregnant women has long been the subject of (unresolved) debate, though most advice tends towards complete abstention.
This week, the CDC took this conversation in a new direction, initiating a FASD prevention campaign that implicates all women of childbearing age by claiming that 3 million women are at risk of injuring a baby because they are “drinking, having sex, and not using birth control”. As a strong supporter of their mission, I was dismayed to see the CDC join the long list of actors holding women individually responsible for public policy goals. To be clear, the concern about FASD is well founded, and women’s health behaviors are an important part of prevention. But the singular focus on women’s personal decisions without regard for the other factors driving alcohol consumption during pregnancy is disappointing from the nation’s leading public health agency.
It is flippant to tell women they should be on birth control when there exists a genuine debate as to whether access to contraception is something women should be entitled to at all. This has real world consequences for women: just this week, a New England Journal of Medicine article found that unintended pregnancies in Texas went up after the state radically cut back on access to family planning. The CDC tells us that half of pregnancies are unplanned, which is why all women who could theoretically get pregnant shouldn’t drink; perhaps it should also be asking what could be done to improve access to care so that more women can plan their pregnancies.
An effective education campaign could help women be more mindful of their alcohol intake, but it doesn’t do much for the highest risk group, women who drink heavily throughout their pregnancy. FASD risk is directly tied to amount of alcohol consumed. Treatment for alcohol dependence requires professional help. However, access to mental health care and substance use treatment is sorely lacking.
The infographic of drinking risks for non-pregnant women has been the source of much of the campaign ridicule. It includes: injuries/violence, heart disease, cancer, sexually transmitted diseases, fertility problems, and unintended pregnancy. While it is amusing to note that no one has been punched in the face by a glass of wine, this list skates dangerously close to victim blaming. Violence, STDs, and pregnancy aren’t solo activities, even if, too often, women are held solely responsible.
I realize that I’m being hard on the CDC. But this campaign is thoughtless and does a disservice both to women and to the important public health issue it seeks to address. Telling women to be more responsible is easier than fixing societal attitudes and policies around reproductive health and mental health and intimate partner violence. But just because those things are hard doesn’t mean we shouldn’t try.