Windy Twilley

Yarn keeps me from opening fire.


Forever Pregnant?
Washington Post writer spins benign guidelines into slippery-slope nightmare

I’m not a betting girl, but I’d wager that January Payne has read one too many Margaret Atwood novels. Her May 16 article in the Washington Post, entitled, “Forever Pregnant,” is an attempt to incite outrage over a set of common-sense guidelines recently set out by the CDC .

The title of the article is, by itself, an incendiary device. What woman wouldn’t get her hackles up at the suggestion that she should be “forever pregnant?” (And what man wouldn’t flee in fear from a woman who was eternally nauseated, grumpy, and hungry?) As a former newspaper reporter, I know that most writers do not get to choose their headlines - but I also know that the headline should not directly contradict the story it tops. There is no suggestion, either in the CDC report or in Payne’s article, that the federal government wants to keep all women between menstruation and menopause shackled in the chains of pregnancy.

The CDC released a set of guidelines on April 21, 2006, in a report entitled “Recommendations to Improve Preconception Health and Health Care - United States.” The full text of the report can be found here. Its stated goal is “to improve the health of women and couples, before conception of a first or subsequent pregnancy.” It discusses the importance of creating a “reproductive health plan,” which “reflects a person's intentions regarding the number and timing of pregnancies in the context of their personal values and life goals.” Or, to put it another way, don’t have babies willy-nilly.

This is common sense to most of us, but not to January Payne. “This means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.”

Horrors! What outrageous suggestions! I’m willing to bet that, even if you had a complete hysterectomy, your doctor would still tell you to do most, if not all, of those things. Additionally, Payne’s shrill “all women” is contrary to the stated goal of the study - but would she say that non-reproductive women should start drinking regular Coca-Cola and eating chicken-fried bacon, with smoke breaks in between? Probably not - although chicken-fried bacon sounds tantalizing, doesn’t it?

Having a baby is probably the most physically grueling process the human body can endure. Doesn’t it make sense to prepare for it? Lance Armstrong didn’t stub out a cigarette before hopping on his bike at the Tour de France. The winner of the Boston Marathon probably wasn’t out doing shots the night before. But for some reason women believe that their bodies can just leap into action at the flip of a switch.

The starting point for the CDC’s report is the idea that half of all pregnancies are “unplanned” - so most women don’t realize they are pregnant for a month or more, at which point damage to the fetus may have already been done. It’s hard to quit smoking when you’re staring down the barrel of a pregnancy test. It’s hard to eat right and exercise when you can barely keep Saltines down and spend hours of your day wondering if you will make it to the bathroom before you throw up on your shoes.

Maybe it has to do with our increasing idea of “fertility on demand.” Women have unprecedented control over when we procreate, and maybe we’re beginning to believe that babies can be scheduled, like a bikini wax or an oil change. And perhaps we do not understand that, in addition to merely being “unhealthy,” behaviors like smoking, or doing drugs, or even pounding Twinkles a dozen at a time, can affect how smoothly your pregnancy goes - and more importantly, how healthy your baby is.

January Payne doesn’t understand that. Instead, she invents the inflammatory term “pre-pregnant,” as though the CDC wants to turn women into walking wombs. She also neglects to list the CDC’s ten recommended guidelines for preconception health, which include ludicrous suggestions like “personal responsibility across the lifespan.”

The CDC’s report follows on the heels of a report from Save the Children, which ranked the infant mortality rate in the US low on the list of industrialized nations. According to that report, 7 out of every 1,000 American babies will die, mostly the result of birth defects, low birth weight, and SIDS. All three of these conditions can be ameliorated through proper preconception and prenatal care. Payne writes that infant mortality in the US is “three times that of Japan, and 2.5 times that of Norway, Finland, and Iceland.” This is a classic scare tactic. 7 out of 1,000 is point-zero-seven percent - a tiny fraction. If I have one M&M and you have two, you have twice as many as I do - but neither of us has enough to satisfy the choco-lust inside. Similarly, if you double and triple tiny numbers, the resulting numbers are still very small.

The other four countries listed in that group are very different from the United States, in that none of them has a large low-income or immigrant population. Additionally, the United States is known for its high-risk obstetrics and neonatal care. Babies that would simply be miscarriages or stillbirths in other countries are vigorously treated and given every chance at life here.

Unlike universal health care schemes, the CDC’s recommendations are helpful to all women, regardless of their insurance (or lack thereof). “Healthier women have healthier pregnancies,” said Merry Moos, a professor in the University of North Carolina's maternal fetal medicine division who was quoted in Payne’s article. And if the overall health of women in the nation was improved, there might not be such a pervasive “need” for health insurance.

Now that’s a shocking idea.


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