The American medical establishment instructs pregnant women to not drink alcohol, and those who ignore this advice — like those who do not breast-feed their children — are subject to social shaming. Is the circle of shame about to get a lot bigger?
Citing the dangers of fetal alcohol spectrum disorder, the Centers for Disease Control last week released an advisory that directs women of childbearing age to abstain from alcohol entirely unless they are on birth control. This recommendation, which unduly burdens women between the ages of about 15 and 44, is deeply troubling on both scientific and ethical grounds.
Despite decades of research, and contrary to public belief, we have no substantial evidence that light drinking during pregnancy as part of a generally healthy lifestyle has any link with FASD. The CDC released a report in 2014 concluding that low to moderate alcohol use did not predict intelligence scores or attention skills in 5-year-olds. Nevertheless, the latest advisory claims that “there is no known safe amount of alcohol — even beer or wine — that is safe for a woman to drink at any stage of pregnancy.”
Even as the CDC cracks down on potentially pregnant women, it offers no parallel recommendations for expectant fathers. Yet we know that men's drinking reduces sperm quantity and quality, and that it has epigenetic effects on their offspring's tolerance for alcohol. Moreover, expectant paternal drinking is correlated with an uptick in the frequency of intimate partner violence, which in turn can cause miscarriage, preterm birth and birth defects.
The specific targeting of women's alcohol consumption — and especially the scientifically unsupported prohibition of any alcohol consumption — is rooted in the belief that mothers have more responsibility for fetal health than fathers, and that women cannot be trusted to regulate their alcohol intake appropriately in light of realistic risk data.
What's more, by extending its no-alcohol advisory to all women of childbearing age unless they are on birth control, the CDC is sending the message that women are in effect always poised for pregnancy, and should subjugate their desires to the maximization of their healthy-baby-making capacities.
Of course many women who are not on birth control are also not on the brink of conception. Some choose to only have sex with other women, or with men who use condoms, or at low-risk times of the month. The CDC's overbroad recommendation implies that women are either incapable of self-control or always at risk of rape — and that they are responsible for modulating their lives accordingly. Both suggestions are underscored by a CDC infographic, which lists “unintended pregnancy,” “sexually transmitted diseases” and “violence and injury” as risks for women who drink.
While asking pregnant women to cut out routine activities “just to be safe” may seem reasonable, taken to its full conclusion this would be completely paralyzing. Almost every food, product and activity poses some risk to fetuses. Getting into a car when pregnant, for instance, is almost certainly more dangerous than having a glass of wine. Besides, alcohol consumption isn't that frivolous; in asking women to abstain, we are excluding them from a wide variety of social rituals, community spaces and events.
This isn't the first time the CDC has suggested that women's needs are secondary to that of their possible future children.
Ten years ago, the agency released guidelines calling on all healthcare providers to reconceive all healthcare for women of reproductive age as “preconception care,” because any woman's visit to the doctor “may be her last before she becomes pregnant.” But what is best for a woman when it comes to prescribing drugs and so forth is not always the same as what is healthiest for a (hypothetical)
Nor is the CDC the first governmental organization to discourage women from participating fully in public life for the sake of their offspring.
In 2009 during the swine flu scare, the British Royal College of Obstetricians and Gynecologists and the United Kingdom's chief medical officer asked pregnant women to avoid crowds and public transportation and to “stay indoors when practical”; the advisory trivialized this exclusion from public space by dubbing it an optional “lifestyle change.” In California, almost all public buildings are decorated with Proposition 65 warnings that indicate, without elaboration, that those buildings might contain chemicals that could cause damage to fetuses.
Targeting individual women's lifestyle choices in order to control fetal risk enhances a culture of blame and implicitly endorses paternalistic control over women's agency. If we wish to reduce the incidence of FASD, we should be looking at structural solutions that will help potential mothers avoid and overcome the true risk factors for that disorder: addiction and poverty.
Rebecca Kukla is professor of philosophy and senior research scholar in the Kennedy Institute of Ethics at Georgetown University.