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May 17, 2006

Women Need These Guidelines More Than A Fish Tank Needs a Bicycle

I'm a huge fan of Echidne, but this assault on the CDC's new "preconception health report" (pdf) is wrongheaded. Women -- and for that matter, men -- are already told to maintain proper nutrition, exercise regularly, resist smoking, properly treat chronic conditions, and maintain a healthy weight. That a crew of doctors, on Mother's Day, suggested that women of reproductive age do the same lest an unplanned pregnancy that they choose to keep end with a low birth weight or otherwise malformed child is no occasion for a glance at A Handmaid's Tale. And to say that "It is not really [a woman's own] health that concerns [their] physician" is a straight insult to a medical profession that is constantly and continually begging everyone of every gender to practice prevention and healthful habits. It would be one thing were this the only context in which health recommendations were offered to women, but that's not true. It's not even near truth. Here's the CDC's women's health page, which has the most prominent billing on their home page. In fact, this week is Women's Health Week. It's just flat-out false that the organization is only attentive to women in their capacity as breeders.

Moreover, the doctors are right. I have more than a couple friends with active sex lives and a prescription for birth control who nonetheless would carry a pregnancy to term were they to accidentally conceive. Few of them realize, though, that certain current behaviors could hurt a potential child, even if they ceased after the first ultrasound. Given their attitude towards an unplanned pregnancy, they should know if their behaviors are making such an event riskier than it would otherwise be. And given the serious horrors that low birth weight babies go through for their entire lives (not to mention the massive sums they cost the parents), women should know that harm can occur between conception and realization, if for no other reason than it affords them more reason to be cautious and more information on whether to keep a pregnancy.

That said, Echidne argues, correctly, that if the government really wants to help women and their children, they should be extending health coverage. I take a backseat to absolutely no one in my pursuit of expanded access, but this report came from the CDC -- they have absolutely no power or influence on insurance issues. It's like wondering why they didn't call for a full employment policy at the Federal Reserve. Even so, Echidne should have read the report (I get the feeling she only read WaPo's coverage of it). One of the the ten recommendations is, and I quote the header here, "Health Insurance Coverage For Women With Low Incomes."

Lastly, it's important to be clear: there's nothing forcing a change in habits here, these are just recommendations. And no one, so far as I know, is arguing against their medical accuracy, nor the intentions of "The American College of Obstetricians and Gynecologists, the March of Dimes, Dartmouth Hitchcock Medical Center, the National Center for Chronic Disease Prevention's Division of Reproductive Health and the National Center on Birth Defects and Developmental Disabilities," all groups involved in the drafting. Women can make their own decisions on how to live their lives. But they should have all the relevant information. And these guidelines are unquestionably relevant information.

Update: In a clarifying post, Echidne argues against the level of intervention the report seems to recommend. Welcome to medical literature. If we actually listened to the reports, we'd all do aerobic exercise for 60-90 minutes a day, eat between 9 and 11 servings of fruits and vegetables (of different colors!), and never touch a donut. These are papers written by doctors intimately acquainted with the most heartbreaking and tragic eventualities imaginable. Their guidelines are written to create medically optimal outcomes. It's up to us to balance them with our lives, our pleasures, and our risks.

Update 2: Echidne further clarifies here (and in comments below). It seems to me that the worst of this report was journalistic coverage of it. The WaPo article that everyone read was a couple orders of magnitude worse than the document itself, a contrast Amanda treats in full here.

May 17, 2006 | Permalink

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» All Women are Pre-Pregnant from Outside The Beltway | OTB
A new set of CDC guidelines suggests that all women of child bearing age be considered potentially pregnant. New federal guidelines ask all females capable of conceiving a baby to treat themselves and to be treated by the health care system ... [Read More]

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» Treat every woman as if she were pregnant from Pound of Cure
I started to write about this yesterday, but decided to wait a bit, just to see what would fall out of the woodwork. The CDC released a recommendation yesterday that physicians should advise all pre-menopausal women to \"consider all treatments, pr... [Read More]

Tracked on May 17, 2006 10:38:56 AM

Comments

I was irked by the tone of the report as well. It's highly patronizing to assume that women simply need more education in order to be in a perfect state of 'preconception' their entire reporductive lives. Note the examples of your friends above. Do you really think they don't know that they should be doing things differently just in case their contraception fails and they have an unplanned pregnancy?

