On June 15, 2021, the World Health Organization (WHO) released the first draft of its Global Alcohol Action Plan 2022–2030 to Strengthen Implementation of the Global Strategy to Reduce the Harmful Use of Alcohol (WHO 2021). I’m all for reducing harmful alcohol use, but I was taken aback by the advisement that “appropriate attention should be given to … prevention of drinking among pregnant women and women of childbearing age …” (emphasis added; WHO 2021). And I’m not the only one; the plan’s release unleashed backlash from media outlets as well as that ever-faithful cultural barometer, Twitter.
Writing in an opinion piece for NBC News.com, journalist Danielle Campoamor charged that the action plan “overlooks men, as usual” (Campoamor 2021). She’s not wrong. The action plan quotes a lot of dueling men versus women statistics, for example:
In 2016, an estimated 2.3 million deaths and 106.5 million DALYs [disability-adjusted life years] among men globally were attributable to alcohol consumption. For women, the figures were 0.7 million and 26.1 million, respectively. … According to the latest WHO global estimates, 283 million people aged 15 years and older—237 million men and 46 million women—live with alcohol use disorders (AUD), accounting for 5.1% of the global adult population.1 (WHO 2021)
Yet despite disclosing these facts, the WHO chose to admonish women of childbearing age rather than their male counterparts capable of fathering children. By the WHO’s own data, more men than women are problem drinkers—and of course a single man can impregnant numerous women in a year while a woman can have only one pregnancy in the same amount of time. So who is more likely to increase birth defects in the population? I don’t think it’s the non-pregnant ladies who enjoy an IPA here and there.
“But, but …” I hear some people sputtering (not you, obviously, but that other guy over there), “women are the ones who carry the babies. What does male alcohol consumption have to do with anything? Isn’t the WHO just protecting the babies with this suggestion?” Au contraire, mon ami. The science says that the WHO may be misplacing the responsibility by placing it on women alone. As Campoamor points out in her piece, according to Dr. Qiongjie Zhou and colleagues, “Paternal alcohol exposure biologically increases the risk of genetic and epigenetic sperm abnormalities. … A paternal drinking rate of 31.0% [of the sample size of men in the study] substantially elevated the risk of birth defects” (emphasis added; Zhou et al. 2021).
The British Pregnancy Advisory Service came out swinging in response to the action plan; its chief executive Clare Murphy said:
Currently there is no consensus regarding whether low to mid-level alcohol consumption during pregnancy is actually harmful [see, for example, Horsager-Boehrer 2016], so to extend this messaging back into the “pre-pregnant” period, regardless of individual pregnancy intention, is completely absurd. (BPAS 2021)
That’s right, folks: Shocking as it might sound, not all women of childbearing age even want to have children—as Campoamor put it, “‘women of childbearing age’ are not pre-pregnant women. We’re women.”
A few media outlets said the WHO’s nugget of advice for
women of childbearing age harkened back to the fictitious
Gilead, the totalitarian society in Margaret Atwood’s 1985
novel The Handmaid’s Tale (Kazi 2021). In
Atwood’s dystopian nightmare—although some anti-choice
conservatives probably consider it a wet dream—women
capable of childbearing are prisoners of the state who are
forced to give birth to the children of the elite.
Of course there was a lot of the almost requisite “That’s not what they said/meant/wrote!” Writing for Snopes.com, Nur Ibrahim labeled the claim that “The World Health Organization (WHO) proposed a ban on women of childbearing age drinking alcohol …” as false. Technically, it’s true that the claim of a ban is false, but many people who search for it on the website will just see the “FALSE” label and may assume the backlash over the action plan has no merit. Pointing out that the WHO didn’t propose a ban on women of childbearing age drinking alcohol kind of misses the point. The WHO didn’t propose a ban per se—but it did suggest preventing all childbearing women from consuming alcohol.
In response to the outcry, the WHO told Newsweek:
The current draft of WHO’s global action plan does not recommend abstinence of all women who are of an age at which they could become pregnant. However it does seek to raise awareness of the serious consequences that can result from drinking alcohol while pregnant, even when the pregnancy is not yet known. (Kazi 2021)
This smacks of panicked backpedaling. The WHO can claim the action plan “does not recommend abstinence of all women who are of an age at which they could become pregnant” all they want, but that doesn’t make it true. The first draft of the action plan is out in the wild, and it explicitly mentions “women of childbearing age” without any qualifications.
There is a world of difference between the categories of all women of childbearing age and women who don’t yet know they are pregnant, the latter representing only a tiny sliver of the former. Do we really want to say all women up to age fifty should avoid drinking because an extremely small number of them may not yet know they are pregnant? I guess these people have never heard of “drink ’til it’s pink.”2
So is the WHO’s action plan sexist? I would say definitively that it is. Even though science points to pre-pregnancy alcohol consumption in both males and females elevating the risk for birth defects, the WHO called out only women. In a time when science and medicine are being discounted by so many, it is imperative that our representative organizations get it right. Bringing sexism into scientific guidelines does men and women alike a grave disservice.
Notes
- Yes, those furious calculations you are conducting in your head are correct: over three times more men than women had alcohol-related deaths in 2016, and over five times as many men as women have alcohol use disorders.
- In case you haven’t heard of it either, “drink ’til it’s pink” refers to some obstetricians’ advice that it is okay to drink moderately until a pregnancy test comes back positive, in contrast with those who say “stay sober ’til it’s over.”
References
British Pregnancy Advisory Service. 2021. BPAS comment on the World Health Organization’s Draft Global Alcohol Action Plan 2022–2030 (June 17). Available online at https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-the-world-health-organization-s-draft-global-alcohol-action-plan-2022-2030/.
Campoamor, Danielle. 2021. The WHO alcohol-pregnancy warning for childbearing women overlooks men, as usual. NBC News.com (June 21). Available online at https://www.nbcnews.com/think/opinion/who-alcohol-pregnancy-warning-childbearing-women-overlooks-men-usual-ncna1271690.
Horsager-Boehrer, Robyn. 2016. Drinking while pregnant: What we know and what we don’t. UT Southwestern Medical Center (June 21). Available online at https://utswmed.org/medblog/alcohol-during-pregnancy/.
Ibrahim, Nur. 2021. WHO isn’t banning ‘women of childbearing age’ from drinking alcohol. Snopes.com (June 19). Available online at https://www.snopes.com/fact-check/who-ban-women-childbearing-alcohol/.
Kazi, Safeeyah. 2021. WHO telling ‘women of childbearing age’ not to drink is likened to ‘Handmaid’s Tale.’ Newsweek (June 17). Available online at https://www.newsweek.com/who-telling-women-childbearing-age-not-drink-likened-handmaids-tale-1601530.
World Health Organization. 2021. Global Alcohol Action Plan 2022–2030 to Strengthen Implementation of the Global Strategy to Reduce the Harmful Use of Alcohol. Available online at https://www.who.int/publications/m/item/global-action-plan-on-alcohol-1st-draft.
Zhou, Qiongjie, Liting Song, Jingqi Chen, et al. 2021. Association of preconception paternal alcohol consumption with increased fetal birth defect risk (research letter). JAMA Pediatrics (April 19). Available online at https://jamanetwork.com/journals/jamapediatrics/fullarticle/2778779.