Policy & Practice


Alcohol Use During Pregnancy

Pregnant women and women who may become pregnant should abstain from alcohol consumption to prevent the effects of fetal alcohol spectrum disorders, the Surgeon General has advised. This updates the 1981 Surgeon General advisory that suggested that pregnant women limit the amount of alcohol they drink. “We do not know what, if any, amount of alcohol is safe,” U.S. Surgeon General Richard H. Carmona, M.D., said in a statement. “But we do know that the risk of a baby being born with any of the fetal alcohol spectrum disorders increases with the amount of alcohol a pregnant woman drinks, as does the likely severity of the condition. And when a pregnant women drinks alcohol, so does her baby. Therefore, it's in the child's best interest for a pregnant woman to simply not drink alcohol.” Since studies indicate that a baby could be affected by alcohol consumption within the earliest weeks after conception, the Surgeon General recommends that women who are considering becoming pregnant should abstain from alcohol. Women of childbearing age should consult their physicians and take steps to reduce the possibility of prenatal alcohol exposure. In addition, the Surgeon General recommended that health professionals routinely inquire about alcohol consumption by women of childbearing age and advise them not to drink alcoholic beverages during pregnancy.

Investigating Cesarean Rates

The American College of Nurse-Midwives is calling on Congress to investigate what it calls the “alarming” increases in the rate of cesarean births in the United States. “ACNM feels strongly that the cesarean rate is heading in the wrong direction,” the group's president, Katherine Camacho Carr, Ph.D., said in a letter to Sen. Mike Enzi (R-Wyo.), chairman of the Senate Health, Education, Labor & Pensions Committee, and Rep. Joe Barton (R-Tex.), chairman of the House Energy and Commerce Committee. ACNM noted that more than 27% of all births in 2003 were delivered via cesarean section. The group is asking Congress to examine the long-term implications for women's health and the costs of obstetric care.

Increasing HIV Screening

HIV screening efforts should be expanded, according to the Society for Women's Health Research. The group echoed the conclusions of two studies in the Feb. 10 issue of the New England Journal of Medicine on expanding screening on the basis of cost and clinical effectiveness. “So many adult women in the United States, including those over the age of 50 do not realize that they are at risk,” Phyllis Greenberger, president of the Society for Women's Health Research, said in a statement. “HIV infection rates among heterosexual women, especially minority women, are rising. The increased availability of voluntary screening in clinics and doctors' offices will raise awareness of the issue and provide opportunities for early intervention if the virus is present.” Increased screening will be a positive addition, Ms. Greenberger said, as long as the screening is voluntary and private, and as long as patients are protected from discrimination.

Legislating Sex Education

Democrats in Congress are offering an alternative to the Bush Administration's proposal to spend $206 million on abstinence-only education. Rep. Barbara Lee (D-Calif.) and Sen. Frank Lautenberg (D-N.J.) have introduced the “Responsible Education About Life” Act (H.R. 768) that would provide funding to states for programs that include information about both abstinence and contraception. The bill would create a grant program administered by the Health and Human Services Department that would award $206 million each year to states for comprehensive sex education. There are three federal programs that fund abstinence-only-until-marriage programs, but no federal funding currently exists specifically for comprehensive programs, according to Rep. Lee.

Perceptions of the Drug Industry

Prescription drugs may be improving patients' lives, but 70% of 1,201 adults polled in a Kaiser Family Foundation survey thought the drug industry cared more about profits than people. Only 24% thought the companies were most concerned with developing new drugs that save lives and improve quality of life. Nearly 60% said prescription drugs increased overall medical costs because they were so expensive, compared with the 23% who said drugs lowered medical costs by reducing the need for expensive medical procedures and hospitalizations. In an earlier poll, Kaiser found that people were more likely to cite drug company profits than other causes as the major cost of rising health care. While not as popular as physicians or hospitals, drug companies were viewed more favorably than oil or tobacco companies, according to the survey.

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