An obstetrician (who is also a feminist) weighs in on the CDC’s “no birth control, no drinking” recommendation

The Centers for Disease Control and Prevention (CDC) recently made the eyebrow-raising recommendation that all sexually active women of reproductive age who are not using birth control avoid alcohol completely. The reason: to prevent fetal alcohol spectrum disorders (FASD). Exposure to alcohol during pregnancy — even the earliest stages — increases the risk of FASD, which can cause a child physical problems as well as challenges with behavior and learning.

This sweeping recommendation rubbed me (and many others) the wrong way. The CDC’s message defined young women as primarily heterosexual baby incubators, ignored the role of alcohol in men’s reproductive responsibilities, and assumed that women cannot logically act on health recommendations within the context of their lives. When I talk to women of childbearing age in my practice about their health, my goal is to help them balance risks and benefits with a breadth of vision about their life and values.

Using shared decision-making, we take into account many things about her life in prioritizing our approach to her health issues and lifestyle. Is she in a relationship? With a man or woman? Does she hope to become pregnant in the next one to three years, or to prevent pregnancy? Or is she not sexually active at all? I point out the dangers of smoking whether pregnancy is in her short-term plans or not. I help educate her on how to eat healthfully. I encourage her to wear seatbelts and bicycle helmets. I talk to her about safe relationships and healthy sexual practices. If she’s trying to avoid pregnancy, I work with her and her partner to determine the safest and most effective way for them to do so. If she’s trying to achieve pregnancy, I counsel her to avoid alcohol from the time she ovulates until she knows whether or not she is pregnant.

I have no dispute with the facts of the CDC’s statement. It is true that 50% of pregnancies in the United States are unplanned. It is true that fetal alcohol spectrum disorders can cause lifelong problems for children. It is also true that there is no known safe level of alcohol in pregnancy. I tell women this every day. The facts are correct, but the messaging is wrong. Here’s how:

• Everyone who chooses to drink alcohol should do so responsibly. This applies to both men and women, within the context of reproductive health and beyond it. Animal studies suggest that alcohol use may damage sperm and potentially affect offspring. Alcohol abuse increases the risk of intimate partner violence, a risk to a healthy pregnancy.
• Educating women on the effects of alcohol on a potential pregnancy is critical, but the recommendations don’t acknowledge that even the most reliable forms of birth control, when used properly, aren’t 100%.

It’s hard to address all of these issues I discuss with my patients within a public health sound bite. But we owe it to women to be respectful when delivering important health messages. And we also owe it to men to make them equal partners in conversations around sexual and reproductive health.