Are you a woman of childbearing age? Do you binge drink constantly and have unprotected sex on the reg? Well, the CDC wants you to know that you’re putting a potential child’s life at risk with your irresponsible behavior. This message was at the center of a mini-firestorm last week after the Centers for Disease Control and Prevention issued a press release telling women between 15- and 44-years-old they need to either quit drinking entirely or get on birth control. Some couldn’t understand why seemingly reasonable advice was so offensive. Luckily, there are many smart, snarky, female writers out there who leapt at the task of explaining why looking at women as existing in a state of “pre-pregnancy” was condescending, paternalistic, and tone deaf. It was all of those things, but it was also bad advice.
The point of the warning was to alert women to the fact that, if they’re not on birth control, they could be pregnant and that their drinking may cause an undetected fetus to develop Fetal Alcohol Spectrum Disorders (FASDs), very serious conditions that are entirely preventable.
Was the message well-intentioned? Of course, as are all of the CDC’s hyperbolic and sometimes incorrect guidelines and warnings. But it illustrates a fundamental problem with government health advice generally: take a complicated issue, for which the science is not “settled,” and turn it into a population-wide categorical directive. Rather than giving us nuanced information about the actual level of risk (the Fetal Alcohol Spectrum Disorders Center for Excellence puts at 10 in 1,000 births not 1 in 20 as the CDC claimed, by the way), and allowing women to make their own calculation about what risks are worth taking, they’d rather scare us into completely avoiding an activity that has any risk at all. Or put more succinctly, they rely on the precautionary principle.
Broadly stated, the precautionary principle holds that when the risks of an action are unknown it is best to entirely avoid it. But every choice we make has risks—even choosing to avoid something—and those risks must be weighed against potential benefits. For example, a woman may rather accept the small risk of a condom breaking on one of the six days a month when she could become pregnant, (necessitating the use of emergency contraception or pregnancy termination) than increase her risk of blood clots and cancer by using hormonal birth control or give up her social life and the possible cardiovascular benefits of consuming alcohol.
“There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy,” the CDC’s press release asserts. This carefully worded sentence isn’t inaccurate. We don’t know yet what level of alcohol consumption, if any, during pregnancy is without risk so, the CDC is saying, you shouldn’t have any. But the same could be said for thousands of other things pregnant women do.
In order to adhere to this standard of certainty about safety, women of childbearing age would also have to eliminate sushi and soft cheeses from her diet, stop drinking coffee, quit their jobs in radiology and other potentially fetus-harming careers, etc. Of course, nobody is advising this of women of childbearing age because risks of some of these activities to a fetus are relatively small and the benefits outweigh the risks.
“We don’t tell pregnant women not to drive cars, even though we are much more certain that there’s a nonzero risk to their fetuses from each car ride than from each drink. The ideal of zero risk is both impossible to meet and completely paralyzing to try to meet. The idea that the pleasures and routines that make up women’s days are mere luxuries that are not worth any risk whatsoever is patronizing and sexist, and it would also turn their lives into complete hell if really taken to its conclusion. It also imposes a much higher risk reduction bar on pregnant women than on parents of small children, for no apparent reason.”
While we are sure that binge drinking during pregnancy greatly increases the risk of harming a fetus, there is also a growing body of research showing that small amounts (up to one drink a day) even in the early stages of pregnancy, do not seem to increase risks. As economist Emily Oster detailed in her book Expecting Better, studies that looked at alcohol consumption levels among women—from total abstinence to more than one drink a day—found that children of abstainers and those who consumed up to one drink a day were the same when it came to behavioral problems and performance on intelligence tests up to age 14.
Even if it turns out that these studies are flawed and there is always some risk with any amount of alcohol, the amount of risk is important. While we know that heavy alcohol use during pregnancy significantly increases the chance of FASDs, we also know that one drop of alcohol doesn’t guarantee FASDs (otherwise folks born before the 1970s would have been screwed). The level of risk is somewhere between null and guaranteed depending on how much you drink. But you’d never know that from reading CDC’s advice. For them, any risk, no matter how infinitesimal, is not worth that glass of chardonnay. Or to put it another way, better safe than sorry.
Yet, for women who aren’t pregnant and aren’t planning on becoming pregnant, the issue will never be this black and white and trying to scare or shame women into going on the pill or teetotalism will not work. Instead, the CDC should have discussed the actual risk of FASDs.
They could have acknowledged that even experts disagree on the safety of consuming alcohol while pregnant, and provided realistic advice, like telling women to keep their drinking to one glass a day if they might be pregnant and advising women and men of their many options for contraception—like condoms. Instead, CDC chose to omit any information that would cast doubt on their position and as a result, the very serious message about fetal alcohol spectrum disorders was lost in the backlash.