by Alma A. Hromic
(Swans - June 5, 2006) 21st century America.
If we were to believe the bright-eyed dreams of yesteryear, we would have bases on the Moon by now, and flying cars would run on air and water, and there would be no problems with parking, congestion, overdevelopment, poverty, hunger, or disease.
Now back up a minute.
Recent health statistics for the United States have, shockingly, ranked the wealthiest and certainly one of the most developed nations of the world as 29th in infant mortality -- three times that of Japan and 2.5 times those of Norway, Finland, and Iceland. On average, seven out of every 1000 American babies die before their first birthday.
USA Today has a state-based ranking, calculated using 18 different measures ranging from high school graduation rates and violent crime statistics to car crashes. The bottom five states (the percentages refer to how the state's statistics relate to the national norm) are Arkansas, -12.1%; South Carolina, -12.9%; Tennessee, -13.1%; Mississippi, -20.2%; and Louisiana, -21.3%.
Reports say that rising rates of obesity and the high infant mortality rate are due to various factors, which include higher percentage of people without health insurance, declining high school graduation rates and increased child poverty. In other words, the wealthiest nation in the world is struggling with trying to provide a basic standard of living for many of its poorer citizens, and it is alone in the "free world" in providing health care that is obstinately biased in favour of big pharmaceutical corporations and HMOs instead of trying to reach out to real people. And this will be the case for as long as patients are treated as products and not as human beings. This is not a business, for crying out loud, people do not choose to get sick, and if they are not given access to health care they WILL die in greater numbers. Look to your statistics, America.
But all that is a by-the-way to the issue that really woke me up to the state of affairs.
The infant mortality stats are directly related, we are told, to mothers having access to both prenatal and pediatric care -- obvious, that, no? But it also tells officials that other maternal risk factors are involved -- including age, obesity, smoking, infection, and stress.
The obvious and primary course of action would be to provide that necessary access to pregnant women and new mothers. Instead, the response of the American health establishment has been... well... jawdropping. I am torn between fury, hysteria, and abject terror for the future.
The issue in question are the federal guidelines issued by the CDC (Centers for Disease Control) and carried by major newspapers such as the Washington Post on May 16, 2006. Instead of addressing the issues that have obviously affected the lives of pregnant women and young children in this country, the CDC has seen fit to call on all physicians to begin programs of so-called "pre-conception" health with their female patients. ALL their female patients. All women of reproductive age, from menarche to menopause.
Let's be quite clear, this is not an instruction to provide adequate pre-conception care for women who have announced their intention of becoming pregnant, and are actively working towards that end result. That's perfectly justifiable, and only to be expected. No, this is a blanket fiat dictating that "pre-conception" health care is to be provided to ALL women, no matter whether they are thirteen or fifty, no matter whether they are pregnant, have ever been pregnant, or intend to become pregnant. This is an "all women are potentially pregnant" statement; it implies that being pregnant is an expected and indeed inevitable thing. Pregnancy is, as it were, only a matter of time. For every American woman.
If you visit the CDC Website, there is an FAQ section that begins to really scare me.
Here's an example:
The new recommendations say that everyone should have a reproductive life plan. What does this really mean?
A reproductive life plan is a set of personal goals about having (or not having) children. It also states how to achieve those goals. Everyone needs to make a reproductive plan based on personal values and resources.
It provides some examples. Here's a few:
I'm not ready to have children now. I'll make sure I don't get pregnant. Either I won't have heterosexual sex, or I'll correctly use effective contraception.
I'll want to have children when my relationship feels secure and I've saved enough money. I won't become pregnant until then. After that, I'll visit my doctor to discuss preconception health. I'll try to get pregnant when I'm in good health.
I'd like to be a father after I finish school and have a job to support a family. While I work toward those goals, I'll talk to my wife about her goals for starting a family. I'll make sure we correctly use an effective method of contraception every time we have sex until we're ready to have a baby.
