December 19, 2007

New Data on the Perpetually Pre-Pregnant Woman

Last year, the CDC was widely criticized following its recommendations on “preconception health care.” Critics noted that the recommendations seemed to focus on improving women’s health solely for the purpose of helping potential children, rather than on the health status of women in general, and did not seem to address the barriers to obtaining the kind of preconception care being recommended (but for a mention of the need for health insurance and public health programs).

The CDC also conducts the Pregnancy Risk Assessment Monitoring System (PRAM) program, a way of tracking women’s behaviors prior to and between pregnancies, and has released a new report on their 2004 data from 26 reporting areas around the country. The data aren’t great, because for some questions only a few areas reported. However, they found:

  • 23.2% of women had used tobacco during the three months prior to their most recent pregnancy

  • 50.1% had consumed “any alcohol” during the three months prior to their most recent pregnancy
  • 53.1% of women who were not trying to become pregnant were not using any form of contraception when they did become pregnant
  • 30.3% of women had some conversation with a healthcare provider about preparing for a healthy pregnancy
  • 35.1% were taking a multivitamin or prenatal vitamin at least four times per week prior to their pregnancy

I’m not entirely convinced that use of “any alcohol” prior to pregnancy is an important measure – the report doesn’t attempt to distinguish between one beer and binge drinking. Additionally, improving on these items (and other issues mentioned in the full report, such as dental visits and certain health conditions) would be useful for improving the health of women in general, without the need for a focus on pregnancy.

Most importantly, though, improving on these issues takes resources – if women can’t afford smoking cessation therapy, doctor visits, vitamins, or nutritious food, the recommendations mean very little. For many of the factors, having private health insurance (which could be a proxy for socioeconomic status) made a difference in whether women were achieving healthy behaviors.

In other words, it’s fine to say, “women should stop smoking and eat better,” but I’d prefer if we did so because we also care about the health of women (not just potential babies, although they’re important, too), and if we were having a serious conversation about how unachievable these goals can be for so many women.

Also:
Numerous blogs are putting out a call today for donations to the Pretty Bird Woman House, a shelter for women of the Standing Rock Reservation who have been victims of domestic violence or sexual assault. They needed to give up their previous location after vandals made it unsafe, and are raising money for a permanent home for the shelter with adequate security.

The shelter’s blog provides additional information and the opportunity to chip in toward a new home for these women. For background on the issue, please see this previous post.


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