- BIOETHICS FORUM ESSAY
The CDC’s Graphic on Women and Alcohol is Flawed: Why That Matters
Last week, as part of its monthly “Vital Signs” report, the Centers for Disease Control and Prevention (CDC) released an infographic outlining the risks that drinking can pose for women, and advising that they avoid alcohol when not on birth control. On its face, this is a benign – intuitive, even – framework: alcohol is bad for fetal development, and may result in miscarriage, stillbirth, prematurity, fetal alcohol spectrum disorders, or sudden infant death syndrome. CDC’s likely intention was to present in an easily understandable fashion its new guidelines, which come out of the 2011-2013 National Survey of Family Growth. It found data-driven evidence to support the claim that “drinking any alcohol at any stage of pregnancy can cause a range of disabilities for [the] child.” In other words, the most charitable interpretation of what the CDC was trying to do here is to hammer home the idea that women should not drink while pregnant, period.
But the CDC’s graphic is not about fetal health: it highlights the risks of excessive drinking for women. The reason it does this is simple: since, according to the new recommendations, any amount of alcohol can harm even the least developed fetuses, and women often do not know that they are pregnant for several weeks after their first missed period, it follows that any woman who might become pregnant (to the CDC, that means any sexually active woman not on birth control) should abstain from alcohol.
The logical train that gets you from “alcohol is bad for fetuses” (which – let me be clear – nobody is questioning) to “sexually active women not on birth control should not drink” is more of a logical rollercoaster, but it’s worth the ride. It rests on a series of flawed assumptions, each with damning implications. It’s worth noting that these assumptions come through much more in the graphic than in the report itself. But the graphic is the way that the CDC has chosen to convey these findings; therefore, it’s neither pedantic nor petty to take exception with it.
The first assumption that it makes is that “women” equals heterosexual cisgender women. Now, you might say, hold on a second – I know that “women” includes queer ladies and transgender ladies, and that many agender folks have uteruses. But isn’t that splitting hairs when the important thing is to tell women who might unknowingly be pregnant that alcohol could harm their fetuses? I might agree if the CDC had not couched its treatise on fetal alcohol syndrome prevention under the banner of “Drinking too much can have many risks for women.” The CDC is addressing all women (or does it mean all people with uteruses?) – and seriously missing some of them.
The second assumption is an even more bizarre one, and involves what the CDC seems to understand to be women’s relationship to pregnancy. By telling women that they should not drink unless they are on birth control, the CDC is targeting its message to those women who do not want to become pregnant (they would, presumably, be the ones going on birth control in order to drink under their guidelines). The CDC makes this case by, in part, elucidating the risks that alcohol poses to the fetus – miscarriage, stillbirth, fetal alcohol syndrome, etc. But in the context of a pamphlet that outlines the risks of excessive drinking to a woman’s health, why frame the harms in terms of the risks posed to an unborn – and unwanted – child? Is the CDC saying that even women who are not ready to have a baby should prepare for the possibility, if they are not using birth control perfectly (or it fails), of both becoming pregnant and deciding to keep the baby? That is the only case I can come up with in which these recommendations are really valid. But the graphic is saying so much more than that.
The graphic highlights the dangers of excessive alcohol consumption for women. But excessive drinking is bad for people, full stop. The CDC wouldn’t find itself embroiled in controversy for enumerating the many ailments that excessive drinking can foist upon humans. And if what the CDC means to do is to publicize the dangers that alcohol – any alcohol – can pose for unborn children, then it should have done just that, rather than layer those warnings within broader grandstanding about women’s health. What the CDC has done, instead, is to characterize women as vessels for children who, once burdened thusly, defer their health responsibility to their fetuses. It fails to account for the other options that women have during unwanted pregnancy, for one, but more importantly, as was pointed out in the New York Times, defers the crux of the problem from birth control – something that can and should involve all parties engaged in potentially babymaking sex, and genuinely does merit more public education – back to the women’s autonomous behavior.
This brings me to the final, and in my view, most critical, misplaced assumption. Drinking too much for “any woman,” according to the CDC, can have the following risks: injuries/violence, heart disease, cancer, sexually transmitted diseases, fertility problems, and unintended pregnancy. In a pointed op-ed in the Washington Post, Alexandra Petri does an excellent job of pointing out the preposterousness of such a list. “Who knew that drinking alcohol could give ‘any woman’ a sexually transmitted disease,” she asks. “That’s the last time I drink merlot alone in my apartment. I don’t want herpes. Furthermore, I had no idea that drinking eight beverages a week could result in a baby. I always thought, somehow, that there were other activities involved. But the CDC knows best.”
What the CDC is saying is an echo of what women and girls have always heard: Drinking too much can make it so that you cannot fend off unwanted sexual advances, so that you are the target of other people’s violence, so that you can’t protect yourself adequately from someone else giving you an STD, so that someone might get you pregnant. This list assumes that women are responsible for – and responsible for preventing – the actions of others. As Petri points out, none of these things can actually happen to women drinking alone: thus, none of them are specifically risks of alcohol consumption. Perhaps they are the risks of being a woman in a world in which these things happen, or the risks of sex with a deceitful partner, or the risks of sex itself, but each of these bad outcomes requires at least the involvement and at most the evildoing of another party.
This graphic is a publication that shouldn’t merit further consideration as a policy recommendation. It’s poorly designed, and I’d imagine that as I write this, the CDC is trying as hard as it can to backtrack away from it. But it deserves the press that it’s getting as a rhetorical devise, and the ridicule that it’s received, for the simple reason that what the CDC says matters. It is one of the most influential health organizations in the world. It is where regular people turn to understand what to feed their children, to figure out if their vacation will put them at risk, and how to fight off the flu. And so when it tells women what to do with their bodies – because that’s how it’s being interpreted, even if that’s not what the CDC meant – people notice. And so it matters when what it publishes legitimates generations of taking the easy way out of solving real problems of violence against women, poor sexual health education, and unwanted pregnancy: the same logic that connects revealing clothing or friendly interest to women being assaulted undergirds the assertion that injuries, violence, and STDs are risks of excessive drinking for women.
Elizabeth Dietz is a research assistant at The Hastings Center.
Published on: February 8, 2016
Published in: Public Health