Saturday, November 21, 2009

Preconception Counseling: Where Feminism and Public Health Collide

I've been thinking a lot lately about the points where public health and feminism collide. I admit, I spend a little too much time each day catching up on the race and gender blogs on my list. The more posts I read addressing the battle some women fight to break free of being a Baby Making Machine, the more I realize certain public health interventions, ones that even I support, go against many long-held feminist objectives.

Take, for example, breastfeeding. In one of my classes, a group presentation presented an intervention to encourage breastfeeding. They labeled their fictitious program "You Were Born to Breastfeed." The title was supposed to empower those women who might not have confidence that their bodies could produce enough milk to feed their child exclusively. It's meant to empower women. But semantically, it empowers the belief that women are Baby Making Machines. You were born to breastfeed, just like you were born to bear children.

I liked their intervention, and I don't take offense to the title. But I see how some women would. It bothers some women profoundly the idea that society thinks they were born to bear children when it is not in their plans. Women also don't like being made to feel guilty when they can't or don't want to breastfeed. It's hard to breastfeed. Especially when you work. Some women just aren't into it. Some women just can't. Feminism tells us it should be a choice. And I have a hard time thinking women should be made to feel guilty about the choices they make about their bodies.

The problem is, public health tells us it's not a choice between two equal options. Breast isn't just Best. Formula feeding is in no way equal to breastfeeding. It's much worse. There, I said it. I made the judgment call. It's that if you don't breast feed, you put your baby at risk. Risk for asthma, for obesity, for a lower IQ, for allergies. It's not about making some women feel guilty, it's about getting as many women as possible to do the very best for their babies. Inevitably, some women are going to feel guilty about this.

I think about this problem in the context of Preconception Health as well. The premise of preconception programs is that 50% of all pregnancies are unplanned, therefore all sexually active women should be considered of reproductive age, in a preconception phase and are targets of the A Healthy Baby Begins With You campaign. The intervention assumes all women could potentially become pregnant, even those that declare they don't want children.

Well, a lot of women who don't want to be pregnant end up pregnant. So it doesn't matter to the program whether it was a choice or not. It happens, it's the truth, so let's deal with it as it is. But I can see how feminism would have a real issue with this line of thinking. The campaign literally views all women as potential Baby Making Machines.

I still think this campaign is a good one. It looks at the problem of infant mortality from a very different angle. A part of that angle is getting women to be proactive about their reproductive plans. If you say you don't want children, make a plan for yourself to achieve that goal. Don't let pregnancy just happen to you. And feminism is working for that same goal. In preventing unwanted pregnancies, the campaign and the ideology walk hand-in-hand.

Just a few weeks ago I was telling a story about my husband to a girl I had just met. In the middle of the story she stopped me and asked "Are you a feminist or something?" Her tone reminded me that not everyone, not even all women who benefit from feminism, are feminists. I consider myself one. I even consider my husband a feminist! But I am also working to be a public health professional. At some point, the truth about our bodies becomes more important than ideals. Women have the potential for pregnancy. Men do not. This makes us different. If we don't want to be bound to that fact, we have to take steps to make it so. Not being pregnant doesn't just happen either.

Obviously feminism and public health both diverge and intertwine in their agendas. In fact, I think they intertwine closely more often than not. Most people in the health field agree that raising women's status in this world would improve the health of everyone. But I find interesting those few points where health and idealism might not flow together so smoothly.

No comments: