On Tuesday, the CDC released a controversial statement on women and alcohol. In it, they recommended that all women who are sexually active, fertile, and don’t use birth control should stop drinking… RIGHT. NOW.
Why? Because of the risk that these bibulous women might give potentially unplanned children fetal alcohol syndrome (FAS), apparently now known as “fetal alcohol spectrum disorders” (FASDs).
The CDC’s explanation for the recommendation essentially consists of the following:
- 3.3 million women between the ages of 15 and 44 are drinking, having sex, and not using birth control.
- FASDs “can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime.”
And that’s pretty much it. Presumably, the CDC is able to omit other helpful information because, hey, they’re the CDC, and the public—in this case, fertile women—are supposed to trust their authority.
[The infographic accompanying the CDC release.]
Admittedly, my background is not in medicine or science, but here are some immediate questions I have that were not addressed in the CDC press release:
- What percentage of children are born with FASDs? (Elsewhere, the CDC says they estimate that it might be 2-5 per 100 schoolchildren.)
- What percentage of women consume alcohol during a pregnancy? (Estimates are that 10% of pregnant women report having any alcohol [could be as little as one drink] during their pregnancies.)
- What percentage of women who consume alcohol during a pregnancy give birth to children with FASDs?
- What’s the amount and frequency of alcohol consumption among those women who give birth to a child with FASDs? (This is perhaps the most important question.)
As far as I can tell, the reason this last question isn’t answered by the CDC is also connected with their umbrella recommendation. There simply isn’t definitive information on mothers who give birth to FASD children. Usually, FASDs are linked to women who consume a lot of alcohol over the course of their pregnancies (15+ drinks per week), but then one has to also take into account frequency of binge-drinking, age, differences in bodies' reactions to alcohol, etc. There’s no formula of alcohol-drinking that will definitely result in an FASD baby. In fact, one of the foremost authorities on the matter has said that only 4 in 100 children of heavy drinkers will have FASD.
And then there are societal factors. The study I see most frequently cited on that score is a profile of 80 women in Washington State published in 2000. Here’s what it revealed about the mothers who gave birth to a child with FASDs:
- 96% had at least one mental health disorder.
- 95% had a history of sexual of physical abuse.
- 61% had less than a high school education and 35% had only some college education.
- 59% had an annual gross household income less than $10,000.
Of the 80 women profiled, 84% felt they had a problem with alcohol use, but 94% did not want to quit because it helped them cope with other issues in their lives. Thus, as Dr. Lisa Wade, professor of sociology at Occidental College, points out, warnings such as the CDC’s don’t really reach what should be the target audience:
“[S]ince women’s choices are not highly correlated with the appearance of FAS, the strategy fails. Very few women actually drink at the levels correlated with FAS. If we did not have a no-drinking-during-pregnancy campaign and pregnant women continued drinking at the rates at which they drank before being pregnant, we would not see a massive rise in FAS. Only the heaviest drinking women put their fetus at risk and they, unfortunately, are the least likely to respond to the no-drinking campaign (largely due to addiction).”
Ivy League professor Emily Oster has also lamented about the lack of nuance in the no-alcohol-during-pregnancy” recommendations. In response to last year’s recommendation made by the American Academy of Pediatrics (AAP), she had this to say:
“To me, this highlights the very real downside of recommendations like this one, which do not involve any nuance. The bottom line is that while there is clear evidence of the dangers of heavy drinking—especially binge drinking—in pregnancy, the same cannot be said for low levels of alcohol consumption. As even the AAP report acknowledges, there is consensus on this issue. A large share of OBs in the U.S. report telling their pregnant patients that some alcohol is fine.”
Again, neither medicine nor science is my specialty, so I only put this out for discussion. From what I’ve read, it seems that the maxim “moderation in all things” applies to pregnant (or potentially pregnant) women when it comes to alcohol. But, if you have compelling evidence that shows that women should avoid all alcohol during pregnancy, please share it with me and the Intellectual Takeout audience.
But shouldn’t the CDC be doing that? Shouldn’t they be the ones who are pointing to compelling research in their press releases? At this point, does it seem irresponsible for them to make a blanket recommendation regarding women’s alcohol consumption?