Preconception and the CDC

[javasaurus]

OK, I've read the CDC preconception guidelines several times now. I don't see what the hubbub is about.

First, there is a national problem: 85% of all women give birth at least once, and about a third of the children have health problems. Also, about half of the women unintentionally get pregnant at least once. So there is definitely a problem. Part (maybe most) of the problem stems from a lack of knowledge and a lack of available/appropriate health care. A large part of the country can't afford health care. The intent of the CDC guidelines seems to be to address these issues.

Second, if you are physically able to get pregnant, then you might get pregnant, whether you want to or not. Accidents happen. Being "childfree" is not 100% effective against pregnancy.

Third, there has also been some hubbub about the focus on women's health, not men's. Note that the guidance is all about getting a healthy child at the end of the pregnancy, not about getting pregnant, for which the man's health and activities would be important. Frankly, the man's health doesn't really matter much for this process (yes, I know there are exceptions to this). If he's got reproductive problems, most likely the swimmers won't find their target, and pregnancy doesn't happen. Unfair as it may seem, the woman gets to be the incubator.

The guidelines seem focused primarily on providing healthcare and information that was not previously provided. Even those with health insurance may find that insurance doesn't always cover preconception issues. It is not about withholding medicine from those that need it, but making the patient aware of the effects of the medicine on a potential pregnancy.

Several have posted about doctors that won't prescribe certain medicines to women of child-bearing ability, even if the woman never plans to have children. That has nothing to do with the current guidelines, but about poor doctor-patient relationships. Get a different doctor.

Yes, I understand that some are afraid of how the guidelines will be abused by over-conservative doctors and politicians. However, it is apparent that those same docs and politicians will do so anyway, while the guidelines work towards providing much needed information and resources to those who don't have them.

Comments

[turnberryknkn.livejournal.com]

I guess here's the way I think about it.

The trade of a jeweler is the shaping of gems. The careful choice of stone; the exact, deliberate placement of facet. The perfect shaping of gems is the product, the life's work of a jeweler. And they do their work with the precision and attention to detail that the trade calls for. Same with a swordsmith, to take another example.

What jewels are to a jeweler and steel is to a swordsmith, words are to a politician -- to anyone involved in the shaping of policy. Because the exact arrangement of words *is* their entire product. The shaping of ideas, the shaping of memes. To effect change, one's tools are words -- speeches, policies, guidelines, articles, etc. Those are the wedges and picks, the files and putty, by which one changes the mental landscape, the collective gestalt. One seeks to shape the collective gestalt of the 100 senators in the Senate such that the final result is one more vote than the other side. One seeks to change the collective gestalt of the voters of a region to lead to the passage of a particular bill or the election of a particular politician. Politicians and activists do what they do because they ultimately want to shape the world -- and words are their tools. And their choice of words is no more an accident than the choice of facets is to a jeweler or the choice of succession of hammering and filing is to a swordsmith.

The crafters of the CDC guideline, for example, obviously wanted to affect change. That's the whole point of a guideline. And at the level of the CDC, it is possible that the shaping of such a document might be done without excruciatingly careful consideration of the multiple messages that are intended to be sent -- but I highly doubt it. On issues lying as close to the heart of so many political movements, anyone with the brains God gave a turnip would realize how such a document could have the power to change the collective gestalt, advance or retard agendas, influence the mental landscape. Because *everything* is just another piece in the puzzle, another opportunity to play another stone on the Great Board. Politicians -- especially those at that level -- know that and do not waste a single opportunity. It's sort of the same way why it *matters* when a parent calls a kid "stupid" all the time. Yes, it's just a word. But it has an effect. It changes the kid's mental headspace into very profound, real-world results. And the same goes for something like a CDC guideline. Any politician knows the most powerful thing you can do to lay the framework for a paradigm shift is to first change the language. It's possible the authors of the CDC guideline didn't fully consider all the ramifications of the way they framed their document. But I highly doubt it.

