Wednesday, May 17, 2006

The Care And Maintenance of the Aquarium

The Washington Post honors the recently passed Mother's Day by a most interesting article on the health of the newborn:

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.

While most of these recommendations are well known to women who are pregnant or seeking to get pregnant, experts say it's important that women follow this advice throughout their reproductive lives, because about half of pregnancies are unplanned and so much damage can be done to a fetus between conception and the time the pregnancy is confirmed.

Are you prepared for this, ladies between the ages of fifteen and fifty-five? You are now in the state of pre-pregnancy! Like a lovely empty aquarium, which needs to be kept ready for any goldfish someone might slip into it. It is not really your own health that concerns your physician, no. It's the potential health of any potential fetus that somehow might appear in your uterus. You must keep your uterus healthy. You should maintain a healthy weight not because it's good for your heart but because it's good for some future imaginary fetus. And these instructions apply to every single woman theoretically able to get pregnant, including nuns. It. Does. Not. Matter. If. The. Woman. Does. Not. Plan. To. Have. Children. Any. Time. Soon. Or. Even. Ever. Because women can't decide for themselves, you know. And because potential future children are much more important than already existing women. And because women exist for the purpose to breed children, just as aquaria exist for the goldfish.

So, my dear aquaria, remember these easy steps: Your boyfriends and husbands and other potential inseminators can do whatever they please: smoke, drink, take up hazardous jobs. But you are the precious aquarium in which their goldfish will one day swim and as nobody knows exactly when they will slip the fish in you better be always prepared. Like a new kind of girl scout.

Or like the women in Margaret Atwood's The Handmaid's Tale. Those women also were urged to eat healthy foods, to exercize and to refrain from smoking and drinking, because they were handmaids: women intended for the breeding of babies. Atwood's book is about a dystopia. It's a little frightening that we have something slightly similar in a government recommendation today, with the difference that our program is still voluntary. For how long it will stay that way remains to be seen.

The reactions in the lefty blogosphere have largely been like mine: shock and fear. Later on I will spell out very clearly why I felt both shock and fear, but some of the reasons have been better stated elsewhere. The Broadsheet, for example, comments on the real reasons for the high infant mortality rates in the United States and how the recommendations of this report largely ignore those: poverty and no access to the health care system:

But that's because we have a sick and failing healthcare system that leaves millions of disadvantaged Americans without anything resembling the care they require. Almost 17 million women lack health insurance.

Pretending that we're going to solve this problem by instituting guidelines that treat women as baby incubators is not the solution. All it does is reinforce an attitude that problems women have with reproduction are the only ones worth worrying about. How about federal recommendations about using birth control to prevent HIV and other sexually transmitted diseases? How about federal guidelines that require doctors to talk to women about the dangers smoking, poor nutrition, unprotected sex, drug use, lack of exercise, and heavy drinking can pose for them, and not just their precious potential cargo?

Dressing up this "pre-conception care" crap -- which is supposed to be administered by every doctor a woman sees, from her G.P. to her gynecologist, perhaps even her podiatrist -- as "a reproductive health plan" to help women shut out of the healthcare system doesn't track.

Even the report itself notes that women who already cannot afford to see a doctor -- the ones whose pregnancies are compromised by poor or nonexistent prenatal care -- aren't likely to be able to get their "pre-pregnancy care" either, since obstacles to this "include getting insurance companies to pay for visits."

No, mostly this sounds like an Orwellian language trick played by the healthcare authorities, letting you know why your health as a woman really matters.

And Stunt Woman in the comments section of this Eschaton post on the same topic concisely states the unfairness of these recommendations by rephrazing them to apply to men:

New federal guidelines ask all males capable of ejaculation to treat themselves -- and to be treated by the health care system -- as active studs, regardless of whether they plan to impregnate a female or donate sperm in the near future.

Among other things, this means all men after their first ejaculation should refrain from smoking, maintain a healthy weight, keep chronic conditions such as asthma and diabetes under control, avoid known mutagens such as caffeine, and keep their scrotum from extremes of temperature.

