Tuesday, November 13, 2012

Walk Wombs: Problems with Preconception Care

Preconception care is not just another term for prenatal care. Prenatal care applies to women who are pregnant. Preconception care applies before a woman conceives. In fact, federal guidelines in 2006 "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." The health of a woman while she is pregnant is widely known, including a large list of dos and don'ts. Individuals who are actively trying to have a child often take precautions to ensure that they will have a better pregnancy and healthier child. For example, they may take folic acid supplements, maintain a healthy weight, keep chronic conditions under control, and refrain from smoking, drinking alcohol or using substances.

Preconception care applied to planned pregnancy is not particularly controversial. This feels like a thoughtful choice meant to stack the odds in your child's favor. However, preconception care becomes a more complicated issue when it is mandated to all woman who are simply capable of conceiving a child. Health experts claim it is important that women follow the health protocol of pregnant women throughout their reproductive lives. Three main arguments support the mandated preconception care: impact on perinatal outcomes, unplanned pregnancies, and equalizing access for those who cannot afford it.

The usual pathways to impact perinatal outcomes (prenatal and neonatal care) often start too late to achieve primary prevention. In 2002, congenital anomalies, low birth weight, preterm delivery, and maternal complications of pregnancy accounted for 46.4% of all infant deaths in the United States (12,996 infant deaths). Some of these infant deaths might have been prevented through interventions targeted at improving the health of mothers and modifying behaviors contributing to adverse pregnancy outcomes. However, poor maternal health, behaviors contributing to adverse pregnancy outcomes, and maternal complications of pregnancy persist despite prenatal intervention.

Approximately half of pregnancies are unplanned. Health professional assert that damage can be done to a fetus between conception and the time the pregnancy is confirmed. Research shows that "during the first few weeks (before 52 days' gestation) of pregnancy" -- during which a woman may not yet realize she's pregnant -- "exposure to alcohol, tobacco and other drugs; lack of essential vitamins (e.g., folic acid); and workplace hazards can adversely affect fetal development and result in pregnancy complications and poor outcomes for both the mother and the infant." Of course not everyone with an unplanned pregnancy will decide to carry the fetus to term. However, some woman will. In the latter situation, women who follow preconception care protocol throughout their reproductive lives have ensured that their body will be prepared.

Lastly, without actively providing preconception care, women of lower socioeconomic status will be disadvantaged. A recent CDC report highlighted disparities in care, noting that approximately 17 million women lack health insurance and are likely to postpone or forgo care. These disparities are more prominent among minority groups and those of lower socioeconomic status, the report states. The NCHS data also reflect these disparities. Babies born to black mothers, for example, had the highest rate of infant death -- 13.5 per 1,000 live births. Infants born to white women had a death rate of 5.7 per 1,000. Finally, using the Perinatal Periods of Risk approach, researchers in three cities concluded that racial and ethnic disparities in feto-infant mortality were largely related to maternal health, and, interventions to reduce feto-infant mortality should include preconception care and improvements in women's health. --> As a society, we have a stake in the health of newborns. This applies to to fiscal conservatives as well, considering birth defects and natal health incur heavy financial burdens on all of us. Since the health of these babies is affected long before they are conceived, there is a compelling state interest to provide reproductive health care to all women of reproductive age.

Despite these logical explanations, I am hesitant when it comes to mandated preconception care. The notion that healthier women have healthier pregnancies leads some to think all women of childbearing age should be taking preconception health measures just in case. Because pre-conception targets women who reach child-bearing age, it assumes that all women should be concerned about future prenatal care. It assumes that all women should be planning for future children and should live their entire reproductive lives in the shadow of these potential future children. preparing their non-child lives for the sake of their future issue. Such policies are prone to pitfalls that reaffirm and strengthen already troubling stereotypes of women being defined by motherhood. (Not to mention a slew of other problems, such as parental/minor rights or absence of men in both research and health protocols.)

Further, preconception care could lead to societal, and even legal, implications and limitations on women. They get dirty looks when they indulge in a small glass of permissible wine or gain to much pregnancy weight. Some states, such as Alabama, have twisted existing laws. The negative actions a mother undertakes can result in criminal prosecutions if it leads to their infant's mortality. This is most often associated with drug use. While criminal convictions of women for their newborns’ positive drug tests are rare in other states, maternal drug use is considered a matter for child protective services. This is an alarming trend. If pre-pregnant health is truly has such an impact, it is easy to see how this can be applied to pre-pregnant women. Sometimes social stigma is worse than the legal ramifications. Any trek into expanding preconception care should be done with this in mind. Women should be able to live their own lives for themselves, without being judged for any potential harm to potential future children. Proper preconception care involves a great deal of education and access to the appropriate health care which is integrated with women's general health. For those woman who think they may want to be pregnant one day, this will allow them to make the choice for themselves without medical mandates, social stigma, or inability to pay for said services out of pocket.


KSergent said...

Great post! To me, there is something totally creepy about requiring preconception care! It reminds me of that book "The Giver," by Louis Lowry, in which everyone in society is assigned their life role at the age of 12. Except with preconception care, we're assigned the role as soon as we are born a female.

MC said...

Thank you for this post Patricija. You write, "[p]roper preconception care involves a great deal of education and access to the appropriate health care which is integrated with women's general health. I am a 27 years old, and before this post, I had no idea about what constituted proper preconception care!

What annoys me about these federal guidelines is that they presume that all women have access to the recommended means of care. As you suggest, women of lower socioeconomic status are absolutely at a disadvantage. We read every day about the widespread inaccessibility to basic amenities including food, housing and healthcare, yet the federal government calls on ALL women to take folic acid supplements, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control. http://www.washingtonpost.com/wp-dyn/content/article/2006/05/15/AR2006051500875.html. This point is quite infuriating.