Hey, guess what! I'm "pre-pregnant"!

A few weeks ago the Centers for Disease Control published new guidelines encouraging all females capable of conceiving a baby to treat themselves—and to be treated by the health care system—as “pre-pregnant”, regardless of whether they plan to get pregnant anytime soon. 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. The CDC emphasizes the importance of women following this advice throughout their reproductive lives because about half of pregnancies are unplanned and much damage can be done to a fetus between conception and the time the pregnancy is confirmed.

Now, I’m not typically one to use the “slippery-slope” argument, but as columnist Dan Savage pointed out:

“Ordering American women to regard themselves as "pre-pregnant" because they may harm a fetus they don't know they are carrying opens the door to prosecuting women who harm their fetuses by failing to regard themselves as "pre-pregnant." How long until "women should… refrain from smoking and maintain a healthy body weight" becomes "women must…"?

An article on the CDC guidelines, “Forever Pregnant,” appeared in the 05/16/06 edition of the Washington Post. It has many Americans up in arms regarding the offensive implication that that all women are nothing more than incubators who should remain healthy not because it’s good for them, but because it makes for healthier babies. Though I am also speechlessly offended by this implication, it brings to mind a few even more sweeping issues in the public health sector that have bothered me for some time now.

A few thoughts:

1. If I am capable of being “pre-pregnant,” that implies the existence of “pre-conceived” children. Are we going to start allocating rights to them as well? It already frightens me to think that the rights of a fetus threaten to someday eclipse my own rights as a woman.

2. It appears to me that the current administration is infinitely more concerned about the health and vitality of the unborn (and now the pre-conceived) child than it is about that child once born. After born, its on its own and can fend for its own health in a society where the number of uninsured citizens is on the rise while, in many cases, the funding for preventative healthcare services doesn’t even keep up with inflation, never mind the growing demand for such services.

The primary example I am looking at is funding for Title X family-planning clinics which provide more than 5 million women with health care services at over 4,500 clinics nationwide. In addition to providing contraceptive services and supplies, Title X clinics provide basic preventive health services, making women healthier. In 2004 alone, Title X funded clinics provided 2.8 million Pap tests, 2.7 million breast exams, 5.4 million STD tests, and 530,569 HIV tests.

According to the National Survey of Family Growth, woman at, and below the poverty line are now 5 times more likely to have an unintended pregnancy than other women! This is disturbing, but even more so is that data indicate this rate is on the rise, rather than on the decline. Twelve years ago, poor women were only 3 times as likely to have an unintended pregnancy. Though the CDC report acknowledges that many women lack access to adequate reproductive health care, it encourages these women to “manage risk factors” such as smoking and weight, rather than encouraging government officials to sufficiently fund programs like Title X which could actually provide adequate reproductive health care to this group of women.

It seems like a no-brainer to me, but perhaps if the government really wants healthier newborns, it should spend less time telling women they are “pre-pregnant” and should be taking folic acid, and more time reducing the number of unintended pregnancies. But heaven forbid we aggressively promote the use of contraception. That would be a morally reprehensible offence. Clearly, the promotion of abstinence is the smarter solution. It’s working too! Unintended pregnancy rate 5 times greater…up from 3 times…uh…wait…never mind.

3. All this talk about pre-pregnancy “risk factors” such as smoking, asthma, folic acid etc. makes me wonder about the relativistic importance of these factors in relation to environmental risk factors. Much evidence is being discovered linking environmental pollution to low birth weight babies, early delivery, and birth defects. For example, a recent study by UCLA researchers found that women living in regions with higher levels of ozone and carbon monoxide pollution were as much as three times as likely to give birth to children who suffered from serious heart defects. But I bet we’ll never see the CDC putting up billboards on L.A. freeways saying “Carpool and demand efficient public transportation. It will make for healthier babies.”