The CDC report on preconception health
On April 21, 2006 the Centers for Disease Control and Prevention issued a series of Recommendations to Improve Preconception Health and Health Care in their Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. (You can read the report here.) The report was covered in major newspapers and received attention because of its definition of preconception health patients, which includes all women between the moment of their first period and menopause. Intrigued, I decided to take a close look at the document.
The report is 16 pages and tailored to the stated goals and recommendations: in that sense, it is more vague and repetitive than informative. While it talks about ‘improving the health of women and couples’ and promoting ‘optimal health for women, children, and families’, you eventually discover its focus. Predictably, buried on page 9 of a 16 page report it says: “The target population for preconception health promotion is women, from menarche to menopause, who are capable of having children, even if they do not intend to conceive.” (Emphasis mine.) And in fact, leaving aside the repeated invocations of benefits to others, the recommended actions are aimed at women.
For example, the first goal is to “improve the knowledge and attitudes and behaviors of men and women related to preconception care,” (p. 1) yet the bulk of the report focuses specifically on women’s preconception health and how to facilitate ‘assessment’ of risk factors and intervention. Aside from general public outreach programs, there isn’t a single recommendation that is geared specifically towards men. It has been established that male fertility is adversely affected by alcohol and smoking and by chronic health conditions such as diabetes. This means that to improve reproductive health men must be participants and not just sideline supporters. Here, however, only women are responsible for fertility or the health of offspring.
Another issue is the definition’s clear dismissal of women’s agency: “even if they do not intend to conceive”. While I am aware that one goal is to improve pregnancy outcomes, including for unintended pregnancies, I worry about the consequences of guidelines that ignore women’s intentions and give precedence to a potential pregnancy. The idea of a life now dictates the healthcare of real, living women.
This may not seem like much when it comes to daily folic acid or even screening for STDs and HIV (though some may object). The emphasis on ‘lifestyle’ risks such as alcohol consumption and smoking becomes problematic when you read “risks and behavior should be addressed during any encounter with the health-care system because approximately half of all pregnancies in the United States are unintended” (p. 5). That means that a woman’s lifestyle may be scrutinized every time she sees a health care practitioner (even her child’s pediatrician, as suggested) because of a possible pregnancy. It’s more disturbing to realize the socioeconomic and therefore racial issues at play, as it is acknowledged that “a small number of women experience the majority of the pregnancy-related morbidity and mortality” (p. 8), and that the intervention is aimed primarily at those women.
If this report meant guaranteed health care for all who are currently without, I might support it. But shouldn’t this be available to all women, regardless of their capacity to conceive? What happens to infertile women? Are they less worthy of care or concern? Are they a lesser benefit to their families or society? Though the report’s goals may be well intended, their linkage to reproduction is unnecessary and troublesome.
Finally, the report’s glaring silence on contraceptive education as part of preconception health makes me wonder about a hidden political agenda. Given the heated debate on the issue of abortion, it seems unusual that the report would mention that “[the] health plan might increase the number of planned pregnancies” (p. 2) without once addressing how unwanted pregnancies may be avoided or reduced. The goal then is not to maximize women’s health, knowledge, or choices with respect to fertility and pregnancy, but to turn women into healthier vessels for a possible life.
I guess it’s time to dust off my copy of The Handmaid’s Tale.
The report is 16 pages and tailored to the stated goals and recommendations: in that sense, it is more vague and repetitive than informative. While it talks about ‘improving the health of women and couples’ and promoting ‘optimal health for women, children, and families’, you eventually discover its focus. Predictably, buried on page 9 of a 16 page report it says: “The target population for preconception health promotion is women, from menarche to menopause, who are capable of having children, even if they do not intend to conceive.” (Emphasis mine.) And in fact, leaving aside the repeated invocations of benefits to others, the recommended actions are aimed at women.
For example, the first goal is to “improve the knowledge and attitudes and behaviors of men and women related to preconception care,” (p. 1) yet the bulk of the report focuses specifically on women’s preconception health and how to facilitate ‘assessment’ of risk factors and intervention. Aside from general public outreach programs, there isn’t a single recommendation that is geared specifically towards men. It has been established that male fertility is adversely affected by alcohol and smoking and by chronic health conditions such as diabetes. This means that to improve reproductive health men must be participants and not just sideline supporters. Here, however, only women are responsible for fertility or the health of offspring.
Another issue is the definition’s clear dismissal of women’s agency: “even if they do not intend to conceive”. While I am aware that one goal is to improve pregnancy outcomes, including for unintended pregnancies, I worry about the consequences of guidelines that ignore women’s intentions and give precedence to a potential pregnancy. The idea of a life now dictates the healthcare of real, living women.
This may not seem like much when it comes to daily folic acid or even screening for STDs and HIV (though some may object). The emphasis on ‘lifestyle’ risks such as alcohol consumption and smoking becomes problematic when you read “risks and behavior should be addressed during any encounter with the health-care system because approximately half of all pregnancies in the United States are unintended” (p. 5). That means that a woman’s lifestyle may be scrutinized every time she sees a health care practitioner (even her child’s pediatrician, as suggested) because of a possible pregnancy. It’s more disturbing to realize the socioeconomic and therefore racial issues at play, as it is acknowledged that “a small number of women experience the majority of the pregnancy-related morbidity and mortality” (p. 8), and that the intervention is aimed primarily at those women.
If this report meant guaranteed health care for all who are currently without, I might support it. But shouldn’t this be available to all women, regardless of their capacity to conceive? What happens to infertile women? Are they less worthy of care or concern? Are they a lesser benefit to their families or society? Though the report’s goals may be well intended, their linkage to reproduction is unnecessary and troublesome.
Finally, the report’s glaring silence on contraceptive education as part of preconception health makes me wonder about a hidden political agenda. Given the heated debate on the issue of abortion, it seems unusual that the report would mention that “[the] health plan might increase the number of planned pregnancies” (p. 2) without once addressing how unwanted pregnancies may be avoided or reduced. The goal then is not to maximize women’s health, knowledge, or choices with respect to fertility and pregnancy, but to turn women into healthier vessels for a possible life.
I guess it’s time to dust off my copy of The Handmaid’s Tale.
posted by Camille Lizarríbar at 12:59 AM
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