Plus, another point that irks is one which is (not surprisingly) completely absent from the report. Birth control. You'd think that amidst all this great advice about how to be a perfect walking baby factory, the CDC might say something about educating women on proper uses of contraception, so that those unplanned pregnancies they're so worried about might instead be planned ones, right? Nope. The only mention of contraception happens in the section devoted to "high risk" behaviors, such as the consumption of alcohol and drugs. Brilliant.

Posted by: fiat lux | May 17, 2006 2:55:15 AM

I deleted the posts because I did read the report and I thought that nobody had read the posts yet...

I've put them back but the links are now different. The original post is
here

and the follow-up here

I'm going to write a third post to explain why I felt so strongly and in what way the original report is better than I thought. Yes, I did write the first two posts before reading the report.

Posted by: Echidne of the snakes | May 17, 2006 3:03:41 AM

And the reason is that I'm on vacation. Vacation! I should not have tried to write something quickly while my mom was waiting for me to go with her.

Posted by: Echidne of the snakes | May 17, 2006 3:04:43 AM

But you misunderstood my explanation post, Ezra, at least partly. The point was not just that the recommendations are very far reaching, including the counseling of women who have no plans to have any more children, but also that this program is about modifying the behavior of one group of people (women or drinkers) to benefit the health of another group of people (infants or pedestrians), and my argument was that we wouldn't do the same extent in the other example.

Posted by: Echidne of the snakes | May 17, 2006 4:06:50 AM

Echidne & Ezra--

can I just say: bravo to you both! Your actions and responses throughout this episode say a lot about the best of the progressive blogosphere--passionate about our rights, scrupulous about getting the facts, willing to learn and change.

I don't know either of you personally, but I'm glad you're both helping to rebuild America.

Posted by: progressiveFan | May 17, 2006 7:03:19 AM

I'd like to agree with both echidne and ezra (and its not that usual for me to agree with ezra). And it is for this reason, which I don't know if echidne is going to explore. I'm impressed that the CDC is *recognizing that all women are sexual beings*. Ever since I got married and had a regular doctor, something I didn't have until I was 35, I have routinely been asked whether I was pregnant, or planning to get pregnant, before every test or treatment that was offered to me. But I honestly don't remember ever being asked that when I was a teenager or a young woman--was that because I was not considered at "high risk" for pre marital sexual behavior? I appreciate tht the CDC is, by implication, saying that being sexually active is a natural part of a woman's life from her teenage years on up and that it is your doctor's responsibility to deal recognize that and deal with that up front. Of course that should include serious pro-contraception counseling as well as the easy availability of plan b and etc... but inevitably its going to include some pre-pregnancy planning. I certainly received that when I first went to an obgyn when we were trying to get pregnant and discovered, for the first time, the role of folic (what is it again, well, I think of it as peas).

That being said I wish they spent the same amount of time and energy--some time and energy, counseling men as fathers not to drink and smoke, or men as husbands and lovers not to drink, smoke, or take too many meds...and why don't they? second hand smoke from your father after you are born is at least as bad for you as smoke from your mother while you are in her belly.

aimai

Posted by: aimai | May 17, 2006 7:30:23 AM

Ezra,

Of course it makes sense for the CDC to promote health for both men and women. The problem with these guidelines is not that they recommend a healthy lifestyle for women in the interest of promoting the health of women. Instead, the point of the CDC guidelines is to promote the health of women qua their ability to produce children.

That is, women in this framework are implicitly valuable only insofar as they can produce children.

Imagine if you had read this instead:

"New federal guidelines ask all Mexican immigrants capable of labor to treat themselves -- and to be treated by the health care system -- as pre-producers...Experts say it's important that workers follow this advice throughout their productive lives..."

There's a world of difference between promoting health for health's sake and promoting health for the sake of what the healthy can do - whether it's produce children or labor in your economy. This is, at the core, the commodification of women as a means of production.

Whether they meant it to be read this way or not, this is the subtext of the CDC guidelines.

Commentariat

Posted by: Commentariat | May 17, 2006 9:32:15 AM

Count me in as another person who finds this offensive due to its subtext, even though I'm all for healthy living (whether I practice it or not, lol) for women in general. I mentioned this elsewhere yesterday-- it's really impossible to separate this from the context of a political movement that seeks to redefine all that is feminine within a framework of sexual barter and endless reproduction for others' benefit. They're doing a good job of it, because maternal & romantic sentimentality are both easy sells, but it's still meant to oppress women in general and deserves to be treated with suspicion.