I'd like to have two children, and space my pregnancies by at least two years. I'll visit my certified nurse midwife to discuss preconception health now. I'll start trying to get pregnant as soon as I'm healthy. Once I have a baby, I'll get advice from a health professional on birth control. I don't want to have a second baby before I'm ready.
I will let pregnancy happen whenever it happens. Because I don't know when that will be, I'll make sure I'm in optimal health for pregnancy at all times.
Sanctimonious stuff, dressed in the pretty clothes of earnestly well-meaning advice. Please note that the only MALE voice in this selection will "talk to [his] WIFE" about family. The jaws of Hell fair gape for anyone whose bed has not been blessed by the establishment, although a huge percentage of people in America today are cohabiting without benefit of matrimony. I suppose I should be happy that the CDC still permits contraception.
"There are many kinds of reproductive life plans. What's important is that you think about when and under what conditions you want to become pregnant. Then make sure your actions support these goals. Health care providers and counselors can help you understand the clinical and lifestyle options that are best for you," the CDC Website goes on to say. Implying a paternal nation which will "educate" you and then "counsel" you forever more, amen. It's as though you have never become an adult, never reached an age of reason and consent, never shown any sign of actually understanding your reproductive life and instead are intent on going submissively along with what is allowed. Please note the absence of the option that I, and many women like me, have chosen: I do not want to have children. Being of sound mind and body I have made a conscious choice for my life, my lifestyle, and my convictions. This does not mean that I am ready to apply to be admitted to the nearest nunnery.
They MAY be addressing that option in a different way, in another question found in the FAQ:
Does preconception health apply to women who do not plan to get pregnant?
Their answer (with my comments in CAPS, interspersed):
Absolutely. Every woman should be thinking about her health, whether or not she wants to get pregnant. SOUNDS GOOD, SO FAR, UNTIL YOU STOP TO THINK ABOUT IT. EVERY "WOMAN"? SO IT DOESN'T MATTER WHAT THE MALE PARTNER IN THIS ENTERPRISE DOES...? Some of the basic recommendations for preconception health include healthy weight and nutrition, and identifying and managing existing conditions and infections. AGAIN, SOUNDS GOOD -- BUT HEALTHY WEIGHT AND NUTRITION? IDENTIFYING AND MANAGING EXISTING CONDITIONS... AS THEY PERTAIN TO WHAT, THE SAFE DELIVERY OF AN INFANT? AND THE MALE PARTNER IS APPARENTLY ALLOWED TO RETAIN HIS BEER GUT AND HIS DISLIKE FOR EXERCISE...? All women should quit smoking and avoid other harmful substances ALL "WOMEN"? AGAIN, HERE IT IS -- WOMEN, YOU WILL NOT SMOKE OR DRINK. YOU WILL WEAR WHITE GLOVES TO CHURCH, AND YOU WILL CERTAINLY WEAR WHITE TO YOUR WEDDING. AND MEAN IT. These are important health goals for everyone, not just women planning to get pregnant. OH, NOW WE GET TO THAT. SO WHY WERE WE EMPHASISING WOMEN TO BEGIN WITH? WHY NOT CONTENT OURSELVES WITH THIS LINE AS A REPLY TO THE QUESTION ORIGINALLY POSED?
Since over half of all pregnancies in the United States are unplanned, women who might be sexually active with male partners should consider their health. OH, AND THE MALE PARTNERS, ONCE AGAIN, ARE EXEMPT? As they might not know they are pregnant, women need to avoid risks, such as using medications that could harm a fetus, whenever possible. SO THEN -- TAKING CARE OF ONE'S OWN HEALTH IS IRRELEVANT AFTER ALL? YOU ARE NOT TO TAKE A CERTAIN DRUG, MADAM, BECAUSE YOU MAY OR MAY NOT BE PREGNANT. THIS CLASS OF LIFE SAVING MEDICATIONS IS OUT OF BOUNDS TO ALL WOMEN, FROM HERE ON, BECAUSE THEY MIGHT NOT, POOR IGNORANT GENTLE SOULS, KNOW THEY ARE PREGNANT, AND WE KNOW THAT THEY WOULD NOT WISH TO HARM A BABY... HAS ANYBODY OUT THERE HEARD OF A SIMPLE PREGNANCY TEST (YES YOU'RE PREGNANT, NO YOU'RE NOT, AND IF THE LATTER THEN WE CAN PROCEED WITH THE CHEMOTHERAPY IF IT'S INDICATED...)
