At this very moment, some 3.3 million not-yet-pregnant women are taking the lives and health of their not-yet-conceived babies into their booze-soaked hands.
So the Centers for Disease Control and Prevention is saying with a new “Vital Signs” report in which it urges all women who “could” get pregnant—meaning not on some form of birth control and sexually active at least once in the last month—to abstain from alcohol completely.
Anyone who has ever been pregnant is painfully aware that becoming so seems to embolden well-meaning strangers around her to weigh in on what’s best for her body and her baby. Public health campaigns have focused on how mothers-to-be should eat, drink, sleep, caffeinate, medicate, vaccinate, work, exercise, dress, and even think. But with this report, the CDC is scaring and shaming a whole new class of women. Welcome to the club, fertile ladies.
In 2005, Surgeon General Richard Carmona updated the 1981 advisory suggesting pregnant women merely limit their alcohol intake while pregnant. For the first time, both pregnant women and women “considering becoming pregnant” were told to stop drinking completely. And yet, despite the warnings, 10 percent of women have continued to drink alcohol during their pregnancies, mostly in modest amounts (one in 33 pregnant women reported binge drinking).
Now the CDC has gone a step further. Roughly 7.3 percent of women ages 15 to 44 are “at risk for an alcohol-exposed pregnancy,” according to the report. These women—based on the methodology—include non-pregnant women who have had sex without contraception sometime in the last month and reported having as little as one drink in the same month. So a woman of childbearing age who toasted with Champagne on New Year’s Eve and had sex with her husband 30 days later would be putting a pregnancy at risk, according to the CDC. Three in four sexually active women who report wanting to get pregnant as soon as possible are also considered at risk.
And what are the consequences of such risky behavior? According to the infographic that accompanies the report, a woman who drinks any amount during pregnancy could produce a baby with brain damage, organ failure, who could turn into a child with low IQ or learning disabilities, who could turn into an adult who can’t keep a job and has “trouble with the law.”
“Alcohol can permanently harm a developing baby before a woman knows she is pregnant,” said CDC Principal Deputy Director Anne Schuchat, M.D., in a press release. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?”
I can think of a few reasons.
Although terrifying and sad anecdotes about the damaged children born to alcoholic mothers exist, the science isn’t exactly clear on what precisely causes fetal alcohol spectrum disorders—a family of health problems that includes physical, behavioral, and intellectual disabilities.
It’s not known, for example, why a majority of pregnant women who binge-drink give birth to babies without FAS. Or why one in a pair of fraternal twins with identical exposure can be diagnosed with FAS while the other twin is clear.
“Even if you find 10 women who drink a quart of vodka a day, maybe only five of those babies will have full-blown fetal alcohol syndrome, because there are other factors that influence the risk,” one study author noted. Factors not mentioned in the mom-shaming anti-drinking campaigns include nutrition, maternal body fat, poverty, family size, and simple genetics.
A review of the literature shows a number of studies that found that light and occasional drinking poses little risk to pregnant women or their fetuses. Many were highlighted in economist Emily Oster’s 2013 book, Expecting Better.
A 2015 study found it to have no effect on low birthweight, preterm delivery, intrauterine growth restriction, and most selected perinatal outcomes. A few studies have even found positive correlations between children born to occasional drinkers, like this one, which found children born to mothers who drank occasionally during their pregnancies experienced better mental health than those whose mothers completely abstained.
And even if restrictions like the CDC is suggesting—stopping all women who could become pregnant from drinking even a little—worked, they won’t stop the FAS diagnoses, said Lisa Wade, a professor at Occidental College and author of the textbook Gender: Ideas, Interactions, Institutions.
The CDC guidelines, Wade said, “seem not to be based in science.” She called the suggestion that all fertile women use contraception or abstain from drinking entirely “extraordinary.”
“It suggests that we are willing to compromise a woman’s autonomy and quality of life on the tiny sliver of a possibility that she might get pregnant and then have a child that is diagnosed with FAS,” she said. “It suggests that the CDC doesn’t think that women can handle the real information and then make reasonable choices.”
Facing a dearth of evidence, doctors and public health officials have opted for that “better safe than sorry” prescription, one that may cover all the bases but is out of step with reality and creates a culture of body policing, Wade added.
“So you stop all of this reasonable drinking that other countries agree is reasonable for pregnant women,” she said. “But not only that, we create an environment where a pregnant woman who has a sip of wine here and there or a glass of Champagne at a wedding is shamed, even bullied, and policed around her behavior, even though this isn’t the behavior that’s causing the problem.”
That finger-wagging hasn’t been effective at getting all pregnant women to abstain from alcohol—and it’s unlikely the CDC will get better results now that it’s extended the scolding to an even wider female audience.