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Why the CDC’s Advice for Some Women not to Drink Isn’t So Bad

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Sorta transcript:

The CDC has just recommended that women who are sexually active but not using birth control should stop drinking all alcohol. This has a number of my feminist colleagues quite upset, as it appears to be part of a stubbornly pernicious movement to treat all women as pre-pregnant, and to treat all fetuses as the be-all end-all of our decision-making processes.

You may have noticed some of this if you or a loved one has been pregnant at any point in the past ten years — pregnancy has become an incredibly anxiety-ridden event where women tend to be put under a microscope to determine if their every move may help or harm their fetus. Sushi, lunchmeat, eggs, pain-killers, and yes, alcohol, all need to be carefully evaluated for their relative risks, and many people look down on any pregnant person who consumes any of the above, plus a long list of other lurking dangers. As Ruth Graham writes in Slate, it’s this sort of thing that “has turned modern pregnancy into a nine-month slog of joyless paranoia.”

It’s also annoying because it comes at a time when women’s reproductive health is seriously at risk, and not from alcohol. In Texas, they defunded Planned Parenthood and immediately saw a spike in childbirth among poor women. So basically we are forcing women to have babies and then getting all haughty about how they’re having them.

With all that said and agreed to, I don’t actually agree with the blanket condemnation of the CDC recommendation. Graham and others point out that the evidence we have thus far suggests that mild drinking during pregnancy just isn’t a big deal. That’s true! However, it’s mostly true of later in a pregnancy — the third trimester is about when it seems you’re pretty much out of the woods and can maybe enjoy a glass of wine every day if you want.

But in the first trimester, the evidence isn’t so positive. Some research has suggested that mild to moderate drinking in the first trimester is fine — ie, up to 1 drink a day. More research shows that any amount of alcohol in the first trimester carries serious risks. The drinks add up more quickly and cause more damage that early in the pregnancy, which can often lead to miscarriages or problems like fetal alcohol syndrome. In fact, drinking alcohol before you even realize you’re pregnant can cause adverse problems. Is it guaranteed to screw up your fetus? No. But is it a risk that you may want to keep in mind? Absolutely.

The CDC recommendation isn’t for all women — it’s directed at women who are having sex without any kind of protection. I think that still isn’t specific enough, and it should be for heterosexual, cis women (and homosexual trans men) with working uteruses who are having sex without any kind of protection, but I get that that’s a mouthful.

I submit that these people largely fall into two categories: those who are ignorant and don’t understand that their actions can easily lead to pregnancy, and those who accept or even hope for pregnancy as an end result. For the first group, the CDC recommendation is useless. The CDC also recommends you use some kind of birth control if you don’t want to get pregnant. Obviously they’re not listening to the CDC. This recommendation is not for them.

And for the last group, who aren’t using birth control and know pregnancy may result, this is definitely advice they should be interested in. Consider that 20% of Americans drink on average more than 15 drinks per week, and 1 in 6 Americans drinks 8 drinks in one session about 4 times a month. I find it very reasonable to imagine a person who, say, downs 10 glasses of wine in one weekend, thinking that if they do find out they’re pregnant, they’ll just stop drinking at that point — not realizing how early the damage can be done.

And one last note: the CDC also has recommendations for men who are pre-paternal. You know, men with working penises who are having hetero sex without birth control: excessive alcohol use can negatively affect your sperm and make you impotent or infertile.

So while I do think that parts of the CDC press release are fear-mongering and anti-scientific, as when it states there’s no safe amount of alcohol to drink at any point in a pregnancy, I do think it’s decent advice to people who may get pregnant in the near future: cut out the booze now if you want your best chance of a healthy, happy little fetus.

Rebecca Watson

Rebecca Watson

Rebecca leads a team of skeptical female activists at Skepchick.org. She travels around the world delivering entertaining talks on science, atheism, feminism, and skepticism. There is currently an asteroid orbiting the sun with her name on it. You can follow her every fascinating move on Twitter or on Google+.

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9 Comments

  1. February 5, 2016 at 9:36 pm —

    Thanks for saying this. All the negative commentary has been driving me a little nuts. They’re the CDC. They’re not idiots. And people who aren’t using birth control should maybe be thinking about what could happen, should maybe be warned that acohol you drink before you know you’re pregnant can still cause medical problems. That’s just reality, blaming the CDC for warning people about it is like blaming a meteorologist for the weather.

    • February 6, 2016 at 5:20 pm —

      Oh, you should see the kind of weird backlash I’ve seen. Acting like a possible (but by no means the medical consensus) case of epigenetic damage from a man drinking like a fish was exactly the same as the consensus about drinking while pregnant.

      The CDC occasionally says something weird now and then, all government agencies do, but, seriously? “Don’t drink while pregnant or if you may become pregnant.” is the consensus and plain common sense.

  2. February 5, 2016 at 10:41 pm —

    There really does seem to be a web journal subculture that is determined to defend alcohol consumption from any hint of criticism. I wonder how much money the booze lobby spends to stir ‘controversy’ where there really isn’t any.

    Still, the people the CDC needs to reach most are the ones who are in the 20% who are above 2 drinks a day, and those like me who drank 6-12 drinks every day. Too bad we mostly were unable to make decisions about our consumption and act on them.

  3. February 6, 2016 at 4:08 am —

    The problem with the recommendation and your evaluation is manyfold.
    1.) Let’s talk about this “may be pregnant”. Reality is: many unplanned pregnancies happen in spite of using contraception. Earliest point you find out that your contraception failed you: when you miss your period. Latest point: your water breaks. There are people who keep having their periods while pregnant or who use contraception that suppresses menstruation. In short, “might be pregnant” applies to all people with a working uterus and ovaries since we don’t even have that much control about who sticks their penis into us, the more marginalised, the poorer, the higher the risk.