Women's lives are rich and complex, OH, YOU NOTICED...? and the possibility of pregnancy is only one factor affecting women's health choices. SO THEN WHY IS EVERYTHING THAT HAS BEEN SAID HERE BEEN PREDICATED ON THE POSSIBILITY -- IF NOT THE PROBABILITY -- OF PREGNANCY? WHY HAS EVERYTHING BEEN COUCHED IN TERMS OF PREGNANCY? EVEN THE NAME OF THE PROGRAM IS PRE-CONCEPTION CARE, PRE-PREGNANCY CARE -- DOES ANYONE ELSE SEE THE PROBLEM WITH THIS? The more that women know about the health care relevant to their own circumstances, the more empowered they are to make the right choices for their lives....AS LONG AS THEY EVENTUALLY BECOME PREGNANT.
Every man and woman should prepare for pregnancy before becoming sexually active, (EXCUSE ME?) or at least three months before conception. AND AGAIN... EXCUSE ME? WIDER CHOICES FOR WOMEN'S LIVES CAN GO JUMP IN THE LAKE, APPARENTLY. WE SHOULD ALL THINK WE ARE PREGNANT LONG BEFORE WE LEAVE OUR OWN NURSERY, IT SEEMS, IF WE ARE THE FEMALE OF THE SPECIES. Women should begin some of the recommendations even sooner (SOONER THAN WHAT?) -- such as quitting smoking, reaching healthy weight, and adjusting medications. GOD KNOWS I AM NOT A SMOKER, IN FACT I'M ACTIVELY REPELLED BY CIGARETTE SMOKE AND WOULD NOT SMOKE AT ALL AND WOULD CERTAINLY NOT ADVISE ANYONE ELSE OF THAT BEING A GOOD IDEA IN ANY WAY SHAPE OR FORM -- BUT IF A WOMAN IS NOT PREGNANT, AND HAS NO INTENTION OF BECOMING SO, HER ONLY INCENTIVE FOR SMOKING OR NOT SMOKING IS PERSONAL PREFERENCE AND POSSIBLY CONSIDERATION FOR ANY COMPANIONS WHOM CIGARETTE SMOKE MIGHT INTERFERE WITH. CERTAINLY NOT THE CONSIDERATION OF A PHANTOM PREGNANCY. AS FOR THE REST OF IT... ADJUSTING MEDICATIONS? ARE YOU SAYING WOMEN SHOULD STOP CANCER TREATMENTS, FOR INSTANCE, BECAUSE SUCH MEDICAL INTERVENTION MIGHT HARM A FUTURE FETUS? I WOULD HAVE THOUGHT THAT THE PREREQUISITE FOR BECOMING PREGNANT AT ALL WOULD BE TO ACTUALLY BE ALIVE TO CARRY THE BABY... Planning for pregnancy is also a good time to talk about other concerns. Issues such as intimate partner domestic violence, mental health, and previous pregnancy problems need to be discussed. INDEED THEY DO. WOMEN DESERVE TO LIVE IN LOVING PARTNERSHIPS WITH PEOPLE WHO RESPECT THEM AND CHERISH THEM. IN ANY EVENT... DOMESTIC VIOLENCE? SURELY THAT SHOULD BE ADDRESSED WHETHER OR NOT A PREGNANCY IS PART OF THE EQUATION. MENTAL HEALTH? WHOSE? ARE WOMEN WHO ARE DIAGNOSED AS, FOR INSTANCE, DEPRESSIVE OR BIPOLAR BUT WHO CAN LEAD PERFECTLY NORMAL LIVES WITH MEDICATION BE BLACKBALLED IN THE PREGNANCY RATE? IS THE PARTNER'S MENTAL HEALTH AT ISSUE? AND -- PREVIOUS PREGNANCY PROBLEMS? SURE THEY NEED TO BE ADDRESSED, AS PART OF A WOMAN'S MEDICAL HISTORY... ALWAYS ASSUMING THAT SHE ISN'T PREGNANT FOR THE FIRST TIME...
