Feminists--including myself--have been in an uproar this week over the tone-deaf and paternalistic decree from the CDC that women of childbearing age shouldn't drink alcohol if they're not on birth control. After all, the CDC reasons, they might get pregnant and not realize it and keep drinking, thereby harming their baby. I agree with much of the excellent commentary pointing out how sexist, condescending and demeaning the CDC’s statement was. (“The language insinuates that your womb is a Schrodinger's box” was a personal favorite.)
I was angry at the patriarchal tone, the exclusion of lesbians’ existence, the lack of acknowledgement regarding contraception access difficulties or the option of termination, the possibility that some women might actually be abstinent, the absence of any mention of sexual partners who contribute sperm and the overall implication that women exist only as potential baby-carrying vessels, not as individuals.
But as angry as I am that my national public health agency devalues my existence as an autonomous human being, I’m actually angrier about what their failure to effectively communicate has wrought with its (deserved) backlash. Because the CDC completely bungled their messaging, people are disregarding the actually important information the agency was trying to convey about alcohol and pregnancy. Everyone is talking about how much they screwed up—not enough people are talking about the very large and serious public health problem behind their statements. Our country, like so many others, is in denial about a lot of the ways alcohol is harmful, including during pregnancy—yes, even a tiny bit. The CDC just gave people a reason to continue that denial.
In the midst of much of the criticism, I’ve seen far too many comments in the media coverage about how the research shows “a glass now and then” can’t hurt, or that “very light drinking shows no effects” on children. As I’ve written before, that’s not the case. I’ve also seen a lot of false equivalence: people think, “They also say caffeine should be avoided. And sushi. And lunchmeat. And soft cheese. I’m not a damn saint!” And they figure if the risk is kind of low-ish with those substances, then so it must be with alcohol.
The problem is that the risks associated with alcohol are different from those other “risks,” some of which (e.g., caffeine) don't exist at all. The risk of listeria from soft cheese is vanishingly small (and you can get it from just about any food), and it's a binary situation: you get listeria, or you don't. With alcohol, there is no question of harm. Alcohol is a toxin that directly damages cells. Harm occurs. The question is the scale and the effect (and whether it’s detectable), and that part of the message was not communicated at all.
Just about everyone has heard about the dangers of heavy or even moderate drinking during pregnancy.... [+]
Should a woman who is pregnant--or a woman who might become pregnant--drink a glass of wine or two? That is not my decision to make, nor is it the CDC's. It’s also not my place to tell a woman what she should do, nor is it the CDC's. But it is important for that woman to know what risks she is taking, whether currently pregnant or having unprotected sex, and it is absolutely the role of the CDC to clearly and transparently explain those risks--and they failed.
Alcohol starts affecting a developing embryo by the third week after fertilization. From then on, alcohol crosses the placenta. Every. Single. Time. What it does once it gets there depends on what's going on at that precise moment. But the idea that it does nothing is a misconception not supported by the evidence base.
I read dozens and dozens of studies in full for the alcohol and pregnancy section of the book I coauthored with Emily Willingham. I began that research thinking a glass here or there was no big deal. I had even had a few glasses of wine or beer sparingly in my second pregnancy and stood by my decision. Heck, I had a half a shot of whisky at the start of my son’s second trimester—it was a free sample and I wanted a taste. I was therefore stunned when I really dug deep into the research: Several dozens of hours reading epidemiological studies, basic science studies, animal studies, in vitro studies, ultrasound studies, developmental studies and various commentaries and editorials on the relative merits and limitations of all these.
To my own surprise, I changed my mind. Once I had a better understanding about what alcohol is at a chemical level, how it works, how it differs from many other substances, how it interacts with cells, how it circulates and how underreported fetal alcohol spectrum disorders—separate from the more serious fetal alcohol syndrome—are, and how poorly these conditions are screened for, detected, diagnosed and managed, I did a complete 180 on this question.
There is no doubt that even one drink—even a half drink—circulates throughout the entire body and reaches the embryo (or, later, fetus). There is no doubt that alcohol damages developing cells. So the question isn’t about exposure but about damage. The more relevant questions are: “Which cells?" and “How bad is the damage?" And there is no way for current technology to answer that at any given moment.
Most certainly, one drink may have so little effect, if any at all, that's it's irrelevant. Or not. It's not the precautionary principle if we have solid evidence of harm that occurs at a cellular level. And we do. In educated, upper-income women with good nutrition, that effect will likely be offset so much that any manifestation would be subclinical—not detectable with current tests—and the parents may very well be fine with that possibility. That’s also why those who have already drunk before they knew they were pregnant should not be shamed. (Paying attention, CDC?) Whatever damage has potentially occurred is likely small enough not to be noticed unless the person was regularly binging.
If a person knowingly chooses to drink while pregnant and accept the risk, that is her decision—I do not in any way judge someone who drinks during pregnancy. Rather, I empathize with her. Being pregnant was no picnic for me, and goodness knows I really felt I needed that glass of wine a couple times. I do, however, believe that people have a right to be fully informed about the science. I wasn’t at that time. Others aren’t either right now, in part, because of paternalistic, oversimplifying, sexist messages like that of the CDC’s.
Instead of clearly EXPLAINING what is scientifically understood about the risk and what the effects are from even small amount of alcohol, the agency issues a blanket statement for “all women” (lesbians don’t matter, apparently) that talks down to women, exonerates men and leaves everyone with just as little information as they had before. Simply stating “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,” and asking, “Why take the chance?” does not actually tell people anything.
Scientists have known for three decades that alcohol disrupts the structure of cell membranes. Even a tiny amount of it. They know it damages stem cells. Does that matter to a developing embryo? Well, that depends. Precisely which organ is in the midst of forming at that exact moment when a pregnant woman downs…a half shot of whisky, for example? We don’t know. Twin studies have found that one twin may be much more affected by a mother’s alcohol consumption than the other. Did one buffer the other? Have a genetic mutation that protected them? Simply hang out in a luckier part of the womb? What effect alcohol might have at any given moment will vary from woman to woman, embryo to embryo, drinking episode/instance to drinking episode/instance. And it’s fully within a woman’s right to take that risk once she is aware of that.
An estimated 40,000 children are born each year with FASDs and related alcohol effects. It’s possible to look at one study here and one study there and find ways to justify that a little bit of drinking won't cause harm, but a close examination of all the evidence together leaves little doubt about even small amounts of alcohol. Most of the studies looking at “light drinking” have not used sophisticated enough tests to detect what effects might be there. Most lesser effects, such as attention and focus problems, difficulty in decision-making and mood problems, do not show up until adolescence, and very few studies have tracked children that far. When including all FASDs and other non-FASD conditions, 1% of all live births in the U.S. are affected by alcohol, and that is an underestimate precisely because of what cannot be detected in healthier, wealthier women. Alcohol exposure during pregnancy is the leading cause of intellectual disability (formerly called "mental retardation") in the U.S.
Yes, consumption of alcohol in those precious few weeks (or months) before a woman knows she is pregnant almost certainly has adverse effects on her child that are preventable. Yes, this is a major health issue, it's not adequately addressed, and the CDC is the appropriate agency to address it. And they completely and totally screwed it up. They bungled it to such a degree that they very well might cause harm by obfuscating just what the risks are with their paternalistic decrees. Women are not children who need admonishment about not touching the stove. They need information—clearly communicated information without euphemisms or tsk-tsks, delivered in a reasonable tone that respects them as adults capable of making their own decisions.
My book, The Informed Parent, with co-author Emily Willingham, is available for pre-order. Find me on Twitter here.