I spent years in activism, on many committees charged with drafting all kinds of language -- statements, policies, resolutions, bills. And I've spent much time and many a fight battling over the most subtle of word choices -- and then, months or years later, using those word choices as the launchpads for still further movement. Subtle word choices can change a debate radically, steer -- or allow it to be steered -- in dramatically different directions. Words matter, and none know it better than professional politicians. Because they could have reframed or rewritten that guideline to provide the exact same information more than one way. That they chose the way they did chose to do it could have been an accident. But that would be like a jeweler who banged out cuts on a jewel at random or a swordsmith who filed without thought. Amateurs might do that; but amateurs don't play on the Washington DC level.

That's my take, anyway.

[turnberryknkn.livejournal.com]

It's a little, I think, like the old stories where there was power in names and that by changing the True Name of something, one could change it's character, it's identity. Politics, in my experience, is a lot like that. Once you reshape how something is described, how it is framed, how it is considered, in the minds of enough people, the something *itself* eventually changes, especially when the "something" is as ephemeral as an idea or a prevailing attitude.

It's like the difference between introducing someone as "the ballet dancer" or "the black kid". Both describe the exact same individual. But the choice of name -- the choice of emphasis -- the way you introduce, discuss, label -- changes in fundamental ways the enviroment that individual will operate in, the assumptions that will be most active, everything moving forward. Names have power. Words have power. The wizards of old knew that; and the modern politician knows that, too.

[javasaurus.livejournal.com]

Something I meant to mention in the above, and it's an important point: women have their full complement of eggs pretty much from birth. No new eggs developing over time. They hang out in the ovaries waiting their turn for release, but they are already there. This is one reason why a woman who wants children someday needs to be aware even years in advance of how she treats her body. Men got the better end of the deal in many ways -- unlike eggs, sperm are replaced regularly, so they are always "fresh."

[turnberryknkn.livejournal.com]

Actually, while preparing dinner, I think I've finally come up with the thought which captures at least how I think of this.

In Recommendation 1, it talks about the need for everyone to have a "reproductive life plan." So, what if, instead of calling the whole initiative "Preconceptive care", they instead called the whole thing "Reproductive Life Planning"? I mean, keep the entire program, all it's ambitions, all it's scientific facts completely the same, and do nothing -- *nothing* -- but change the name?

It seems pretty obvious to me how that simple change dramatically changes the effect on the political debate, the effects on the mental headspace.

I mean, just try out "Preconceptive Care is an important women's health issue" vs. "Reproductive Life Planning is an important women's health issue". The exact same set of practical actions, with two different names -- to me, the implications on the shaping of the collective consciousness, on the political debate, are as obvious as a two-by-four to the forehead. And if I could think of that while microwaving ramen, I'm certain the folks whose full time job was to create this surely could have thought of the same. They chose one over the other. They almost certainly didn't do it by accident -- and almost certainly didn't do it unaware.

[faireraven.livejournal.com]

*BINGO*

And that's what bothers me. The wordsmithing that has currently been used most definitely leans towards the direction of "women need to have kids" instead of "women should plan their reproductive lives". And in the hands of a politician, that can be very, very dangerous. What the CDC said slants in the one direction more than the other, and therefore leaves what "should" be done versus what "must" be done up to interpretation... And there's a lot of interpretation that a politician can do with the current wording that can take this to a whole new level.

[javasaurus.livejournal.com]

I think there is a critical difference between "reproductive life planning" and "preconceptive care" though. The problem that the guidelines were drafted to address was that there are one hell of a lot of kids that are born with problems, and a lot of them were unplanned. The problems can range from physical problems for the mother during pregnancy to special neonatal needs and even to life-long medical requirements for the child. "Preconceptive care" is aimed at reducing some of these problems. "Reproductive life planning" would only address the case when the child is planned. It is a part of preconceptive care, but not the same as.

I don't doubt that a lot of thought went into the term. I suspect there was no joyous huzzah at the choice but a resigned compromise. Why? There really isn't a single word or simple phrase that refers to women who are biologically able to become pregnant. I can understand that it sounds like conception as the eventual outcome is assumed by the term (and apparently for the vast majority of women, 85%, pregnancy happens at some point).

