Pregnancy and Policy: Who Decides? Time to Stop Focusing on Fear and Shame
Fetal alcohol spectrum disorders (FASDs) are completely preventable. FASDs are caused when alcohol, consumed during pregnancy, crosses the placenta and can result in effects that range in severity. The exact prevalence is unknown, but it is estimated that at least 10 out of 1,000 children have FASD (May & Gossage, 2001). This estimate, though high, may still fall short of the actual cases due to the window in which a diagnosis occurs. While the most severe cases of FASD are obvious at birth, less subtle effects of FASD, such as developmental, cognitive, and physical disabilities, may not be obvious until the child ages, delaying diagnosis and treatment. FASD is a public health issue where prevention is our best approach. The questions remains: How do we prevent FASD while preserving a person’s autonomy before and during a pregnancy?
With 1 in 10 people drinking during pregnancy (CDC, 2015), the solution is more complicated than simply asking people to abstain from alcohol use while pregnant. Almost 50 percent of all pregnancies in the US are unplanned, which can delay pregnancy awareness (Guttmacher, 2016). Unplanned pregnancies can result from a lack of knowledge about or access to birth control. Many people are unaware of their pregnancy for eight weeks or more and drink during this window of time. Consuming alcohol during this window unknowingly and unintentionally exposes the fetus to alcohol’s potentially damaging effects. People who become pregnant may be unaware of the effects of alcohol exposure on the developing fetus, or may need support to minimize or abstain from alcohol use. Furthermore, those who suffer from serious addiction or mental health issues require a network of support to address their drinking. In order to address the complexity of FASD, we must understand the very important intersections between access to contraception and education about alcohol’s effects on the fetus.
This is an issue that has not gone unaddressed. The CDC recommends that reproductive-age women, not using birth control, should abstain from drinking any alcohol (CDC, 2016). Abstinence is the safest approach, but provides no educational information about why one should abstain or how one can access health care, counseling, or birth control. This abstinence-based approach does not address underlying trauma, mental health issues, or access for treatment of alcoholism. Given that a large portion of the population enjoys responsible drinking, suggesting abstinence from alcohol is an unrealistic expectation. This approach comes off as paternalistic and infers that women’s participation in the world is solely to produce offspring. Another strategy that has been used is point of sale warning posters and labeling on alcohol-containing products. While these strategies demonstrated a small decrease in FASD, the effect has waned as people have tuned out these familiar messages. While some providers screen for alcohol use, there is no universal screening for alcohol use in the obstetric setting. These prevention initiatives have failed as they do not address the multifactorial nature of FASD.
As former methods are proving ineffective, it is time to address FASD through a reproductive justice framework. Society must recognize that women deserve to be viewed as more than just reproductive vessels and consider the larger contextual issues. Education and access to healthcare are two extremely complex, yet undeniably critical factors necessary to address FASD. Women who have access to family planning information and care will have more control over their fertility and pregnancy planning. This strategy may significantly decrease the number of children born with FASDs caused by late pregnancy recognition.
The CDC asks women who are sexually active and do not use birth control, “Why take the risk?” when it comes to alcohol. This sets the precedent that women live and act with malicious intent for a theoretical pregnancy, thus promoting societal shame. Shame occurs through the lack of conversation and screening for alcohol use during prenatal visits, and is a major contributing factor to the under-diagnosis of FASD. A reproductive justice lens avoids shaming women and avoids fear-based tactics. Instead, it asks women about their alcohol use and provides information, resources, and the necessary support to help women make informed and un-coerced choices. This includes ensuring that women are provided with accurate education about alcohol consumption during pregnancy that reflects the complexity of this subject.
FASDs will not be resolved with any one simple intervention. A paradigm shift has the strongest potential to move towards healthier outcomes for pregnant people and their children. It is time to move away from the current focus on fear and shame. FASDs are completely preventable, and their incidence can be reduced in the US by adopting a reproductive justice lens.
Your voice can make a difference on this issue. Join the National Organization for Fetal Alcohol Syndrome’s campaign to end FASD and pledge to Stamp Out Stigma! Use your voice and help us move away from the current focus on fear and shame, and move towards a more empowering approach to preventing FASD. Go to http://www.nofas.org/stigma and take the pledge today! It will take all of us to make the paradigm shift necessary to lower FASDs and move towards healthier pregnancy outcomes and healthier babies.
http://www.cdc.gov/vitalsigns/fasd/index.html (CDC, 2016)
http://pubs.niaaa.nih.gov/publications/arh25-3/159-167.htm (May & Gossage, 2001)
Authors Full Name(s): Shannon Durst, Fatima Malik, Annie Richardson, Annie Song, EB Troast, Peg Walden
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