The Centers for Disease Control and Prevention (CDC) recently recommended that all women of childbearing age who could become pregnant should abstain from alcohol consumption. Some have called the manner in which the organization presented this recommendation sexist and misleading—which it is. It’s also emblematic of a peculiarly puritanical and unhelpful approach Americans take toward vices. There is a wide gap between the standards Americans publicly set for themselves and their behavior in private, and that gap is not helping to rid the country of the real problems it faces.
One rationale the CDC gave for its recommendation is that half of pregnancies in the U.S. are unplanned. Aside from the fact that it’s completely unrealistic to expect a woman to say, “Just in case I ever have sex when I’m not entirely prepared, forget to take a pill, or have a condom break, I’m never going to drink alcohol,” shouldn’t we be more focused on preventing those unplanned pregnancies? American rates of unintended pregnancy are among the highest in the developed world, and its rates of birth control usage among the lowest. We are busy prohibiting sex education and creating legal and financial barriers to contraception and abortion, and our answer to the unplanned pregnancy problem is to tell all menstruating women not to drink alcohol? Maybe that makes sense to a government that thinks that we can prevent teenage pregnancies by telling teens not to have sex.
There is a wonderful moment in the film Peggy Sue Got Married when a mother tries to broach the subject of sex with her teenage daughter. After some fumbling miscommunication, the mother finally blurts, “Peggy, you know what a penis is? Stay away from it!” The line is funny because we know that it is utterly ineffectual advice. (In fact, that teenage daughter does end up pregnant.) The CDC recommendations about alcohol consumption resemble a well-intended but hapless parent trying to give a child sex advice. According to the CDC, even when not pregnant and on iron-clad birth control, women are supposed to consume no more than one alcoholic drink, or 14 grams of alcohol, per day. This may be good advice, but it’s a long way from what Americans actually do: In the U.S., per capita annual consumption is close to 9 liters per person over age 14—but fully half of that population doesn’t drink at all. That means that the drinking population is consuming more like 18 liters per person, or 38 grams per day. This is significantly more than twice the upper limit recommended for women. If we spread alcohol consumption evenly among all Americans who drink, we would classify every single woman as a heavy drinker. The same is true of drinking during pregnancy. One in 10 American women admit to drinking while pregnant—probably an underestimate, since not everyone admits to it—despite the fact that every container of alcohol warns: "According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Why do so many women ignore the government’s recommendations about alcohol consumption? No one knows for sure, but I would guess that lack of trust has something to do with it. When I was at university in the late 1980s, we received dire warnings about sexual HIV transmission. But despite how terrifying AIDS was, most students ignored the warnings. In a small college town full of relatively privileged young adults, we had never encountered anyone who contracted HIV through heterosexual intercourse. Similarly, I know many women who consume more than one alcoholic drink per day and who drank during pregnancy, and both they and their children seem just fine. Alcohol use is so common, and alcohol-related disease so rare, that we don’t take the CDC's recommendations seriously. In fact, the more government rhetoric diverges from our personal experience, the more likely we are to discount it entirely. When the CDC claims that “up to 1 in 20 U.S. school children may have fetal alcohol spectrum disorders (FASD),” which is more than 150 times higher than previous estimates—and far outside my experience, as there doesn’t seem to be a child with FASD in most of my kids’ classes—I am tempted to ignore everything the CDC has to say about the perils of alcohol.
And that is a real problem.
Diseases related to alcohol are an enormous threat across the globe, and the U.S. is no exception. Worldwide, analysts directly attribute an estimated 2.5 million deaths each year to alcohol, with the highest percentage occurring among people between 15 and 29 years old. Fetal alcohol spectrum disorders may not be common, but they are devastating for the affected individuals and their families—and they are completely preventable. We should be trying to eradicate these diseases, but alarmist and impractical suggestions won’t help.
In medical school, when I was learning to take a patient’s medical history, I was told that I should multiply a man's reported alcohol intake by a factor of two and women’s by a factor of three. That’s because North Americans have been taught to feel ashamed of drinking. I have never met anyone from France who feels compelled to tell me that she doesn’t usually drink; Europeans don’t apologize for drinking the way Americans, and women in particular, seem to. This shame around alcohol makes it hard to get good data about drinking habits, and it prevents people who abuse alcohol from asking for the help that they need. The CDC contributes to the shame by setting unrealistic standards, exaggerating risks, and making recommendations with judgmental overtones. The most recent one conflates concerns about fetal health with sexually-transmitted infections and domestic abuse.
Government should educate the public about the dangers of alcohol, but instead of fear-mongering, they should gain our trust by openly discussing the limitations of our current understanding about the relationship between alcohol consumption and disease. Instead of blurting out, “Ladies, you know what a beer is? Stay away from it!” officials should recognize that alcohol use is deeply entrenched in the culture, and that abstinence-only recommendations are unlikely to be effective.
Women are smart enough to understand that behaviors and lifestyle choices carry risk. They deserve to know the truth, which is that the risks of alcohol consumption lie somewhere between the extremes of “everyone is doing it” and “there is no safe level.”