PoAC: Reproductive hullabaloo

[velvetpage]

The issue is this article: http://www.washingtonpost.com/wp-dyn/content/article/2006/05/15/AR2006051500875.html?referrer=emailarticle

Basically, it lists some new federal (American) guidelines saying that all women of reproductive age should treat themselves, and be treated by the health care system, as pre-pregnant. That means taking folic acid supplements, not smoking, maintaining a healthy weight - you get the idea.

I have some comments about this.

1) No one is forcing anything here, or suggesting that anything be forced. These are guidelines for family pratitioners and other front-line medical personnel to include in their regular care, elements relating to a woman's potential fertility. I would imagine that if your doctor asked some of these questions, and you told him you never intend to be pregnant and would abort any pregnancy that happened by accident, he would back off - and if he didn't, you should vote with your feet and find a new doctor. These are simply on the list of things women should be doing for optimal health.

2) I see no assumption here that every woman is simply a womb with legs. What I see is an understanding that 80% of women will be mothers at some point in their lives, and about 50% of pregnancies in North America are unplanned. Given those stats, it seems reasonable to offer counselling about reproductive health to women coming for regular medical attention, as part of a general check-up. It's always up to the woman to refuse to take the advice, of course.

3) These guidelines are sensible. They should be part of regular healthy-living counselling even for women who will not be having babies - yes, even the folic acid one.

4) The spin that has been put on this recommendation is unfortunate, because it raises spectres of forced pregnancy for those who are already concerned about that. However, throwing out the recommendations because you're afraid of the source is throwing the baby out with the bathwater - if you'll forgive the expression.

5) While the main source of the recommendation is the Center for Disease Control and Prevention, which is a somewhat suspect organization, the backers of the recommendation are not tainted that way. They include the College of Obstetricians and Gynecologists, the March of Dimes, and other agencies concerned with two main categories: birth defects, and women's health. Therefore, I would say any bias that exists in targetting women only is a function of the goal of the guidelines, which is to reduce birth defects in unplanned pregnancies. This goal is almost entirely independent of a man's role in reproduction, making it logical to leave him out.

Final analysis: the spin was unfortunate, but the recommendations are reasonable in and of themselves. I'm going to find something more worthy to be scared of.

Comments

[collie13.livejournal.com]

You know what I always wonder? First, why did this useful information for women have to be tied to childbirth? I don't intend to ever have children -- does that mean I shouldn't take care of myself? I agree -- the spin on this was indeed truly unfortunate. Secondly, why are there never any similar programs for men, targeting them as (perhaps) pre-paternal or something? ;)

[velvetpage.livejournal.com]

Is there a group of doctors whose mandate is specifically men's health, as there are for women (gynecologists)? Because if there isn't, that may be a reason. No one has the specific mandate of formulating recommendations for men.

Mind you, it could be argued that Viagra and the whole erectile disfunction issue is exactly that - the male version of these types of recommendations for women.

And I agree that there should be something in these recommendations suggesting that this is good general advice even for women who will never have children. There's no reason why non-reproducing women should feel left out of good health care - that's just carelessness on the part of the people issuing the recommendations.

[collie13.livejournal.com]

I think it's not so much there's a group of doctors whose mandate is specifically men's health, as that a man is for some reason considered the 'species norm.' So doctors formulate good recommendations for the 'norm,' and then 'deviations' from that norm get different recommendations. That's how you end up with doctors who specialized in children's or women's medical issues.

Lest I sound particularly paranoid, I will note one of my older second cousins is a doctor, and used to bemoan the lack of female cadavers for dissection in medical school. The doctors-to-be literally learned only male bodies. She once showed me a fascinating book about the human body, and pointed to the drawings of "cut-aways" of the muscular system of a female and a male human. The muscles of the male groin/abdominal area were well known and completely drawn in. The muscles of the female groin/abdominal area were simply reflections of the male's, except around the lower groin, which was smooth and featureless as a Barbie doll.

As my cousin noted, there are a great many muscular differences in the female there... but the book simply didn't note them, because they didn't know -- the female subject in that time period (when she was becoming a doctor) was not worthy of extensive research. Frankly I would not wish to trust my health to a book which copped out with a sort of map-maker's "here there be dragons" mentality to what it doesn't know.

And that's why I find the "labeling" of this issue alarming: it reverts to a sort of "you're not the norm, you're the means of re-creating the male norm" mentality which I really don't want to see becoming more common in my country. Paranoid? Perhaps. On the other hand, why wasn't this labeled as simply good medical advice for all women? Why can't I buy Norplant in my country any more, despite it working excellently for me, and why do I not see any other easy-to-use forms of birth control coming up on the medical horizon? Why are pharmacists being allowed to (in effect) prescribe drugs for women based on nothing more than their personal morality, rather than on the medical needs of the woman herself?