According to the CDC guidelines, the five most important things a woman can do for preconception health are:
- Take 400 mcg of folic acid a day for at least 3 months before becoming pregnancy to reduce the risk of birth defects.
- Stop smoking and drinking alcohol.
- If you currently have a medical condition, be sure these conditions are under control. Conditions include but are not limited to asthma, diabetes, oral health, obesity, or epilepsy. Be sure that your vaccinations are up to date.
- Talk to your doctor and pharmacist about any over the counter and prescription medicines you are taking.
- Avoid exposures to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.
- And again, I have to ask -- 3 months before becoming pregnant? This is not a precise science. You cannot measure the precise moment when you will "become pregnant." When are these three months supposed to begin? The day a girl gets her first period? Should we be force fed folic acid every day of our lives if we are born female...just in case that, some three arbitrary months down the line, we might be so happy as to become impregnated by a healthy, happy partner in a home free of domestic violence, mental illness, poverty, and stress?
- Permanently? For good? For ever? If I am female, I am not allowed a glass of wine with my dinner? Ever again?
- You know, it would stand to reason that a woman who finds out she is pregnant will try and make sure her "current medical conditions" are under control -- but if she isn't supposed to be taking medication for these conditions for fear of harming the potential fetus, then how does one become safely pregnant and keep, for instance, one's epilepsy under control? Or are we starting to talk eugenics here?
- Stands to reason -- isn't ANYONE else feeling as though women are being treated as creatures with very little brain power here?
- Oh, okay. Cats of America, hit the road. Guess who cleans cat litter boxes in the home? Even in those three months before she "becomes pregnant"? Did anyone provide the CDC with studies showing how pets can improve the mental health of any household...even if they DO require their cages cleaned every so often...by Mom...?
The Washington Post article on this whole kerfuffle has the following lovely paragraph in it:
While most of these recommendations are well known to women who are pregnant or seeking to get pregnant, experts say it's important that women follow this advice throughout their reproductive lives, because about half of pregnancies are unplanned and so much damage can be done to a fetus between conception and the time the pregnancy is confirmed.
The time between conception and confirmation of pregnancy is typically four weeks, or less -- the time that elapses between two menstrual periods. When a woman misses one, it's usually a good indication that she is in fact -- as they used to put it -- with child. And at this point, most pregnant women, yes, even the ones whose pregnancies weren't planned three months ahead, will do the right thing and stop any behaviour which may endanger the life they are beginning to nurture within them. However, this covers women who have access to education, decent health care, and food on the table. A sixteen-year-old crack addict from the ghetto is unlikely to stop taking crack because she is pregnant - but then again, neither would she have been taking her folic acid supplements daily. In order to force the women of America to follow these steps and ensure a bountiful supply of healthy bouncing baby citizens, you have to improve the living conditions of women in America. In the end, it has nothing to do with being potentially pregnant. It's everything to do with being potentially civilized.
The article goes on to say:
Research shows that during the first few weeks (before 52 days' gestation) of pregnancy -- during which a woman may not yet realize she's pregnant -- exposure to alcohol, tobacco and other drugs; lack of essential vitamins (e.g., folic acid); and workplace hazards can adversely affect fetal development and result in pregnancy complications and poor outcomes for both the mother and the infant.
Once again, this is presupposing a lifestyle quite different to what we are all used to. Many if not most women work -- these "workplace hazards" which are so dangerous to the fetus, how dangerous are they for the woman worker? And is the only way she can "avoid exposure" to such hazards during a time in which she does not yet know she is pregnant to stop working altogether?
