New advice from the Centers for Disease Control and Prevention aimed at preventing fetal alcohol syndrome has created quite a stir.
The CDC estimates that about 3 million women "are at risk of exposing their developing baby to alcohol because they are drinking, sexually active and not using birth control to prevent pregnancy."
About half of all pregnancies are unplanned. And according to the CDC report issued Tuesday, about 3 in 4 women "who want to get pregnant as soon as possible do not stop drinking alcohol when they stop using birth control."
So the CDC is now advising women to stop drinking if they are trying to get pregnant or not using birth control with sex. That's right, abstain from drinking.
The way this advice was communicated has struck many women as severe and condescending. "CDC to younger women: Better take your birth control before you drink that glass of wine," read one headline.
The Internet let forth a tsunami of derision. One columnist for The Washington Post quipped, "That's the last time I drink merlot alone in my apartment. I don't want herpes."
Indeed, the CDC did also point out that drinking can make a woman more vulnerable to injuries or violence and sexually transmitted diseases. But many commenters pointed out that there was no report warning men that drinking can lead to violent behavior and STDs.
"The way [the CDC] stated this is very extreme," says Emily Oster, an economist at Brown University who wrote a book on the sometimes anxiety-producing advice that women are given during pregnancy.
Oster says the CDC has an important message to convey. Some women undoubtedly are unaware of the risks of alcohol during the early weeks of pregnancy when they may not even know they're pregnant.
But given the tone and the judgment woven into the messaging, Oster says, it touched a nerve.
The backlash also reignited the controversy about whether any amount of alcohol is safe during pregnancy.
The American College of Obstetricians and Gynecologists released a statement Tuesday pointing to its policy that recommends women completely abstain from alcohol during pregnancy.
But this doesn't mean that having a few drinks in the early weeks of pregnancy — before a woman realizes she's pregnant — is harmful.
"I practiced for 30 years," says Hal Lawrence, an OB-GYN and CEO of ACOG. He says he would see women who'd had a glass of wine or two before they knew they were pregnant, "and generally you can reassure those [women] that it's not an issue."
But Lawrence does say the best advice is to avoid alcohol completely during pregnancy. "Alcohol exposure in any of the trimesters [of a pregnancy] can have some impacts on ... the fetus."
The CDC now appears to be extending that advice to thinking about getting pregnant, too.
"We really urge women, and their partners and friends — to be supportive of that idea: I'm not going to drink for a while because I'm thinking of getting pregnant," said the CDC's Anne Schuchat during a briefing announcing the new guidance.
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It's not every day that advice from the CDC leads to outrage. But it's happening with new guidelines on alcohol, women and pregnancy. The CDC says U.S. women are at risk of exposing a developing baby to alcohol because they're drinking, having sex and not using birth control to prevent unplanned pregnancies. Given the risk, the agency says health providers should tell women to stop drinking if they're trying to get pregnant or if they're not using birth control. NPR's Allison Aubrey reports on the criticism.
ALLISON AUBREY, BYLINE: The CDC's recommendation that pregnant women avoid alcohol has been in place a long time, but this week came a new message aimed at raising awareness about the number of unplanned pregnancies, which is about half of all pregnancies, and the potential risk of fetal alcohol syndrome. Given that some women drink alcohol, have sex and end up pregnant, the CDC says one thing women can do to prevent this is not drink at all. And this advice has struck many women as over-the-top. Emily Oster is an economist and mom who's written a book on all the anxiety-provoking rules women are given during pregnancy.
EMILY OSTER: And the way that they've stated this is very extreme and kind of makes it seem like they're judging all women for enjoying themselves, for having a drink occasionally, for engaging in behaviors that mostly people think are fine.
AUBREY: Oster says it's not as if the CDC doesn't have an important message to convey here. Some women are likely unaware of the risks of alcohol in the early weeks of pregnancy. And many people don't realize just how common unplanned pregnancies are. So Oster is not dissing the message, not at all. But she says the CDC may have missed its moment.
OSTER: Because they said it in this way where the messaging was so skewed, you kind of don't get people to take you seriously. They're like, oh, the CDC, once again, telling me all this nonsense.
AUBREY: So by some accounts, the CDC message backfired and at the same time, reignited questions among some about whether any amount of alcohol is safe during pregnancy. Hal Lawrence is an obstetrician and CEO of the American College of Obstetricians and Gynecologists.
HAL LAWRENCE: I mean, I practiced for 30 years and occasionally, you'd see somebody who was early pregnant and they'd had a glass of wine or two before they knew they were pregnant. And, you know, generally, you can really reassure those people that's not going to be an issue.
AUBREY: But he says generally speaking, the advice to women who are pregnant or thinking about becoming pregnant is this.
LAWRENCE: The best thing for your baby is no alcohol.
AUBREY: He says there's a whole body of evidence pointing to the risk.
LAWRENCE: You know, alcohol exposure in a pregnancy in any of the trimesters can have some impact in psychological and neurological development for the fetus.
AUBREY: This is a message that most women have already heard before they get pregnant. After all, the risks are printed on bottles of beer and wine. But given the high number of unplanned pregnancies, it seems one message the CDC was trying to articulate is beware. And another message, perhaps more straight forward, is that the best advice is to stop drinking alcohol when you start trying to get pregnant. Here's the CDC's Anne Schuchat who spoke to reporters.
ANNE SCHUCHAT: We really urge women and their partners and the friends to be supportive of that idea of that I'm not going to drink for a while because I'm thinking about getting pregnant.
AUBREY: So a reasonable message that perhaps got misconstrued. Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.