Posted by: latts | May 17, 2006 10:07:58 AM

Commentariat:
"The problem with these guidelines is not that they recommend a healthy lifestyle for women in the interest of promoting the health of women. Instead, the point of the CDC guidelines is to promote the health of women qua their ability to produce children.
That is, women in this framework are implicitly valuable only insofar as they can produce children."

Let me introduce you to the post:

"It would be one thing were this the only context in which health recommendations were offered to women, but that's not true. It's not even near truth. Here's the CDC's women's health page, which has the most prominent billing on their home page. In fact, this week is Women's Health Week. It's just flat-out false that the organization is only attentive to women in their capacity as breeders."

Read, mark, learn and inwardly digest.

Posted by: ajay | May 17, 2006 10:16:46 AM

Whether they meant it to be read this way or not, this is the subtext of the CDC guidelines.

Which is precisely what Ezra seems to have a problem with.

Ew, I say. Sounds so utilitarian.

Posted by: Adrock | May 17, 2006 10:22:32 AM

Ajay,

Again, of course the CDC is not exclusively attentive to women in their capacity as breeders. The CDC folks who wrote the policy probably don't think of women in the context of breeders, or think that they think of women in that context. But that's not really important, what they intended. The valuable thing to take away from this is just how social identity is constructed and propagated - usually without the knowledge or intent of the people doing the propagating. So the result is health guidelines that don't just promote health as a goal in of itself (though this was surely CDC's intent), but health guidelines that reinforce the social identity of women as reproducers.

Men, for example, are not targeted with health guidelines that suggest they think of themselves as inseminators who need to do X, Y, and Z to insure their sperm is healthy and motile, and carries few defects.

So yes, of course the CDC should promote the health of women, just as it should promote the health of Mexican immigrants. It should, however, promote their health because they are human beings, not because of what they can do with their health. The fact that it does says more about how we think of ourselves and each other, and how hierarchies and inequalities are established and maintained than it does about the CDC itself.

PS - "Read, mark, learn and inwardly digest." Next time, try not to be such a condescending prick.

Posted by: Commentariat | May 17, 2006 10:44:59 AM

No Commentariat, the CDC should promote the best medical research in the form of useable health guidelines. Unless you have an argument with the concept that poor health habits can damage a fetus during the period separating the start of a pregnancy from the awareness of the pregnancy, these are important guidelines. In addition, the report, which I can't stress enough that people read, spends a fair amount of time talking about men. From the summary:

The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of child-bearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes.

And it does indeed talk about better behaviors for men. Does it focus on women? Of course, but that's biology being sexist, not the CDC. It's not that I don't see your point about the possible implications being discomfitting, but we on the left are constantly talking about the need to separate science from politics, information from agendas. This report is soberly, fairly, and correctly written. No one has argued with its conclusions. And, as such, while we should wage war on some of the societal trends you identify, it's straight hypocrisy, and ultimately self-defeating, to attack high-quality evidence from respected researchers. Moreover, women (and men) deserve access to this information and the capability to make fully-informed choices. We have to trust them to do so.

Posted by: Ezra | May 17, 2006 11:04:56 AM

The most objectionable thing about the report is what is does NOT say. The single most important recommendation to improve pregnancy outcomes would be that sexually active men and women who are not actively trying to conceive should always use contraception. This is particularly true for teenagers, who experience more and more severe complications in pregnancy than older women. The seond most important is that couples should use condoms to prevent the spread of STDs including AIDS, which complicate pregnancy and may be transmitted to newborns.

But the word contraception is mentioned precisely ONCE in the report and only in the most passive manner.

Although each recommendation on its own is perfectly reasonable, the fact that women and couples have control over their fertility is simply ignored. That is why the guidelines are offensive.

Posted by: JR | May 17, 2006 11:30:11 AM

But that's similarly not quite true. The report argues for more federal funding on Title X, which it explicitly says distributes contraception. Moreover, this report was not about how to avoid pregnancy, but about how to ensure a healthy one, be it planned or unplanned. It's not for doctors to shoehorn in our agendas. This report, in the way it's being discussed, had a very simple point: many unplanned pregnancies are brought to term, and you should be aware that poor health behaviors can do damage before a pregnancy is recognized. That was the message being distributed, and it wasn't one that needed to come with a contraception chapter.

