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  • TUESDAY FEBRUARY 20 2007 11:00 AM

Bearing Responsibility



Why do I care about the rights of pregnant meth users? Let's start small.

For most "respectable" women, the main thing you'll be told when you get pregnant is "don't drink alcohol." In fact, let's grab a beer out of the fridge and look at what the warning label says:

Government Warning (1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.


Everyone who drinks has seen these warnings, right? So we all know — and when you're pregnant, your doctor will remind you — that pregnant women shouldn't drink.

Notice, in fact, that while pregnant women "should not" drink, non-pregnant women — and men — aren't told what they should, or shouldn't do. They're given the facts — drinking "impairs your ability to drive" and "may cause health problems" — and expected to make their own, informed, decisions. Pregnant women, on the other hand, are told directly what they should do.
There are two implications here: first, that pregnant women are less able than men or non-pregnant women to think for themselves; and second, that alcohol is more dangerous for pregnant women (or their fetuses) than it is for "normal" people.

The first implication — that pregnant women can't think for themselves — is obviously stupid and insulting. If you're like me, when someone tells you what to do, you're inclined to tell them to fuck off. But before we tell the "don't drink while pregnant" crowd to fuck off, let's see what the problems with drinking while pregnant actually are — after all, it's a Big Deal, this pregnancy thing, and we wouldn't want to let knee-jerk attitudes about being grownups (after all, we're pregnant! How much more grownup can you get?) affect our judgment.

So let's move on to the second implication. Is alcohol, in fact, more dangerous for pregnant women than it is for everyone else? To find out, I'm consulting Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder. I stole the title of this post from the book, by the way. According to the author, Elizabeth Armstrong,

The fact is we simply do not know. . . . while ample evidence indicates that heavy prenatal alcohol exposure can be tetrogenic (that is, cause birth defects) in some pregnancies, . . . the number of fetuses exposed and affected is small.

First, we know that FAS is not an "equal opportunity" birth defect. Fetal alcohol syndrome is highly correlated with smoking, poverty, malnutrition, high parity, and advanced maternal age.
[...]
Second, despite evidence to suggest that FAS may have a genetic component, there has been surprisingly little research. . . . One (kind of evidence) is from studies of twins: the medical literature has reported cases of franternal twins, in which one twin is affected with FAS and the other is not.
[...]
Third, even among women who are alcoholics, only a small number have babies who are affected. . . . In fact, only about 5 percent of children born to alcoholic women have FAS.


Five percent of children born to alcoholics. That ain't much. I think it is fair to say, without dismissing the importance of FAS, that most "normal" women — the kind of women who read alcohol warning labels, who see doctors during pregnancy, who are inclined to think about what they eat and drink — do not have much to worry about. Alcoholics, by and large, don't read warning labels and are far less likely than most of us to get decent prenatal care (which may, in and of itself, be a big part of the problem). If you care about FAS, your primary concern should be helping pregnant alcoholics get prenatal care, which includes treatment for their alcoholism.

Finally, let's don't forget that most women don't realize they're pregnant for a month or two. By which point, if you've been drinking, you've probably already done the majority of whatever damage you're going to do. IME, that ain't much; I went out drinking with my friends every weekend for two months before I realized I was knocked up, and as far as I and my kid's teachers can tell, he's smarter than most of the other kids on the playground. God knows, at 10 lbs 1 oz, he didn't have low birthweight (supposedly one of the markers of FAS). He's reading at grade level, his math is well above grade level, and he can tell you how DNA works, what a metaphor is, and how to build a working rocket.

So yeah. I'm inclined to say that drinking during pregnancy — by which I mean, "drinking during pregnancy by women who aren't alcoholics" — is okay. I'm inclined to think that people who claim that there are "tons" of kids with FAS in public schools are talking out their asses. I'm inclined to think that people who give you the fisheye when you order a cocktail in your seventh month are judgmental assholes. And I'm inclined to think that a lot of the hype around women's "responsibility" not to drink while pregnant is a big, guilt-tripping load of bullshit.

Bitch_PhD likes a good fight, and thinks people who pass judgment on pregnant women need to be smacked.