If you go back to the CDC Website, it's adorned by photograph after photograph of happy couples nuzzling at one another, holding rosy-cheeked infants up high in pictures of domestic bliss, holding hands. The reality of the modern world is that the stay-at-home mom is not exactly the most frequent domestic arrangement. Women sometimes work because they have to, because their income supplements the family's in substantial enough a manner for its lack to be potentially catastrophic. There is no way to avoid exposure to "workplace hazards" without avoiding work. Too many are not in a position to do this.
But over and above that -- not only are women supposed to not smoke and not drink, not to mention that they are supposed to turn away in holy martyrdom from any medicine whatsoever from over the counter cough medicine to life-saving cancer treatment, they are also supposed to avoid "exposure to workplace hazards," i.e., they are supposed to stop working. Is anyone else channeling Margaret Atwood's apocalyptic vision of The Handmaid's Tale here...?
The Washington Post article goes on to point out that seventeen million American women -- SEVENTEEN MILLION! -- lack basic health insurance, and are thus likely to think twice about seeking medical attention. For anything, let alone pre-natal care. That, to me, seems to be a far more important question to address than whether a working woman has a glass of wine with her supper without being 100% certain that she is not pregnant. That is a fundamental failure of the system. The system discriminates against the poor and the minorities, the very people who HAVE to work for a living but whose jobs are likely to be minimum wage without benefits. Address that, and you'll suddenly see a massive improvement in health statistics. The HMOs might have to take a cut in profits -- but aren't we talking babies here? Sweet innocent babies?
Putting profit before the nation's children has never been acceptable, but it's even more egregious when it's as coated in hypocrisy as this.
The article also discusses "obstacles" to preconception care. These include an acknowledgment by so-called "experts" that women with no plans to get pregnant in the near future may resist preconception care.
I honestly don't know why that would come as a surprise to anyone.
Remember where we started this article? By reminding ourselves that this was 21st century America?
Cling to that knowledge, my sisters of this great nation. There are women who suffered and died so that we, in this future, could have a vote, could have a choice. I am forty-two years old and I am no longer likely to become a mother -- but it offends me deeply that there are people out there who still treat me as "pre-pregnant" because I haven't quite hit the 'Change yet. I would have been even more outraged back when I was thirty-five, or twenty-two. I was a woman -- but I was first and foremost a human being, with a lot to offer the world other than just my womb.
In the past, because of the baggage it does inevitably carry with it, I have resisted being labelled a "feminist" -- and yet, today, right now, in the aftermath of the anger and fear that this program has left in its wake, I am standing here and telling you, yes, this is what a feminist looks like. If being a feminist means that I am nobody's chattel, nobody's property, that my body is my own property and does not, in any way shape or form, belong to the state or to any other human being beside myself. I will decide what to do with that body. Living in a civilized country means, to me, that I am entitled to basic and decent health care for that body -- health care that does not presuppose that I am going to be tied down and impregnated at some time before I cease to be able to carry a child, in order to fulfill my duty as a female of the species. I chose not to have children, and it offends me that a health care provider might be forced to treat me as though I am a feeble-brained child who doesn't know her own mind -- that the only reason I am not yet pregnant is because I have not yet had the opportunity.
Someone recently reported seeing the slogan "She's not a choice, she's a child" on a pro-life bumper sticker -- and the instant counter to that, as the reporter suggested, is "She's not a womb, she's a woman."
We are women. We are men's equals, not their toys. But until such dictums as "WOMEN should not drink or smoke" stop being trotted out as guidelines to govern the behaviour of the female (but not the male) of the species, our battles are still not won.
If you find yourself, as I did, with something to say on this new health edict, here are three pertinent public servants to whom you may address yourself:
Jose Cordero, MD, Director
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
1600 Clifton Rd, Atlanta, GA 30333
Julie Gerberding, Director
Centers for Disease Control and Prevention
1600 Clifton Rd, Atlanta, GA 30333
Michael Leavitt, Secretary of Health and Human Services
U.S. Department of Health & Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
"USA in a fragile state of health, report says"
By Robert Davis, USA Today -- November 7, 2004
Guidelines: Treat Nearly All Women as Pre-Pregnant"
By January W. Payne, Washington Post Staff Writer -- May 16, 2006
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