The CDC risks its credibility with new pregnancy guidelines
The Centers for Disease Control and Prevention issued a bulletin last week advising all women of reproductive age who are sexually active and not using birth control to abstain from alcohol. The concern? The woman might be pregnant, and even one drink might cause lasting damage to the baby. “The risk is real. Why take the chance?” warned Anne Schuchat, a principal deputy director for the CDC and its Agency for Toxic Substances and Disease Registry.
The CDC’s overly broad advisory damages its credibility as a source of clear, balanced advice about health risks. A risk may be “real,” but it may not be large or well substantiated. The CDC claims that “drinking any alcohol at any stage of pregnancy can cause a range of disabilities” for a woman’s child.” Yet a balanced review of the scientific evidence does not support such unequivocal claims. In fact, medical research suggests just the opposite. For example, the Danish National Birth Cohort Lifestyle During Pregnancy Study demonstrated that moderate drinking during pregnancy carries no long-term risks.
Women are constantly bombarded with advice about what to eat and drink and how to behave during pregnancy. Rather than add to this growing roster with yet another simplistic injunction, the CDC should do everything it can to provide women with credible information about how to weigh reproductive risks.
First, the CDC needs to be clear that science on the risk of alcohol during pregnancy is far from settled. Any advice about reproduction should respect the autonomy and intelligence of women by presenting evidence in its full context. Public health officials should provide perspective about the size of the effects relative to other common risk factors. And they should be straightforward in describing the evidentiary base for health advisories.
Second, when it comes to reproductive risk, we need to stop focusing so myopically on women’s health and behavior. There is growing evidence that men’s exposure to various chemicals, from tobacco to toxins, can damage sperm and affect pregnancy outcomes and children’s health. The CDC’s own website includes a list of guidelines for men about how to grow healthy sperm, but Tuesday’s guideline contains no mention of men whatsoever. It’s time to stop ignoring the role men play in reproductive outcomes.
The CDC can regain credibility in this realm by providing information to women and men that details the relative risks of various behaviors, as well as the state of scientific debate regarding the evidence supporting these assessments. Rather than its now-infamous infographic depicting the many harms awaiting a woman who drinks, imagine instead a CDC-designed graphic for both women and men. It would array a range of risks to a fetus from women’s and men’s health behavior, from an occasional alcoholic beverage to binge drinking — and also skiing, hot tubs, or speeding down the interstate at 70 miles an hour. For each risk claim, the CDC would provide an assessment of the degree of scientific certainty given the current state of medical research. Individuals could then easily compare and weigh the risks in reference to their own lives and values.
Certainly it is not easy to develop high-quality health information that accurately conveys the evidential strength of scientific claims. But there are models. The highly respected Cochrane reviews weigh the strength and relevance of diverse forms of scientific evidence pertaining to public health decisions. The British National Health Service’s “Behind the Headlines” series helps consumers interpret the evidence underlying often-hyped health warnings.
The CDC’s mission is to identify and address clear and present dangers to the public health. As such, their credibility is literally a matter of life and death. Most recently, women turned to the CDC for guidance about the Zika virus, a situation where the scientific evidence is sparse and sometimes conflicting. When it comes to everyday reproductive risks, the CDC can play a valuable role in helping women — and men — navigate the morass of conflicting data. Issuing guidelines with all the nuance of a sledgehammer only damages the public’s trust in federal health recommendations.
Sarah Richardson is an associate professor of the history of science and studies of women, gender, and sexuality at Harvard University and the author of “Sex Itself: The Search for Male and Female in the Human Genome.” Rene Almeling is an associate professor of sociology at Yale University and the author of “Sex Cells: The Medical Market for Eggs and Sperm”.