Letters to the Editor
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Whoa! Easy there...
As someone who works in this area of public health, I think that you are taking this far too defensively. Pre-conceptional counseling as an idea has been around for a long time and most public health folks believe it should be promoted. NOT as a way to control women or minimize their opportunities, but as a way to improve health. IF a woman has no intention of having kids and is certain of that choice, she does as she pleases, although with the same guidance on healthy living. IF on the other hand there is some ambivalence or doubt or perhaps a desire to have children someday, taking care of your body only makes sense.
Guidelines are just that, guidelines are not laws. Should health providers promote smoking cessation, folic acid intake, etc? ABSO EFFING LUTELY. But just like any medical advice you are free to ignore it.
The justification, as was pointed out, is that a large proportion of pregnancies are unplanned. Unfortunately Margaret Sanger's cause has suffered, especially recently. The article like Planned Parenthood, is not suggesting that everyone must prepare to become a handmaid in any totalitarian sense, but rather that all women should understand the effects of folic acid on preventing neural tube defects, or the many cancers that are associated with smoking and may make their lives,including pregnancy, should they ever so choose, more difficult.
The large proportion of women for whom pregnancy is unplanned, are at greater risk for adverse outcomes than those who are planning pregnancy. Every effort should be made to help women live healthy lives. Whether they choose to do so, just like pregnancy itself, should be up to them.
Furthermore, your suggestion that access to care is what is driving the disparities in infant mortality just doesn't track. The root causes of the disparity are far more complex and include a variety of influences including poverty, violence, social isolation, nutrition, drug use (legal and illegal) just to name a few. I would argue that economic depravation is the greatest cause, but that is not one the medical community can address directly. Nutrition and health are, and they would be negligent if they didn't. To go farther, while there are definite access problems, research being done now and over the past 15 years suggests strongly, that other factors are more important. My assertion that economics is the underlying cause, includes access, but also includes the added stresses of poverty related to social support (not healthcare)and nutrition.
As a long time reader, I'm very disappointed that your response was so negative and unfair. I agree wholeheartedly that the current administration is setting women's issues back, and the CDC (under this administration) has been guilty of the that, specifically in the areas of adolescent sexuality, however, to suggest that pre-conceptional counseling is crap is just flat out wrong.
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"You can't simultaneously prevent and prepare for war"
Einstein said it best!
Since access to birth control and abortions are both being limited by the govt, this recommendation that we all be on chronic pre-pregnancy alert would logically follow, would it not? Yikes.
I agree with other posters that the infant mortality rate issue has much to do with the US healthcare insurance crisis, and nothing to do with whether we are taking folic acid suppliments with our Wheaties. Like most other positions taken on reproductive issues in the current administration, it declines to address reality in favor of vague, do-nothing moralism. Is anyone surprised?
Also, ditto to the poster who mentioned promoting the HPV vaccine. Now *there* is an issue where an ounce of prevention is worth a pound of cure (and again, where insurance reform would save lives). However, allegedly, promoting the HPV vaccine indirectly implies govt approval (!) for non-procreative / extramarital sex and/or that the govt would have to invest time/money in a woman's healthcare issue and thus, a few dead women are a fair price to pay to save a few bucks and religious fundie votes.
You know what the saddest part of all this is? Women's reproductive freedom is so consistently under attack that I have the impression that a lot of younger / childless women don't even have the slightest clue how to feel positive about their own reproductive ability, because they are so busy trying to defend their right to control it. I see a lot of activist women taking up this reactionary attitude that pregnancy and motherhood are disgusting, demeaning activities, babies are sprogs and mothers are breeders, etc., except that a lot of them will find later in life that that childbirth has personal value and meaning, and, *surprise!* the govt is not supportive of the choice *to* reproduce, either, despite its faux-pronatalist stance on birth control.
The real truth is of course that America wants to retain its policy of limiting money and resources for women's health care, period. *That* is why we have a crappy first world infant mortality rate.
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oh I think everyone is being a bit alarmist here
It may be that all of you knew all of the things that the CDC is warning you about. Until I started trying to get pregnant, I did not know about many of the threats to a developing fetus. I tend to over-intellectualize, so of course my first thought upon embarking on a new project (baby making) was to get a book about it. But I know lots of people for whom this is not a typical approach. Is it really so bad for doctors to remind potentially fertile women to think about their fertility and what might affect it?
I honestly don't see the harm, given our fetal mortality and birth defect rates, in telling women in their potentially fertile years that some things are harmful to a developing fetus. One then has the knowledge to use or ignore at will. C'mon, is it really so awful that a public health program targeting a specific problem (infant mortality) wants to raise awareness of that problem with the group most capable of addressing some aspects of the problem? I totally agree that it would be best if we all had health insurance and decent health care. But in the mean time, isn't it ok to give women some information they might want to use?