Wednesday, March 02, 2005

Menopause: Bless You!

About the only reason I can think for looking forward to menopause is this: At least then the society will leave my body alone. I can count the years and cross them off my almanac, and one day I will wake up - free at last! Maybe.

What brought up these musings you may ask (if you are still reading), as if there isn't quite enough material on all the pro-fetus stuff every day to make me fret. But you are sharp-eyed, there is indeed something extra that has made me hope for more rapid aging, and that is our dear U.S. Surgeon General, one Dr. Richard H. Carmoda. He is very concerned about the health of babies, and this concern comes out as - you have guessed - concern over the behavior of women. And not only the behavior of pregnant women but the behavior of all types of women who might, just might, get pregnant some day.

We get lots of advice from Dr. Carmoda:

U.S. Surgeon General Richard H. Carmona today rolled out his 2005 agenda, announcing it as The Year of the Healthy Child. The Year of the Healthy Child agenda will focus on improving the body, mind, and spirit of the growing child. A healthy child begins before birth, so the Office of the Surgeon General will highlight steps that women should take to keep themselves healthy, especially when they are considering becoming pregnant. This includes a healthful diet, exercise, and eliminating tobacco use and alcohol consumption.

Do you know what this new prevention approach is called? It's pre-pregnancy prevention! It might seem as if Dr. Carmoda is just talking to women who are planning to become pregnant some time soon, but nope. He is actually talking to all menstruating women:

U.S. Surgeon General Richard H. Carmona today marked Folic Acid Awareness week by reminding all women of childbearing age to consume the recommended amounts of folic acid each day.

Folic acid is a B vitamin necessary for proper cell growth to ward off such birth defects as neural tube defects, serious birth defects of the brain (anencephaly) and spine (spina bifida). Research has shown that, if taken before and during early pregnancy, folic acid can prevent 70 percent of these birth defects. Therefore, every woman of childbearing age, even if she is not planning on becoming pregnant, should supplement her diet with 400 micrograms of folic acid each day.

Even nuns living in convents should supplement their diets this way. Why? Because so many pregnancies are unintended. This means that the Surgeon General can trust no woman to plan her pregnancies and can trust no woman to remain childless. I am not making this up. You can read on all this in the archives of the Office of the Surgeon General.

And here's the most recent advice on alcohol and women:

1. A pregnant woman should not drink alcohol during pregnancy.
2. A pregnant woman who has already consumed alcohol during her pregnancy should stop in order to minimize further risk.
3. A woman who is considering becoming pregnant should abstain from alcohol.
4. Recognizing that nearly half of all births in the United States are unplanned, women of child-bearing age should consult their physician and take steps to reduce the possibility of prenatal alcohol exposure.
5. Health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy, and advise them not to drink alcoholic beverages during pregnancy.

So if you are a pre-menopausal woman, prepare yourself to hearing little speeches about alcohol when you go for your annual checkup. And about your folic acid intake. And possibly about your diet and exercize, too, if we find that these directly impact fetal health.

Ok. One can argue that the cause is a good one: to have only healthy babies born in this country. That is certainly true and it is good that the information is available for those women who need it. But I find it pretty insulting that all women are seen as potential receptacles for babies in this way, incapable of controlling their own fertility. Will the health professionals be advised to ask men about their alcohol consumption? After all, alcohol consumption is involved in many violent acts.

And what about the advice the Surgeon General gives prospective fathers? I see none on his website, yet a quick Googling brings up several studies that bear upon this topic: on the effects of father's exposure to radiation and various occupational health hazards before the birth of an affected child and on the effects of aging sperm on the child's health.

Maybe these studies are not good enough. Who knows? But I suspect that most studies look at women rather than men, not for any medically valid reasons, but because we all tend to think of women as the loci of parenthood, and the Surgeon General is unlikely to be free of this bias. That women are not the sole loci of parenthood or not just the loci of parenthood tends to be forgotten.

There is something very puritanical about all this, and it is most clearly visible in the information about alcohol and pregnancy which states:

* No amount of alcohol consumption can be considered safe during pregnancy.

What does this mean, exactly? Consider that the Italians and the French have been drinking wine routinely for centuries, including during pregnancies. Do these countries suffer from extremely high levels of the Fetal Alcohol Syndrome? Or what about the older generations in the United States?

I am not advocating drinking alcohol during pregnancy, but I wonder why the usual risk analyses we perform before making various societal recommendations don't apply in this particular case, why instead an absolutist standard is selected. Using the same method, we should reduce the allowable blood alcohol levels to whatever teetotallers might have in deciding when someone is driving under the influence. Or at least recommend zero drinks to anyone who plans to drive or to interact in general with other human beings. After all, most accidents and fights are not pre-planned.

Just think about that. This is what women are being told, right now.