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When I first read about this in AJ Hall's journal I was as freaked out as everyone else was. I was also still high on muscle relaxers they gave me, though, and I knew that. When they started to wear off, I looked up and I read the full instructions to providers from the CDC with respect to "pre-pregnancy":
Now that I've had some time to read this carefully, I'm a lot less upset than I was.
These are recommendations, and they don't carry the force of law. Furthermore, the recommendations to lower doses of teratogenic medications and advise the cessation of alcohol use do apply only to women who are, actually, planning a pregnancy. Both these documents advise that female patients be encouraged to think about the ramifications of their current behaviour should they become pregnant, and to therefore adopt a reproductive plan, which may be not to reproduce.
At least that's how it reads to me--because I'm used to reading this sort of document, being as how I work in the medical field. It does not read to me as though they're saying "don't let anyone female between the age of 12 and 65 take Depakote", but rather "if your female patients in this age group take Depakote, keep on top of their sexual activity and reproductive plans and be prepared to change the drug/lower the dose if it looks like they're seriously considering having a kid."
We do, in the USA, have a terrible infant mortality rate. Especially among nonwhites. It's really very horrifying to compare our infant mortality rate to countries with comparable scientific and industrial advancement. I suspect the people who are behind this are not actually looking to create "Gilead", but rather to do something about this problem.
I work in a teaching hospital and I know a fair bit about how providers operate. Most of this is stuff they are supposed to be doing anyway. You are always supposed to take into account that a woman is of childbearing age when you prescribe drugs and other treatments for her. You know how they ask you for the date of your last period when you go to the doctor? That's because they want to know how likely it is that you're preggers and don't know it. If you are asked this and you've been sterilised, tell them that: unless you're there for menstrual problems, it usually shuts them up. Sometimes they will get shirty with you if you have been sterilised and you have to remind them of this and say that no, you don't want any birth control pills with your Accutane, thanks, but mostly, the medical profession DOES treat all women between 12 and 65 as "pregnant until proven otherwise".
Most of this material is nothing very new. This is not actually a law. Your doctor is not required to force you to watch your weight, take folic acid, stop drinking or smoking, take care of your asthma or diabetes even if you ARE pregnant (although it would be a good idea for him/her to strongly advise these steps, so that s/he doesn't get sued if something is wrong). The CDC is pointing out that 30% or more of American pregnancies are not planned, so if it looks like your female patients are sexually active and unlikely to abort any resulting pregnancies, you need to keep in mind that they may become pregnant and decide to have the baby.
If someone starts suggesting that they pass a law forbidding non-pregnant adult women from drinking, changing cat boxes or taking anticonvulsants, I will be just as worried as the rest of you, but that really is not what I am seeing in the actual CDC documents.
By all means write to the CDC and tell them that doctors should trust their educated, articulate, responsible female patients who aver that they do not intend to have children, now or ever; but the documents I read actually encouraged doctors to talk to their patients about making plans for their reproductive future, rather than just breeding indiscriminately. Unfortunately, America is full of people who do not think about this stuff--who do get pregnant without thinking, have the baby because that's just what is done in their social world, and therefore need to be told "by the way, if you are not actively trying to prevent a pregnancy, and you will not terminate one should you start it, you should not be doing X, Y and Z."
If you are afraid that your doctor is sekritly planning Gilead and isn't giving you a high enough dose of your meds or the best med for your condition, then you need to educate yourself. The most important thing that women who have to take potentially teratogenic meds, whether or not they want kids, can do is educate themselves about medications. Get a good nursing drug reference from a medical bookstore and buy a new one every few years. Look up the drugs you are given and check to see if they are being prescribed on label and in a realistic dosage for a person of your size and age. This isn't hard to do and you don't need to be afraid that you won't understand it. Avoid the PDR because most of the material in it comes directly from drug companies.
Women get misprescribed shit all the time. There's been a recent scandal or three involving bipolar women who are "obese" not receiving the proper first-line treatments for bipolar disorder and being given snake oil like Topamax (great if your migraines are so bad and so resistant to all the other treatments there are that the resulting cognitive deficit is acceptable, which isn't most people; not so hot for bipolar patients, but hey, it doesn't cause weight gain!) because the more dangerous drugs with the nastier side-effect profiles may not be as likely to cause them to maintain a high BMI or gain more weight.
I do not like some of the proposed restrictions on Accutane use that I have seen in entirely other places, but it's also regrettable, given the good that thalidomide does for some conditions, that thalidomide is so difficult to get.
This document does NOT carry the force of law. It's a set of recommendations, and it's got some really nice aspects, like the part where planning is encouraged, or the part where all of a sudden they noticed that if women don't have access to good health care throughout their lives, giving them good prenatal care may not be enough to help them when they really need. But this is nothing new. If you are between the ages of 12 and 65 and your provider does not know that you are sterile, they have probably been treating you as "prego till proven otherwise" for a good long while. The best defence against this kind of treatment? Get to know your provider, demand a new provider if your provider doesn't treat you well or respect you, and develop a relationship with your provider so that they know you ARE a well-educated, informed patient. A good provider won't be threatened by this.
Don't get distracted by this. The real threat to your reproductive freedom does not lie in this document, but in the draconian abortion laws that are being passed in various states in the hope of overturning Roe vs. Wade, and the various 'fetal protection' laws that have been proposed in many different places for a good long while now.
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The original post can be found here.