Ejaculating men are also urged to avoid participating in sports with fast moving projectiles or other objects which might injure their testicles and cause their sperm to mutate.

When it's put this way the horror of the proposal becomes considerably clearer. Men are never asked to consider themselves as the potential purveyors of healthy goldfish for women's aquaria. Even though medical evidence shows that sperm quality can be affected by workplace exposure to toxins and by smoking and drinking.

Not all commenters on the government recommendations view them with my reactions. Some men think the ideas are good ones, possibly because they are not asked to modify forty years of their own lives for the sake of two or three pregnancies during those four decades. I also got the impression that most of those who viewed the proposal favorably assumed that "preconception care" applies to only those few months when a couple tries to get pregnant. That's not what the government recommendations state. All women are assumed to be either pre-pregnant or pregnant from menarche to menopause. Aquaria, in other words.

I find these recommendations frightening. They really taste like the Handmaid's Tale to me, they taste like scorn to women as human beings, they taste like contempt towards women's ability to plan their own lives. Women have been made into tools for the purpose of giving birth to babies, and now women are to live their lives as tools. That the goal of the recommendations is a laudable one doesn't change any of this. Human beings are not to be regarded as mere tools, not even for the purpose of saving other human beings.

And consider the tradeoffs that the government has decided to find worthwhile: To have all fertile women on their toes all the time, for the sake of future and currently nonexisting fetuses, but to say nothing about the things that fertile men should do. To seriously recommend that a woman keeps herself superfit for pregnancy from the age of fifteen to the age of fifty-five. To recommend that she stays away from lead paint and cat feces and jobs that can be hazardous for developing fetuses, and not just when she is planning to become pregnant and during pregnancy, but every single month of those forty years! What this means, for example, is that no fertile women should have cats as pets, and soon it might mean that no fertile women can work in certain industries. And every woman should buy folic acid supplements for forty years (add up how much that costs), because it has been shown that it's impossible to get the necessary amount of folic acid for the prevention of birth defects from a good diet alone. Then add the mercury in fish and it might well be a bad idea for any fertile woman to eat fish. Forget about drinking, even if a glass of red wine might be good for your heart. Alcohol is not advised for pregnant women and now all women are potentially pregnant.

The assumption these recommendations make is that no woman can control her own fertility, even if she takes oral contraceptives, even if she is unpartnered, even if she is a nun in a convent. And why does the government assume this? Because roughly one half of all pregnancies are unplanned. This does NOT mean that every woman has a fifty percent chance of unplanned pregnancies, but it's easier for the government to ignore that. Once women are viewed as aquaria a lot of steps become easy.

Is it really necessary to regard us as fish tanks? Suppose that we make a very radical assumption: that physicians should care for women for the sake of their own health. What might happen if we took this unprecedented step? Can I make a guess? The women would also be healthy for any future pregnancies! But I keep forgetting that it makes no sense to talk about the health of aquaria, only of the fish in them, and the only cause of ill health in those goldfish is naturally the aquarium.

How many million fertile women are there in this country? Estimate the cost of providing all the necessary behavior modifications so that each of them becomes a pristine aquarium. That would be a very large amount of money. What if we spent the same amount of money in a different way: By buying health insurance coverage for poor women who currently have none and by starting antenatal clinics in poor areas.

Which do you think would save more infant lives? I'd be willing to bet the latter does, because the U.S. infant mortality rate is high largely because of the high mortality rate in poor and largely black areas. Why not focus the resources first to the neediest areas, by making sure that the women who are planning to get pregnant or who are currently pregnant have access to good care? Why are we doing the exact reverse, by redefining pregnancy as something all women are almost falling into? Consider that the average woman has somewhere around two children during those forty years, and it is fairly clear that for the vast majority of those forty years she is not pre-pregnant and it's really quite inane to treat her that way: like an aquarium.