    2.) This recommendation doesn’t happen in a vacuum. It happens in a country and a climate where the embryo is constantly put before the pregnant person. It happens in a country where women have lost custody or been jailed for “child endangerment” because of things they did during pregnancy. This links up to #1: a potential pregnancy, whether planned or not, is seen as more important than the person who might be pregnant AND a baby that might suffer is portrayed as the inevitable outcome of such a pregnancy.
    If the CDC had said “if you plan to be pregnant, stop drinking” nobody would have made a fuss. I even accept the “better be safe than sorry, don’t drink at all”.
    3.) Let’S talk about those who don’t use contraception. You gave the Texas study as evidence and for me it’s evidence how this only adds to the burdens of marginalised people. Quite obviously they had choices taken away from them. They can no longer access contraception. Now they get told how to arrange their lives around the fact that they have lost their options, taking away even more options. It falls squarely into the blaming poor people for all the bad things that happen to them because they’re poor category.

    4. Your whole article misses the BIG clusterfuck of that recommendation which is the right side where “violence” and “STDs” and “unplanned pregnancies” are listed as risks women run due to a”drinking too much”. Before we blamed the alcohol men drunk for the violence they inflicted on women, Now we blame the alcohol women drink on the violence men inflict on them.
    This is victim blaming par excellence. Women are held responsible for the violence they suffer. Women are told they can avoid rape and violence by behaving good. There is a direct link from alcohol to heart disease. There is no direct link from alcohol to an unplanned pregnancy.

    5. The “too much” is especially ridiculous with regards to the risks that are actually NOT risks related to alcohol. Don’t get me wrong, I think that you shouldn’t regularly drink 8 or more drinks a week, it’s simply not healthy. But how does a second beer on Saturday night after you had a beer already every day of the week put you at risk of an STD?

    • February 6, 2016 at 6:06 pm —

      1.) Not sure your point here. Just because there is a very small chance that someone may become pregnant while using birth control is no reason to not offer medical recommendations to the people who have an astronomically higher risk of getting pregnant (and giving birth).

      2.) I agree, which is why I included that point in the video.

      3.) I agree, which is why I said exactly that in the video.

      4.) I didn’t discuss the infographic (which is for doctors), only the press release. That said I agree that “violence” shouldn’t be listed. As for heart disease and unplanned pregnancy, those absolutely result from excessive alcohol use as a major contributing factor.

      5.) I believe they’re saying that drinking too much can lower your inhibitions. People who are drunk are more likely to take sexual risks, including agreeing to have sex without protection against STDs. Again, not something I talk about in the video, mostly because I think it’s fairly obvious.

      • February 7, 2016 at 5:38 am —

        How is an unplanned pregnancy a direct result of too much alcohol like heart disease?

  4. February 6, 2016 at 8:19 am —

    I like the thoughtful analysis of Echidne of the Snakes, who is one of the most careful and skeptical bloggers that I know:

    http://echidneofthesnakes.blogspot.ca/2016/02/hi-baby-making-factories.html

    She wrote a long post on this topic, including this:

    ” Try this thought experiment: Suppose that you have the data the CDC had and decide that it’s sufficient to make a recommendation about people’s pre-conception behavior. You have several choices.
    1. You could recommend that all fertile women who are sexually active in a heterosexual relationship and who consume alcohol should use reliable contraception, and that all couples who plan to become pregnant should abstain from alcohol consumption.
    2. You could recommend that all fertile men should use reliable contraception if they have vaginal sex with women who don’t use contraception and who consume alcohol.
    3. Or you could recommend that all childbearing age women who have unprotected heterosexual intercourse should abstain from alcohol for as many years as those conditions remain in place.
    There are probably further choices than those I have listed. The point is that the one the CDC picked tells us something about the underlying beliefs and values, about who is assigned the responsibility and for what.

    None of those recommendations is terribly likely to work in practice. But I think recommendation number one has the highest odds of working at all. So why didn’t the CDC go with that?”

    • February 6, 2016 at 8:24 am —

      That is to say, I don’t think you’re wrong, Rebecca, because you’re sort of saying the same thing as Echidne. But I don’t think you are quite doing justice to the feminists who perceive the CDC advice as deeply problematic. Doling out advice, as the CDC did, that is unlikely to be followed, but which gives more power to those that like to control the daily lives of women is, in my opinion, irresponsible.

  5. February 8, 2016 at 4:12 pm —

    I think that general recommendations for any kind of health situation would be great, if they stayed just that and were used as talking points at physical exams. But that is not how people are nor how these recommendations get used. There is blaming and shamming. And pregnancy/pregnancy/being a woman that is even considering having a child is full of it.

    I haven’t used birth control in 10 years. I have had one child in this time period and I am sexually active. And I drink alcohol. And I am not going to use birth control because I got pregnant once. :) What I have done is chosen to have a conversation with my doctor about healthy living habits that surround my life choices that we were both comfortable with.

    The thing is no one thinks, what other people do is their business and I should worry about myself and my life choices and have my own conversations with my doctor. (That is why any recommendation stinks, because if you are pregnant or planning to become pregnant you get to hear about another thing from the people in your life.)

    But in general is the recommendation bad…I agree with Rebecca, no. But it is also something to discuss with your doctor, not your coworkers/friends/people on the street.

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