Sexually active women of reproductive age

Young woman standing on the street suffering from pain. She has a take away cup of coffee and touch her temple

The Centers for Disease Control and Prevention (CDC) recently made the eyebrow-raising recommendation that all sexually active women of reproductive age who are not using birth control avoid alcohol completely. The reason: to prevent fetal alcohol spectrum disorders (FASD). Exposure to alcohol during pregnancy — even the earliest stages — increases the risk of FASD, which can cause a child physical problems as well as challenges with behavior and learning.

This sweeping recommendation rubbed me (and many others) the wrong way. The CDC’s message defined young women as primarily heterosexual baby incubators, ignored the role of alcohol in men’s reproductive responsibilities, and assumed that women cannot logically act on health recommendations within the context of their lives. When I talk to women of childbearing age in my practice about their health, my goal is to help them balance risks and benefits with a breadth of vision about their life and values.

Using shared decision-making, we take into account many things about her life in prioritizing our approach to her health issues and lifestyle. Is she in a relationship? With a man or woman? Does she hope to become pregnant in the next one to three years, or to prevent pregnancy? Or is she not sexually active at all? I point out the dangers of smoking whether pregnancy is in her short-term plans or not. I help educate her on how to eat healthfully. I encourage her to wear seatbelts and bicycle helmets. I talk to her about safe relationships and healthy sexual practices. If she’s trying to avoid pregnancy, I work with her and her partner to determine the safest and most effective way for them to do so. If she’s trying to achieve pregnancy, I counsel her to avoid alcohol from the time she ovulates until she knows whether or not she is pregnant.

I have no dispute with the facts of the CDC’s statement. It is true that 50% of pregnancies in the United States are unplanned. It is true that fetal alcohol spectrum disorders can cause lifelong problems for children. It is also true that there is no known safe level of alcohol in pregnancy. I tell women this every day. The facts are correct, but the messaging is wrong. Here’s how:

  • Everyone who chooses to drink alcohol should do so responsibly. This applies to both men and women, within the context of reproductive health and beyond it. Animal studies suggest that alcohol use may damage sperm and potentially affect offspring. Alcohol abuse increases the risk of intimate partner violence, a risk to a healthy pregnancy.
  • Educating women on the effects of alcohol on a potential pregnancy is critical, but the recommendations don’t acknowledge that even the most reliable forms of birth control, when used properly, aren’t 100%.

It’s hard to address all of these issues I discuss with my patients within a public health sound bite. But we owe it to women to be respectful when delivering important health messages. And we also owe it to men to make them equal partners in conversations around sexual and reproductive health.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

1 Corinthians 6:18 ESV Flee from sexual immorality. Every other sin a person commits is outside the body, but the sexually immoral person sins against his own body.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Matthew 22:37 ESV And he said to him, “You shall love the Lord your God with all your heart and with all your soul and with all your mind.

Isaiah 43:18-19 ESV “Remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the wilderness and rivers in the desert.

Psalm 119:1-176 ESV Blessed are those whose way is blameless, who walk in the law of the Lord! Blessed are those who keep his testimonies, who seek him with their whole heart, who also do no wrong, but walk in his ways! You have commanded your precepts to be kept diligently. Oh that my ways may be steadfast in keeping your statutes! …

Philippians 2:13 ESV For it is God who works in you, both to will and to work for his good pleasure.

Psalm 19:14 ESV Let the words of my mouth and the meditation of my heart be acceptable in your sight, O Lord, my rock and my redeemer.

Psalm 131:1-3 ESV A Song of Ascents. Of David. O Lord, my heart is not lifted up; my eyes are not raised too high; I do not occupy myself with things too great and too marvelous for me. But I have calmed and quieted my soul, like a weaned child with its mother; like a weaned child is my soul within me. O Israel, hope in the Lord from this time forth and forevermore.

1 John 4:8 ESV Anyone who does not love does not know God, because God is love.

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