In the end, birth control is simply the medical issue I'm most familiar with. What other, more important medical issues is this particular US government meddling ignorantly in? That's what scares me most.

[velvetpage.livejournal.com]

Good points, all, and I'm concerned about the tone - but with the reading I've been doing, this just seems like old news to me.

[dagoski.livejournal.com]

The Washington Post article I read noted that these recommendations have been knocking around the medical community for twenty years. So they're nothing new, they've just the momnentum now. The sad thing is that the social-religous climate in the US has dteriorated to the extent that we have to be suspicous of these kind of guidelines. Given the religous right's nonstop war against women these past twenty years, some amount of paranoia is justified. Fortunately, the paranoia is also easily dismissed when you read more.

[velvetpage.livejournal.com]

Exactly. I would think my doctor had lost his marbles if he failed to ask me about taking a multivitamin and maintaining a healthy weight at a general checkup, whether it was about future babies or just being healthy (and both are important to me.) Most of this stuff is just SOP. Even folic acid is included as a regular addition to cereals and breads, so the rates of spina bifida have dropped dramatically for the current generation already.

[melstra.livejournal.com]

I just read the article and there was also a special on this topic on CBS's "The Early Show" today. Personally, I really don't find anything offensive at all, religious or otherwise. As you said, they're just recommendations and things most people probably wouldn't think about. In my case, I can calculate back to when I probably conceived Max and I went to a conference several days later where I had a couple drinks. Did I do major damage? Nah, doubtful. Considering I was TTC anyway, I certainly wasn't planning to get drunk, but as I look back, I did have that little twinge of "oh my, but I drank something and i was pregnant" ("Safe" amounts of alcohol usage while pg is a whole other issue, I realize). My cousin works for the March of Dimes, so I'm particularly aware of the amount of damage that can be done before someone even realizes she's pregnant. I'm all in favor of these recommendations.Sure, they are true things for women in general anyway, but I do think there's a diffference here. NOt a demeaning one, simply a fact. Women get pregnant. Why aren't the same recommendationsn there for men? WEll, unfair as it may be, their only real contribution is the sperm, and so far as I know, not too many birth defects are caused by "faulty" sperm. For better or worse, it's the living environment afterwards that's the most important.

I may have a few facts wrong here, but I personally am surprised at all the hullabaloo. (And lest this spark anything, I am agreeing with your points, not arguing... *Smile*)

[curtana.livejournal.com]

My main concern with this whole business is also raised here (http://shadesong.livejournal.com/2871261.html). The drugs that a doctor is willing to prescribe to a 'potentially-pregnant' woman could be limited. Numerous drugs and treatments are known to cause problems for fetuses - but they're also known to help adults. If my doctor were to tell me s/he wouldn't prescribe a particular drug for me because I might become pregnant while on it, I would be very dismayed. Informing me of the risks, sure. Asking what birth control methods I'm using, fine. Telling me I can't have something that would improve my health because it could endanger the health of someone who doesn't exist? Not cool.

It's another step in the gradual erosion of abortion rights, as far as I'm concerned. Rather than saying "if you accidentally get pregnant while on this medicine, you would be advised to abort the fetus", it's heading towards "we can't give you this procedure/medicine in case you accidentally get pregnant, because of course you wouldn't abort."

[velvetpage.livejournal.com]

That is the first non-paranoia-based reason I've seen yet - the idea that women will not be prescribed the drugs they need for other conditions, because they may become pregnant while on them. Of course, that has been happening even before these recommendations, and it's flat-out bad medical practice. There's simply no excuse for it.

We are not talking eugenics here

[catarzyna.livejournal.com]

I don't know why everyone has their knickers in a twist. Even if you are not EVER planning on having children, if you are of the right age and have the potential to have a child you should keep yourself in good health. I have a friend who was doing serious drugs and alcohol during a dark part of her life. She found herself pregnant and thankfully the child was unharmed by her activities but it could have turned out quite tragic.

I have been to a nutritionist who recommended I take folic acid because I was at the right age to have children. She never once told me I had to have children. I just see this as good medical advice.

As far as men are concerned, yes they should be advised to keep themselves healthy but men's health and women's health are vastly different. They have no cycles, no menopause, nothing that so dramatically changes within their bodies on such a consistent basis.

[dawn-again.livejournal.com]

See my "f-locked to avoid drama" post regarding the linked journal above.

[velvetpage.livejournal.com]

Got it. Thanks! :)

[velvetpage.livejournal.com]

Folic acid has a role to play in good mental health and memory, so it's worthwhile for anyone. It just happens to be crucial for babies in the first few weeks of pregnancy.

[girlydoll.livejournal.com]

Oh I know, but I am saying without pushing vit's on people, the rest is very good generic health advise for anyone.

[girlydoll.livejournal.com]

Well, I should hope that regardless of the spin that women take note, it's sound health advise, not just for women but men too. Well minus the folic acid.

