Preconception Care: A good idea that just keeps seeming worse

See below article from (once again) the Daily Women's Health Report from The Kaiser Family Foundation.
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Pregnancy & Childbirth | Public Health Officials Emphasizing 'Preconception Care' Message for Women of Childbearing Age
[Nov 28, 2006]
Some public health officials are "recast[ing]" their message of prenatal care by adding what they call "preconception care," which urges all women of childbearing age to maintain physical and emotional health well in advance of pregnancy to reduce the risk of preventable birth defects and other complications, the New York Times reports (Rabin, New York Times, 11/28). CDC in the April 21 edition of its Morbidity and Mortality Weekly Report published preconception care recommendations. Preconception care, which takes place in multiple physician visits, involves "interventions that aim to identify and modify biomedical, behavioral and social risks to a woman's health or pregnancy outcome through prevention and management, emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact," according to the recommendations (Kaiser Daily Women's Health Policy Report, 5/9). Although the recommendations were "criticized in some quarters for treating all women as though they were eternally 'prepregnant,'" some experts say that preparing for a healthy pregnancy can require behavioral changes that take months. Pregnant women usually do not have their first prenatal visit until 10 weeks to 12 weeks after conception, doctors say. "If a birth defect is going to happen, it's already happened," Peter Bernstein, a maternal fetal medicine specialist at Montefiore Medical Center who helped write the CDC recommendations said, adding, "The most important doctor's visit may be the one that takes place before a pregnancy is conceived." The recommendations highlight the importance of family planning and child spacing and encourage young people to develop a "reproductive life plan," the Times reports. According to the Times, physicians have been recommending preconception care for decades but "it has never really caught on." The issue has taken on "added urgency" because of higher rates of unplanned pregnancies and low birthweights, the Times reports. In addition, the U.S. obesity rate and number of women delaying pregnancy continues to rise, meaning that women are more likely to have high blood pressure, diabetes or prediabetes when they become pregnant, according to the Times. Some health providers say that pregnancy planning and contraceptive use are essential in preconception care and urge all doctors to counsel women of childbearing age about the possibility of pregnancy. "It's not like we have an injection we can give someone" to prepare her for pregnancy, Hani Atrash, associate director for program development at CDC's National Center on Birth Defects and Developmental Disabilities, said. "Some of the interventions, like weight management, need time to happen," Atrash said, adding, "What we're actually talking about ... is women's health" (New York Times, 11/28).
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First off, this whole concept of 'preconception care' initially turned me off because it seems to be designed exclusively for women with enough privilege to access health care.

Aside from that though, I think there is a larger issue here than access. Imagine, if you can, universal healthcare. And then, to make this fantasy world even more unrealistic, let's imagine most pregnancies are planned. There is still a problem with the concept of 'preconception care.'

Are doctors really prepared to deal with what they will uncover in these pre-pregnancy visits? Aside from sending a women away with some sort of awareness of her risk factors and suggested behavior modifications that will create an ideal internal environment for her future child, what interventions are doctors really prepared to implement? Will they be screening for domestic violence? And if so, are they getting adequately trained to do so? Are they prepared to offer helpful interventions for DV? Are they screening for drug abuse? And if so, are they prepared to offer treatment? There are endless risk-factors that one could uncover in such a visit, and I imagine that most of the ones I can think of are ones for which doctors couldn't or wouldn't help. Good health doesn't exist in a bubble separate from the stressors of an individual's life.

Additionally, it seems that we are setting mothers up to be criminalized further. What if at a preconception appointment, a women finds out that her unconceived child is at risk for 'life-threatening disease X' and upon actual conception or birth or at age 13, the child in fact is found to have 'life threatening disease X.' Was the mother criminally negligent? It sounds crazy, I admit, but this seems to be the direction that society is moving in with regards to pregnant women. What if she was found to be an addict at a preconception visit and conceived and gave birth to a child that was drug-impacted? That doesn't sound nearly as far-fetched, does it?

