The World Health Organization is advising that “women of childbearing age” should be a focus of alcohol prevention efforts — regardless of whether they know they’re pregnant. The suggestion was included in an early draft of the organization’s global action plan on alcohol, which argues that anti-alcohol campaigns should target women specifically due to the risks alcohol poses to the health of a fetus. Yes, even a fictitious, does-not-yet-exist fetus.
The onus, at least according to science, does not just fall on women who choose to imbibe. But it does in the minds of WHO officials.
The recommendation was met with immediate backlash after it was released on June 15. “It is extremely disturbing to see the World Health Organization risk hard-won women’s rights by attempting to control their bodies and choices in this way,” Clare Murphy, chief executive of the British Pregnancy Advisory Service, said in a statement. Others shared pictures on Twitter of their wine glasses and alcoholic beverages. As one woman noted, “I intend to have an alcoholic drink tonight for the fourth evening in a row. Not something I normally do, but as a woman of childbearing age I feel it is my duty.”
Though the WHO responded to the outcry by stressing that it “does not recommend abstinence of all women who are of an age at which they could become pregnant,” it continued by saying that “it does seek to raise awareness of the serious consequences that can result from drinking alcohol while pregnant, even when the pregnancy is not yet known."
Yet men who drink can damage fetuses — known or unknown — as well, but they aren’t mentioned in the WHO guidance. Unintentional though it might be, the implied message is that parenthood is a woman’s inevitable purpose rather than a life choice; that our needs come second to the needs of a baby yet to be born and a family we may or may not want to create; and that women are still not afforded the same bodily autonomy as the men who can impregnate us.
An April study of over 520,000 couples found a 35 percent increase in the risk of birth defects when a father drank alcohol regularly up to six months prior to conception. As the researchers wrote in JAMA, “Our finding suggests that future fathers should be encouraged to modify their alcohol intake before conceiving to reduce fetal risk,” noting how it “substantially elevated the risk of birth defects.”
The onus, at least according to science, does not just fall on women who choose to imbibe. But it does in the minds of WHO officials, who are continuing a long practice of putting the entire burden — and blame — of childbirth on women by singling out their behavior.
Not only are there similar scientific understandings, or questions, about the effect of fathers’ alcohol consumption on the fetus as the mothers’, there’s much less awareness about it. If the WHO truly wanted to provoke thoughtful consideration of the connection between alcohol and childbearing, that would be an important point to emphasize.
Alcohol can also adversely affect both sperm and eggs, yet how much public health outreach and messaging is devoted to the male side of the equation? One 2014 study of 1,221 men ages 18 to 28 found that even “modest habitual alcohol consumption” had “adverse effects on semen quality” and was linked to changes in men’s testosterone levels. And 15 cross-sectional studies of over 16,000 men in 2016 found that “alcohol intake has a detrimental effect on semen volume,” though it noted that daily alcohol consumers experienced a larger change in semen health than occasional drinkers or those who abstain, suggesting that “moderate consumption” not done every day could be safe.
“It’s difficult to say definitively, because there are certainly other factors that contribute to egg and sperm health,” Dr. Jennifer Butt, an obstetrics and gynecology specialist practicing in New York City, told me. “So I think it’s difficult to really just pinpoint it to that one particular habit — drinking. Similar to women, light to moderate drinking will likely not affect sperm health.”
Less difficult to pinpoint is how this proposed guideline — like rules and regulations that aim to curtail access to birth control, abortion and other family planning services that confirm a pregnant person’s innate autonomy — will harm women whodowant to be pregnant and become mothers just as much as it shames the ones who do not.
“Our culture is fantastic at punishing women simply for making choices,” said Dr. Pooja Lakshmin, a board-certified psychiatrist specializing in women’s mental and perinatal psychiatry. “One devastating effect of this messaging — whether it’s about alcohol or medications or exercise — is that it causes women to question themselves even more, and internalize the misogyny.”
That self-doubt can be most intense when it comes to pregnancy. This country already has a deep misunderstanding of what leads to miscarriage and infertility — for instance, chromosonal abnormalities cause at least 60 percent of miscarriages, yet a 2015 study of 1,084 adults found that 75 percent of participants believed a miscarriage was a result of a stressful event, while 64 percent blamed a woman lifting something heavy, and 22 percent thought it was the result of lifestyle choices, like smoking and drinking.
While studies have shown drinking can increase the risk of miscarriage, so can infections, hormonal irregularities, issues with birth control implants and an increase in caffiene consumption. The WHO has yet to issue a statement regarding the harm over-caffeinated, potentially pregnant women may have on fetuses, however.
“When somebody faces miscarriage or infertility, it almost feels natural to self-reflect and see what may have ‘gone wrong,’” Butt noted. But she cautioned, “There really are a multitude of factors, and sometimes there may or may not even be an explanation.” Yet to treat every woman who drinks as a possible incubator potentially harming a fetus that may or may not exist, while not even including their male sexual partners in the conversation, is to pre-blame women for a reproductive outcome that does not end in a live birth.
And “women of childbearing age” are not pre-pregnant women. We’re women. Women who want to but cannot become pregnant or become pregnant and cannot carry that pregnancy to term or simply do not want to be pregnant are not failures experiencing the consequences of their actions. They’re simply women who are experiencing a myriad of reproductive outcomes, all common and often unpredictable.
“One of the central psychological questions that comes up in pregnancy and in motherhood is, ‘Am I allowed to meet my own needs when I’m responsible for the needs of another human being?’” Lakshmin said. Men should be facing this question, too.