The Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, the March of Dimes, Dartmouth Hitchcock Medical Center, the National Center for Chronic Disease Prevention’s Division of Reproductive Health and the National Center on Birth Defects and Developmental Disabilities have joined together to come out with new guidelines and recommendations for women based on a concept they call “preconception care.”
Women don’t need preconception care: policymakers do. Their preconceptions are showing all over the place, and interfering with good sense and good thinking.
The basic theory is that all women between the ages of puberty and menopause should be considering themselves as “pre-pregnant,” which means taking folic acid supplements, refraining from smoking, maintaining a healthy weight, and keeping chronic conditions such as asthma and diabetes under control.
With the exception of the folic acid supplements, which are pregnancy-specific, and the possible exception of “keeping a healthy weight” (which I agree with if I get to define healthy weight), this is good basic Western medical advice for everyone, regardless of age or gender.
Let’s look at the preconceptions that go into these guidelines:
1) Women are basically baby machines. There’s no reason for us to be healthy except insofar as we might make babies. By extension, the important babies are the male babies, since the only reason for the female babies to be healthy will be to make more babies.
2) The health of our children is more important than our own health. The psychological concept of projection talks about how we can displace our feelings about ourselves onto the other. In contemporary American culture, this is extremely common between parents and children, and between society and children. We don’t let ourselves say “We want to be healthy because we’ll feel better, like ourselves better, and have better lives”? Instead, “we want to be healthy so we can have healthy babies.” Our health doesn’t matter, but our children are important!
3) The high infant mortality rates in the United States can be addressed with health guidelines. The report mentions the infant mortality issues but it does not (because our government will not) address the issues of poverty and access to health care which truly underly this problem. The vast majority of women living on minimum wage and junk food will not read these guidelines, and will not follow them if they do read them, for a host of very good reasons. Like every other health directive in our country, some affluent folks with doctors, health insurance, and lots of food choices will pay attention; most people will either not know, not care, or not have the resources to change their habits. So it’s yet another smokescreen for the hard choices that the society won’t make.
4) (An unlikely preconception for the Bush administration, to say the least) Every 12-year-old girl should preconceive herself as “pre-pregnant.” Won’t this encourage both teen sex and teen pregnancy? Are we willing to pair it with access to safe and effective (and very inexpensive) birth control? Some folks would cast this as being about pregnancy outside of marriage; for me, unsurprisingly, it’s about being ready to mother a child.
My prescription: preconception care for the government policymakers: let’s sweep out the preconceptions about conception, women, health, and sex, and start over with some fresh ideas that might be respectful and effective.
Thanks to Pat Kight for the link.