[turnberryknkn.livejournal.com]

Except that one of the implied assumptions of the "preconceptive care" paradigm, I think, is that all women need to be prepared to carry a baby to term because in the event of an unplanned pregancy, failure to do so could harm the chances of the baby being carried to term in a healthy manner. Which in turn makes the assumption that unplanned pregnancies inevitably lead to deliveries. And in America, there has been for many years an alternative option regarding an unplanned pregnancy: the one that began from Roe v. Wade.

Or, put bluntly, if a woman deliberately chooses to abort any child not deliberately sought, she could argubly not need preconceptive care; since any baby she did want she would scrupulously avoid endangering from the moment of attempted conception; and she would not need to take precautions to make sure any unplanned baby was not harmed because no unplanned baby would ever make it to term. Almost all the guidelines deal with that -- harm to fetus -- and very few to harm to the *potential* fetus -- that is, the eggs of the mother. And for very good reasons, basically centering on anything good for the eggs of a woman (or a man's sperm) is good for every other cell in their body, and you'd need no particular reason to single out the reproductive cells from the rest.

*That's*, in my mind, the *real* difference between "reproductive life planning" and "preconceptive care". Because, at least by what is currently legal in America, the strategy I laid out in the prior paragraph is an entirely legal and completely rational means of avoiding the dangers of harm to an unplanned pregnancy. One doesn't need to take measures to protect an unplanned pregnancy if one decides their contingency against an unplanned pregnancy is that no unplanned pregnancy will ever reach term.

[wilhelmina-d.livejournal.com]

Several have posted about doctors that won't prescribe certain medicines to women of child-bearing ability, even if the woman never plans to have children. That has nothing to do with the current guidelines, but about poor doctor-patient relationships. Get a different doctor.

I have had real world experience with this. I've known since I was twenty that I don't want kids. The first doctor I asked about long-term pregnancy prevention was just sure I would change my mind and wouldn't even talk to me about my options.

My new doctor, even though I'm still under the "recommended" age, said "call my secretary and I'll fit you in the first day I have space". (I'm still not sure I want to do it - invasive surgery, previous history of bad reaction to general anesthesia, etc, but to know I have the option is incredibly important!)

[faireraven.livejournal.com]

At least you found somebody... Someone I knew once knew from the time she was an early teen that she never wanted kids. Her doctors (yes plural) all told her that until she hit 35 she couldn't get her tubes tied, because she'd change her mind someday. Well, "someday" she got raped, and couldn't afford the abortion until it was too late.

She gave the kid up for adoption.

STILL, any doctor she went to refused to do it until she hit 35. She'd already proven she didn't want to have/keep a kid, but they wouldn't let her get permanently sterilized.

For her 35th birthday, she got a tubal ligation.

Why is it that doctors think that the magic age is 35, and women can't seriously make up their minds before then?

Java, it's not always so easy to find a new doctor. With respect to having babies, few doctors are willing to risk that a woman won't change her mind later and sue them for causing her to have to go the test tube route. Some (like my previous example) will tell a woman flat out "she needs to have more babies", even if she's already had as many kids as she wants and wants to stop. But (and I realize you've never had this told to you, considering you'll never have to worry about getting pregnant), the vast majority of doctors out there will flat out tell you they won't do it before you're 35, because they're afraid you'll change your mind.

What truly irks me is they even tell this to women and/or couples that shouldn't be having babies in the first place, because of medical/physical/mental concerns.

I wouldn't object to this whole thing so much if they discussed it as "reproductive planning" rather than as a "pre-conception" thing. I wouldn't object so much if it weren't for the sheer number of doctors out there who WON'T allow a woman to no longer be "pre-conception". It's damned difficult to find a doctor who will agree to sterilizing a woman before she's mostly done with the "safe" reproductive years, and half of them won't do it unless your HUSBAND agrees. If you're single, forget it.

Yeah, we get shafted six ways from sunday.