Allison brought up a great point in a comment on my last post: when it comes to choices related to reproductive health, why not err on the side of caution?
The most obvious answer is that we should not settle for error if finding the correct answer is an option. But certainty is hard to find in this world, and I believe in the primacy of the well-formed conscience. So, when one is deciding for oneself, it is perfectly appropriate to subject oneself to a tough standard in order to be cautious.
There is, however, a world of difference between choosing to “be cautious” in one’s own life, and holding up the same standard as a universal obligation.
I believe that everyone should make a point of getting adequate vitamins and minerals (preferably from the perfect diet, of course) and that almost all sexually active women should take prenatal vitamins during their reproductive years. Half of all pregnancies in the United States are unplanned, and folic acid, for instance, is crucial before most women even know that they are pregnant. I am not concerned as much about folic acid for myself since I get a lot of folate in my diet, but as a vegetarian I do have to watch out for some other B vitamins (B12 in particular) and iron for my own health. Supplements are not as good as a perfect diet, and may be a complete waste for some women, but most people are lazy, and taking a multivitamin is the least they can do to prepare for a healthy pregnancy, even if they are not planning on pregnancy.
That seems pretty reasonable to me, but there is so much more that all women could do, if we really wanted to err on the side of caution. Somehow though, I cannot expect all women to have all amalgam fillings removed months prior to conception, stop wearing makeup, coloring their hair, using traditional cleaning products, maintain exactly the ideal weight as well as ideal cardio fitness, stop eating all refined flours and sugars, chemical additives, or non-organic meat or dairy, and insure that their husbands complete a full detox and vitamin regimen months before ever having sex. I might do all of those things myself, but it is not a reasonable universal expectation because it is not only likely unnecessary, it is also inconvenient.
And if I could not tell other women to stop eating fast food while pregnant because it is inconvenient, how much less could I tell another woman suffering from endometriosis that she may not take artificial hormones when she is in significant pain?
There is yet another problem with the desire to “err on the side of caution” when it comes to women’s1 reproductive health: sometimes being “cautious” may actually be harmful.
A pregnant woman who has the flu may decide that her baby is more important than her discomfort, so she refuses to take anything to ease her symptoms. She then goes for days with a fever and vomiting, exposing her baby to both the risks of fever and dehydration.
Or perhaps another healthy woman reasons that she should not exercise during pregnancy because doctors frequently instruct women not to exercise if they are at risk for miscarriage. Better extra safe than sorry, right? So the pregnant woman gains unnecessary weight, her obstetrician may freak out about fetal macrosomia and require a cesarean, and “erring on the side of caution” unnecessarily caused respiratory issues for the baby.
And what about the woman with severe pain from endometriosis? If we urge her to “err on the side of caution” and not take hormonal birth control, what is the most likely alternative? Often her doctor will suggest high doses of NSAIDs. If the woman has pain daily, she is likely to take painkiller every day. If her pain is only associated with menstruation, then she will be instructed to begin taking the NSAIDs prior to the point when her pain typically starts. In either case, she is more likely to become pregnant than a woman on the pill, and would be taking the medication prior to knowing that she was pregnant. With the pill there is only conjecture about miscarriage, and currently little fear about birth defects. With NSAIDs there are studies linking the drug to increased rate of miscarriage and birth defects. So it is possible that in urging women to “err on the side of caution” we may actually be urging them to try an alternative which is actually more likely to result in miscarriage or birth defect.
We must all weigh relative risks and research our options for ourselves. At the moment I cannot see how “erring on the side of caution” can be good universal advice when it comes to reproductive health.
1. And it is always women’s reproductive health that we’re concerned about, isn’t it? It does not matter if there is evidence that abnormal sperm morphology can cause miscarriage. No one is going to worry ask whether your 40+ overweight husband is causing miscarriage or suggest that he should not take his blood pressure medication because it is an abortifacient. So a woman may only take the pill for pain if a couple is willing to live with complete abstinence, but there is no problem with a couple having sex while the man continues to work at a place which exposes him to toxins which we know impact sperm quality which we know is correlated with repeated miscarriage?
- Birth Control Pill an Abortifacient?
- I am thankful 4/25/2010