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.