The CDC’s recent warning about the risks of alcohol for women is not only condescending, but also erases women in same-sex relationships and transgender women.
Let’s state up front: Fetal alcohol spectrum disorder (FASD) is a serious condition. It makes sense to me that people who are pregnant or trying to be should stop drinking.
But this report on women and alcohol, part of the CDC’s monthly Vital Signs newsletter, makes pronouncements that are too sweeping and too patronizing.
The CDC report said, “More than 3 million US women are at risk of exposing their developing baby to alcohol because they are drinking, having sex, and not using birth control to prevent pregnancy.” And CDC Principal Deputy Director Anne Schuchat, M.D., explained, “Alcohol can permanently harm a developing baby before a woman knows she is pregnant. About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?”
Major media outlets, including the New York Times, LA Times, Boston Globe, Washington Post, The Atlantic, and Slate, interpreted the CDC to be saying that sexually active women should not drink unless they are on birth control. Many writers saw it as an attempt to be far too controlling of women’s lives.
As Darlena Cunha at TIME points out:
Since birth control wouldn’t be a factor in women already developing a fetus inside of them, we must assume that the CDC is telling all women of child bearing age not to drink at all, in case they might accidentally fall pregnant. They are protecting a fetus that doesn’t exist. . . . The paternalism is stunning. Suddenly, it’s no longer a political question whether a mother’s right to her body outweighs the right of an unborn fetus inside of her. Instead it is a medical guideline that a woman’s right to her body vanishes if there is a mere possibility that a fetus might reside there someday.
And Rebecca Kukla at the LA Times notes:
Despite decades of research, and contrary to public belief, we have no substantial evidence that light drinking during pregnancy as part of a generally healthy lifestyle has any link with FASD. The CDC released a report in 2014 concluding that low to moderate alcohol use did not predict intelligence scores or attention skills in 5-year-olds. . . .
Sarah Richardson and Rene Almeling of the Boston Globe also assert, “a balanced review of the scientific evidence does not support such unequivocal claims.” Personally, I think it seems sensible to stop drinking if pregnant or trying to be—but the lack of scientific consensus makes me think the risk of moderate drinking for a woman who is sexually active, not on birth control, but not trying to conceive is probably low. I’m not a medical doctor, though, so that’s merely my opinion.
FASD aside, however, the top section of an infographic published with the CDC report conveys to women, and women alone, that drinking too much can lead to “injuries/violence,” “sexually transmitted disease” and “unintended pregnancy,” among other things. Cunha observes that this “is a blanket statement that stretches over a river of decisions that must be made by two people, not one.”
Kukla also astutely notes:
Even as the CDC cracks down on potentially pregnant women, it offers no parallel recommendations for expectant fathers. Yet we know that men’s drinking reduces sperm quantity and quality, and that it has epigenetic effects on their offspring’s tolerance for alcohol. Moreover, expectant paternal drinking is correlated with an uptick in the frequency of intimate partner violence, which in turn can cause miscarriage, preterm birth and birth defects.
The CDC seems to have taken this top part of the infographic off of its website (but you can still see it at the Internet Archive).
The CDC’s Schuchat tried to defend the report, telling the New York Times in a follow-up article that “We weren’t as clear as we had hoped to be. . . . We’re really all about empowering women to make good choices and to give them the best information we can so they can decide what they want to do themselves.”
Believe Schuchat or not, but there’s still another issue with the report, and that is the total erasure of women in relationships with women, not to mention transgender men who may still be able to get pregnant. The CDC infographic that remains tells healthcare professionals, “Encourage [a woman] to always use condoms to reduce risk of sexually transmitted diseases. . . . Advise a woman to stop drinking if she is trying to get pregnant or not using birth control with sex.” Personally, I’ve never used birth control with sex—but I’ve been married to a woman for almost 23 years, so I haven’t needed to. (Actually, the only time in my life I took birth control pills was when my spouse and I were trying to start a family and we needed to synch our cycles so I could give an egg to her.)
The first New York Times article somewhat snarkily said the report “appeared to refer exclusively to heterosexual sex,” but didn’t explore the ramifications. I’m perfectly fine with the CDC issuing advice solely to straight, cisgender women (hopefully in addition to advice for lesbian, bi, and trans women)—but if they’re going to do so, they should say that that’s the target audience. By not stating that explicitly, the CDC reinforces the idea that all women’s healthcare needs are the same. (It’s unclear to me, and I assume to others as well, whether the “if appropriate” in the infographic refers to queer women.) That’s dangerous and outdated thinking.
In general, I think the CDC is a force for good. After all, it’s going to be on the front lines in any zombie apocalypse. It can do better, though. For example, while it has a page of resources on LGBT health, it was last updated nearly two years ago. The link to “Ten Things Lesbians Should Discuss with Their Health Care Providers” on its page for lesbian and bi women actually goes to a page of 10 things for trans people. (Important, but not what the link was indicating.) And the U.S. Department of Health and Human Services (HHS) page on lesbian and bi women’s health that the CDC links to has a “safer sex” section advising condom use if having sex with men, but then merely stating, “If you are unsure about a partner’s status, practice methods to reduce the chances of sharing vaginal fluid, semen, or blood.” It would be helpful if they actually mentioned some of these methods, such as dental dams, for those with female partners.
Discrimination, erasure, and misinformation in healthcare isn’t news to LGBTQ people, or to women in general. That doesn’t mean we shouldn’t call it out when it happens.