Pre-pregnant?

[mmcirvin]

There's lots of interesting argument going on about whether the CDC (not the Cult of the Dead Cow) is just being sensible or indulging in Handmaid's Tale creepiness in its health guidelines for women of childbearing age (PDF), as reported in this Washington Post article that freaked a lot of people out. Amanda Marcotte thinks the creepiness is emanating from the Washington Post, not from the CDC. Lindsay Beyerstein differs, and draws a distinction between the (largely sensible) recommendations in the report and its overall tone and emphasis. samantha2074 thinks the CDC just stumbled inexpertly into a politically fraught area without realizing how sensitive the topic was, at a time of major battles over abortion, contraception and working women. I'm not sure.

The WaPo article mentions that a lot of groups were involved in preparing the report. Given their recent activism on Plan B emergency contraception prescriptions, I'm pretty sure that the American College of Obstetricians and Gynecologists (one of the mentioned groups) isn't interested in turning American women into broodmares; quite the opposite—they know that giving women control of their reproduction is a key part of ensuring that babies are healthy and happy.

(This, incidentally, is one of the most obvious signs of the anti-abortion/anti-contraception movement's disconnect from reality: their refusal to accept that the people fighting the hardest for reproductive rights tend to be not some cabal of baby-hating abortion enthusiasts, but OB/GYNs and other perinatal care specialists who probably got into the business at least in part to help babies. But I digress.)

But Beyerstein is right that the CDC report seems to be shying away from saying anything substantive about family planning, and especially about abortion. Because, after all, if you're telling women who don't want or plan for kids to behave as if they're going to have them, you're implying that abortion, no matter how early or how extreme the case, is not an option. And the mere fact that that is so unsurprising is itself disturbing.

Comments

[ronebofh.livejournal.com]

Thanks, Matt. This was about how i felt about it, but you put in the time to look at things and expand on it.

[swinehund.livejournal.com]

Exactly. I've talked to a lot of women who originally did not intend to have children, but who are currently mothers, as 'something changed' once they realized they were pregnant (though some of them admitted to regretting their decision afterwards). Also many women who have had an abortion claim the experience has changed how they would handle a subsequent accidental pregnancy (they would not abort again). These have not been 'broodmare' types at all, but generally strong and independent women who had not previously envisioned themselves as mothers. Their experiences have encouraged me to make sure that my contraception is as effective as possible. While I say now that I wouldn't think twice about having an abortion if I became pregnant, I also know that I can't be sure about this decision if it actually happened.

Considering this wacky hormonal or whatever effect, the recommendations make perfect sense, as does ensuring that safe and effective (pre-conception) birth control is universal. I would be irked if this plan were forced on me and demanded major and otherwise unnecessary changes in my lifestyle, but they seem to be just promoting better overall health.

[graydon.livejournal.com]

I think the CDC makes a perfectly reasonable point. Most of the pregnancy scares I've witnessed involved just that: being scared. Not being ready. Maybe having a baby when not having made the proper preparations. Usually only because "Hmm, it's been a bit too long .. why aren't I menstruating?" That's a bad time to be wondering if you should stock up on folic acid. The CDC is absolutely right in that.

But you're also right that the easiest way to make sure people don't have unhealthy (not to mention unwanted) babies is to make sure they don't have babies by accident, and that this is not the sort of message the other side of the culture war likes to promote. Any discussion or treatment of "pre-conception" health is incomplete without recommendation and training in how to stay "pre-conception".

[mmcirvin.livejournal.com]

Of course that does happen, and had things gone a little differently Sam and I might well have found ourselves in that situation, which is why she's been taking folic acid supplements all along. (She also doesn't smoke and has never done much drinking of alcohol, though it wasn't for reasons having to do with pregnancy.) I do think that that situation's primarily what the CDC document is trying to address, though I wish it had been a little more explicit about it.

I suspect that the authors of the report had good intentions, but have had to modify their official message somewhat given the political climate.

[paracelsvs.livejournal.com]

Wait, this Amanda Marcotte makes a big deal about the recommendation about avoiding cat feces, thinking it some sort of dig against cat-owning women. It might be an understandable reaction when that recommendation comes right out of the left field and makes so little sense in the context of common knowledge, but...

That's really just the toxoplasmosis craziness again! This thing really is starting to drive me nuts, arrrrr.