[girlydoll.livejournal.com]

I have to start making sure my hubby logged off before I cruise LJ,,, Blah.

[michellinator.livejournal.com]

The problem is that our government seldom stops with "guidelines." A fine example can be found here: http://shadesong.livejournal.com/2871261.html

I've never smoked. I'd be happy if nobody ever INVENTED smoking, because sucking everyone else's exhale has done and continues to do some serious damage in my life. But, it's still legal, so I take my alleregy drugs and keep going. I take a crapload of vitamins and supplements, and my current weight isn't pushing my blood pressure up like before. My problem with treating my body as if it's "pre-pregnant" is that I also take three different drugs for psychiatric treatment that are NOT recommended during pregnancy. Someday, I may have to choose between my sanity/control of my actions and reproduction. I'd rather that choice be mine, not my government's.

[velvetpage.livejournal.com]

Without saying more than I have to, let me just say that that post is rather one-sided. We have no way of knowing what the doctor was actually thinking - we only know what she thought he thought.

If it's true, it's frightening. I'm inclined to think it's an exaggeration, though.

[michellinator.livejournal.com]

After having found myself forced to claim irregular periods to get birth control prescribed (by the only doctor my then-insurance covered, who worked in a building owned by a Catholic-run hospital) I'm more inclined to believe that doctors can be swayed by morality that isn't even their own. This doctor made it clear that she could ONLY prescribe pills (no shots, nothing that is strictly to prevent pregnancy) if I was having ::wink,wink:: irregular periods. I said, "Oh, they're terrible, 27 days, 29 days, I never know!"

This is a scary, scary time to be a woman in this country. With what's already happening in South Dakota, I don't think it's advisable to allow any more government control of our health care. "Recommendations" are fine, as long as it stops there.

[velvetpage.livejournal.com]

Not to downplay your experience - because it absolutely should not have been that way - but obtaining bc pills is a long, long way from obtaining hard-core meds for a chronic, debilitating neurological disorder.

We're agreed about the recommendations - as long as that's all they are, they're okay.

[mysirensong.livejournal.com]

I know I'm a month late, but our "conversation" in dark_christian today made me come read your LJ. LOL Anyway, there was a big thing about this on feminist_rage (I'm probably totally messing up those LJ links) and I can't post there because apparently the mods have read my user info and I'm not "feminist" enough for them so they won't ALLOW me to be a member. UGH. Anywho, the freak-out was that someone's doctor said, "I'm going to put you on pre-natals" even though the woman was a) not planning on becoming a mother and b) seeing that particular doctor that day for a colposcopy -- ya know, finding out if you have CANCER is really not the time to be discussing pre-natals, in the humble opinion of someone who's been there several times, thanks. I think the doctor was a piece of crap for saying he was going to "put (her) on" anything -- rather than suggest that she start taking them if she planned on becoming pregnant. So, I understand the desire to not have our doctors go even further into the land of "I know more about your body and reproduction than you do so just shut up and do what I tell you to." At the same time, I'm trying to get my body into shape for becoming pregnant eventually -- so I welcome the guidelines as tips for ME -- but think they're disgraceful if they're used in any authoritarian way. Do I think they'd ever be used that way in Canada? No. Do I think they're a pre-cursor to the total prohibition of abortion rights in the US? Yep.

As someone who desperately wants to become a mother, and a midwife, and will advocate for healthy pregnancies and all of that, I also don't want women to be seen only as Future Mothers of America, and that's really what I fear is happening here. It's such a fine line, you know? Do we act now when they're just sweet little guidelines and nudges in the right direction for women who plan to become mothers, or do we take action just in case those sweet little nudges are just a sign of really bad things to come?

Oh, and I'm on meds I'd NEVER think of taking when TTC. If my doctor withheld them from me because I'm of child-bearing age I'd be a wreck, and yet the minute I plan on ttc they're going down the toilet. Shouldn't I be trusted to make that decision?

Your LJ rocks; you make me think -- and with the fibromyalgia-fog I'm in lately that's a good thing. I'm going to friend you, if that's ok, so I don't forget to read you. :)

[velvetpage.livejournal.com]

You're quite welcome to friend me. Most of the interesting political stuff is public, but some of the political (or vaccination-oriented) rants are locked. I'll add you, but keep in mind that these days, there's a lot less "stuff to think about" and a lot more "Isn't the baby adorable?" You see that default icon? It was taken less than three weeks ago. I know that for sure, because the baby is three weeks and three days old. :)

I see your points about the recommendations. I still feel that the problem was more with the spin than with the recommendations, but I'm not the one who has to live with the threat that my rights will be trampled by an over-reaching right-leaning government. I consider any country that doesn't have socialized medicine to be barely civilized; and yet, if the Bush administration were deciding what health care to pay for and what to disallow, I'd probably be even less happy with the state of things in the States.