HOLD YOUR FIRE!

The progressive blogosphere (which I consider myself to be a card carrying member of) is currently shitting a brick over this news report from the Washington Post. The skinny:

"Forever Pregnant"

New federal guidelines ask all females capable of conceiving a baby to treat themselves -- and to be treated by the health care system -- as pre-pregnant, regardless of whether they plan to get pregnant anytime soon.

Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.

As inflammatory as this may sound to many, it is music to the ears of anyone like me who is currently preparing for a career in the (overwhelmingly progressive) field of public health. The USA has the worst prenatal care health outcomes in the developed world precisely because we're not facilitating the kind of preventive medicine. Still, many of my compatriots are worried that this guideline is going to lead down a slippery slope.

A good glimpse of what's being said is just a Technorati search away.

Considering that the Post article didn't link to it, I doubt many of the folks angry about this have read the actual report. In a nutshell, it has four goals:

1) improve the knowledge and attitudes and behaviors of men and women related to preconception health;
2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health;
3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and
4) reduce the disparities in adverse pregnancy outcomes.

Those goals have prompted 10 recommendations:

1) individual responsibility across the lifespan,
2) consumer awareness,
3) preventive visits,
4) interventions for identified risks,
5) interconception care,
6) prepregnancy checkup,
7) health insurance coverage for women with low incomes,
8) public health programs and strategies,
9) research,
10) monitoring improvements.

snip

CDC developed these recommendations by 1) reviewing published research; 2) convening the CDC/ASTDR Preconception Care Work Group, representing 22 programs; 3) evaluating presentations of best and emerging practice models at the National Summit on Preconception Care in 2005; and 4) convening the Select Panel on Preconception Care (SPPC), comprised of subject matter specialists on obstetrics and gynecology, nursing, public health, midwifery, epidemiology, dentistry, family practice, pediatrics, and other disciplines.

snip

The health status of minority women with low incomes contributes to persistent, and sometimes increasing, disparities in birth outcomes. In one study, the reduced overall health status (including poorer physical and emotional health) of women with low income during the month before pregnancy was associated with an increased risk for preterm labor (59). Socioeconomic status directly and indirectly influences three major determinants of health: healthcare access, environmental exposure, and health behavior (60,61). Racial inequalities in access to effective treatment also influence these determinants of pregnancy outcomes for women and infants

So let's recap. We're making an evidence-based, collaborative approach to a problem that disproportionately affects poor and minority women by empowering them to make changes in their lives that will ultimately help to pull them out of the vicious cycle of poverty and poor health outcomes. Sounds a lot better when we look at it that way, doesn't it?

But what are we to make of goal #2? Isn't it strongly worded?

Yes, it is, but for good reason. Bear with me.

This isn't a case of "them" trying to disguise an anti-abortion agenda as being about healthy babies. This is a case of "us" trying to disguise the progressive agenda as being "pro-family." We're fighting fire with fire. Poor women, under the guise of "prepregnancy checkups," will have added access to birth control. Minority women will have fewer poor pregnancy outcomes thanks to effective preventive care. Women as a whole will be given greater access to affordable health insurance... and all we have to do is put up with it being called "prepregnancy care" (a term taken from the scientific literature). Talk about the lesser of two evils.

Look, I'm as much about keeping the government's hands off of my wife's uterus as anybody, but these guidelines are about empowering women to take control of their reproductive health.

To my allies in the liberal/progressive blogosphere... please don't make the CDC's good advice a casualty of friendly fire. If we're serious about ensur[ing] that children will be wanted and loved (Planned Parenthood), we need to take the above steps, and take them in a way that brings our political enemies on board with us.

Please visit these fine progressive bloggers and ask them to read what the CDC wrote and reconsider their harsh judgment of this set of guidelines.

Bitch, PhD.
Feministing
Atrios
Feministe
pesky'apostrophe
Road to Serfdom
Hughes for America
Pinko Feminist Hellcat
Shakespear's Sister

and all the rest.

Update:
More bloggers are weighing in, mostly without reading the report first, it seems -
Bring it on
Gun Toting Liberal
Blondesense
edrants

Fortunately...

Outside the Beltway gets it.
Pandagon gets it.
Gabbiana gets it.
Echidne of the Snakes tones things down a bit after reading the report itself

One Last Thought:

From Ezra Klein:

If we want to remain the side committed to serious science and the preservation of expertise, we've got to support well-documented research when it emerges, even if its leaves us uncomfortable.

Put a fork in me... I'm done.

Technorati Tags: forever pregnant, sexual health, health disparities, poverty, health, insurance, prenatal care, CDC, abortion, preventive care