Posted by: Ezra | May 17, 2006 11:40:56 AM

Ezra,

I have to respectfully disagree with what I think I hear you saying. Yes, it is good medical advice ... for everyone. The fact that it is targeted directly at women for the reasons stated ... this is what makes it 'wrong.' Failing to call them on this tacitly condones it and enables them for further positioning. BTW, I am a male and that report make smy skin crawl. Set the Wayback machine for 1950, Sherman.

Posted by: Cathexis | May 17, 2006 2:39:12 PM

Ezra- first off- happy birthday and may you have many more in which to educate, provoke, and entertain us.

Second, the report doesn't argue for more Title X funding for contraception. It merely passively notes that Title X funds programs providing "family planning education and contraceptives" and then suggests that these programs can be used to piggyback "preconception health" programs.

Seriously, Ezra, if you're a health professional dealing with a 16-year old sexually active girl, what is more important in preserving her health and the health of the children she will eventually have? Teach her to insist that her partner use a condom or urge her to take a folic acid pill every day? Yes, perhaps she should do both, but where should the emphasis be?

You say, "many unplanned pregnancies are brought to term, and you should be aware that poor health behaviors can do damage before a pregnancy is recognized." That's absolutely true. But it's just as true that most unplanned pregnancies are unwanted pregnancies that can and should be prevented. By far the best way to reduce bad outcomes for unplanned pregnancies is to work to reduce the number of unplanned pregnancies.

This report tries as hard as it can to pretend that contraception doesn't exist. Although it mentions the word, it never, ever, suggests that wider use of contraception would vastly improve the health of women of child-bearing age and of their children. And that's why it's objectionable.

Posted by: JR | May 17, 2006 5:05:37 PM

This report tries as hard as it can to pretend that contraception doesn't exist.

I think that's subjective, and dependent upon what you take to the report when you read it. I so suspect that earlier drafts might well have been more explicit; and that might be where the true story lies, rather than in the slack, slapdash treatment given by the WaPo.

Posted by: nick s | May 17, 2006 7:35:41 PM

Ezra - you are both right and wrong in saying this report addresses men.

It does repeatedly say "Women, men and couples", but gives specific examples of and recomendations to women with the sole exception being to form a reproduction plan which is specifically directed to both.

If a woman has an annual check-up, and an annual visit with her obgyn and also happens to visit for a severe sinus infection or poison ivy outbreak or anything else, each of the health professonals should subject her to insulting her intellegency by telling her she should not smoke, drink, should take vitimins each and every time they see her? Not for her good health but because she might get pregnant?

Right. And this isn't full of sexist subtext that regulates all women of childbearing age to the status of womb carrier.

Posted by: Helen H | May 18, 2006 1:05:06 AM

Ezra, it isn't *just* "biology being sexist."

You do know that exposure to toxic chemicals can cause *your* future children to be born with birth defects? Including apparently harmless ones like plastics, not just tolune? Or that there's a strong likelihood, awaiting larger studies, that having smoked *at any time* in your life may give your children cancer?

Not much talk about that, about protecting the precious spermatozoan-Americans, in the CDC report.

The CDC report wasn't as bad as the WaPo made out. Most of it, including the "informed woman" but particularly the "lack of health care is bad" and "planned pregnancies are better" aspects, are stuff we can wholeheartedly get behind. But it's still not perfect or unbiased, and don't pretend that it isn't in centrist anxiety to be fair.

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Posted by: Eric Laurence | Jul 30, 2006 10:16:37 PM

The quality of education is, is not lower than 15 years ago

Posted by: cigar cruise smoking | Aug 8, 2007 6:03:37 PM

My life's been basically boring. Such is life. Nothing exciting going on worth mentioning.

Posted by: beer bong halloween | Aug 11, 2007 3:16:43 AM

The Aging Population Hurts The Economy

Posted by: college book store athens oh | Aug 12, 2007 5:23:46 AM

I feel like a fog, not that it matters. I've pretty much been doing nothing , but eh. Today was a loss. I haven't gotten much done for a while.

Posted by: vinyl tote bag | Aug 14, 2007 2:44:07 PM

I feel like a fog, not that it matters. I've pretty much been doing nothing , but eh. Today was a loss. I haven't gotten much done for a while.

Posted by: vinyl tote bag | Aug 14, 2007 3:00:25 PM

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