[eb-oesch.livejournal.com]

To me, it appears that the Post was wrong about the extent of the gap between the US and other countries. I cannot say whether Save the Children made an error or not, but the Post at minimum repeated inaccurate claims and quite possibly originated them. Perhaps the Post mistook Save the Children's statistics regarding "probability that a mother will see a child die in the first year of life", which is a statistic that combines infant mortality and pregnancy rates, for simple infant mortality rate statistics. In any case, according to the Post, "The U.S. infant mortality rate is higher than those of most other industrialized nations -- it's three times that of Japan and 2.5 times those of Norway, Finland and Iceland, according to a report released last week by Save the Children, an advocacy group," but US's IMR is about 7.0/1000, while Japan's (indeed the lowest) is about 4.0 -- a considerable difference, but much less than three times greater. (See http://www.cdc.gov/omh/AMH/factsheets/infant.htm and http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8295019&dopt=Abstract -- these statistics may be slightly off or slightly dated, but not nearly enough to justify the Post's claim. Unfortunately, the latter link is only an abstract -- the entire article would probably be an interesting read in this context.)

It apparently is true that the IMR for black mothers in the US is about 2 1/2 times greater than for white mothers. I see no reason to suppose that race is directly (as opposed to indirectly) relevant to the IMR, so if one divided the population using indicators that did bear directly on infant mortality, one would presumably see differences that were much higher still. While I haven't proven it, I doubt many would dispute that raising the conditions of the worse-positioned half of mothers to average levels would have a far greater effect on the US IMR than would raising the conditions of the better-positioned half to that of the ninety-ninth percentile. The real key to cutting the gap isn't adopting extraordinary measures to protect fetuses, but insuring that ordinary measures are available and used more widely, and this might partly explain the reactions the article received. (Having said that, taking a daily average-strength multivitamin -- none of this more-is-better "2000% RDA of vitamin X" crap -- always seemed to me to be a no-brainer anyhow. A friend's assertion that giving a daily multivitamin to all public school students would be an extraordinarily cost-effective health measure seems more than reasonable, whether or not he was correct that malnutrition largely explains why Head Start students tend to fall behind academically again after exiting the program.)

[eb-oesch.livejournal.com]

OK, I looked at this a little more. One can find claims for infant mortality for Japan that are considerably lower than 4 -- as low as 1.8, in fact -- and in fact Save the Children said just what the Post writer said they did. But it's still bogus. The sticking point is wide variations in counting whether the baby was alive in the first place (http://www.qando.net/details.aspx?Entry=3848), and while I'm not Catholic enough to care too much about which definition one uses, one should at least pick a definition and stick to it. I believe that the CDC and NIH documents do this. The US has a bad infant mortality problem -- 75% higher than Japan is a big difference -- but the more extreme claims are irreponsible.

Aside: it is apparently a myth that the disparity in infant mortality rates between children of black and white women has any explanation whatsoever (http://www.state.nj.us/health/bibs/myths.html). I have to admire the subtlety of the misdirection used, and I probably would have fallen for it if they had left themselves any wiggle room instead of coming within a hair of proving that 1=0.

Of course, the IMR among white women in the US is considerably higher than necessary also, which can be proven in many ways. One could point out that it's still 50% higher than the rate in Japan. Or one could point out that, since this country does not practice explicit segregation, the social problems that greatly inflate the IMR for black women must affect many white women also.

[mmcirvin.livejournal.com]

I'd guess that this might be one of those cases Malcolm Gladwell likes to talk about, where going after the median case is not going to help that much because the problem is mostly with a minority of terribly malnourished and desperate mothers and kids.

[eb-oesch.livejournal.com]

I was inclined to guess the same way, but after looking at the government statistics (http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_16.pdf) I'm more doubtful. A mere one-third drop in the infant mortality rate from the least to the most educated black women just doesn't fit the notion that the problem is largely confined to "terribly malnourished and desperate mothers and kids", although I'm sure the mortality rate among those who could be counted in that category is terrible. There's also an old paper that points out that the relevant "pre-pregnant" stage starts from the mother's conception, i.e. the lifelong nutrition and general health of the parent affects infant mortality. It could still be a diet issue, but then we might have to count overweight junk food addicts who aren't desperate at all in the "malnourished" category. And why do the Cuban immigrants have an excellent infant mortality rate while the nearby Puerto Ricans' is almost twice as high? I figure that somebody must have a pretty good idea of the importance of the various environmental causes of infant mortality in this country, since it's a large effect that has affected a large population for a long time, but I sure don't.

[kumho35.livejournal.com]

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