Don't get me wrong, I am strongly in favor of healthy pregnancies and better outcomes, but perhaps naively, I still believe we can acheive this end without implementing policies, laws and recommendations that privilege some while targeting others.

At risk of sounding anti-establishment, I simply don't trust it. If this were to become the new norm for medically or socially acceptable (or dare I say it, legal) conception, it would negatively impact AT LEAST as many women as it would positively impact. To me, it looks like a way for even more control of a person's reproductive autonomy to shift to health care providers.

What do abortions have to do with immigration?

Below is a disturbing story as reported by the Kaiser Family Foundation.

State Politics & Policy | Legalization of Abortion Contributing Factor in Undocumented Immigration to U.S., Report Says
[Nov 15, 2006]
Abortion procedures have caused a decrease in the number of U.S. residents, leading to a shortage of workers in the country and an increase in immigration of undocumented immigrants, according to report drafted by the Missouri Special Committee on Immigration Reform and submitted last week to state House Majority Leader Rod Jetton (R), the AP/MyFox St. Louis reports. The report was dated Oct. 24 and signed by all 10 Republicans on the committee, but it was not signed by any of the six Democrats on the panel. It says that the "lack of traditional work ethic, combined with the effects of 30 years of abortion and expanding liberal social welfare policies have produced a shortage of workers and a lack of incentive for those who can work." The report estimates there are 80,000 fewer Missouri residents because of abortion and that many of those residents now would be in a "highly productive age group for workers." Democrats on the committee said text regarding abortion was neither discussed nor agreed to be included in the report. Committee chair state Rep. Ed Emery (R), who opposes abortion, said the committee heard some testimony about abortion during one of its hearings, adding, "I felt like [it] was significant enough and fundamental enough that it warranted addressing it in the report." Emery on Monday also said, "We heard a lot of arguments today that the reason that we can't get serious about our borders is that we are desperate for all these workers," adding, "You don't have to think too long. If you kill 44 million of your potential workers, it's not too surprising we would be desperate for workers." State Rep. Trent Skaggs (D) said the abortion assertions discredit the entire report, adding, "There's a lot of editorial comment there that I couldn't really stomach."


It goes on, but I will cut it short by a bit. I have to second Trent Skaggs and say that there is a lot here that I could not stomach. I have never seen such a ridiculous linkage of issues as abortion and immigration. I am being dead serious, I just took pause from my writing to make sure that I was not using hyperbole. I sometimes worry that I overuse hyperbole thus rendering it an ineffective tool when in my hands. But, it is in fact the most ridiculous linkage of issues I have encountered to date. There, I said it twice.

Immigration inspired by unbridled domestic abortion. That takes the issue of abortion so far away from women's right to self-determination and twists the matter to shed some pretty scary light on the issue for me. I have often naively wondered what real and true investment pro-lifers have in the fate of the fetuses inside of bodies of women they do not know. The explanation of moral outrage alone always left me feeling that I was not getting the full story. I mean, pro-lifers are frequently pro-death penalty, a contradiction that is so alarming it feels like a cliche. This proclaimed reverence for life is clearly not very deeply felt.

Perhaps everyone else already knows this, and I am a little slow on the uptake. Are pro-life politicians actually simply trying to ensure a growing labor force? That is sick. Sick, sick, sick. That makes the fight against immigration even more unsavory. I mean, it seems obvious to me that anti-immigration policy is driven in large part by racism. But, I thought it was at least partially related to concerns about limited resources for the people that already live in this country, (namely health care.) But, if they want the population to grow and grow does it honestly matter to 'them' whether the underpaid and exploited work force in this country came out of the wombs of poor americans or across the border?

There is something very creepy about the idea of linking reproductive decisions and the future of industry. We are not drones, there is a real person attached to that womb.

It doesn't take much reading between the lines to extract the message: do your duty patriotic American women, bear the future generation of exploited workers.