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December 2000

Staff Editorial
There is hope in an era of Bush.
by the PERSPECTIVE staff

UC Endorsement
Steve Smith and James Coleman are the liberal's choice.
by the PERSPECTIVE staff

Canadian Comrades
It really is better up there.
by Danny Schlozman

Triumph or Tragedy?
Clinton's legacy is one of calculated compromise.
by Jeffrey Theodore

Buying Survival
Africa needs money, now.
by Ved Lekic and Alexandra Neuhaus-Follini

Pharmitas
Pharmaceutical companies fund Harvard research.
by Nathan Perl-Rosenthal

Students for What?
Folic acid has a hidden message.
by Shelby Meyerhoff

Greens Take Root
PERSPECTIVE talks to Cliff Ginn.
by Dev Purkayastha

A Year to Remember
A year from Seattle, the WTO protests go on.
by Bob Elliott

Cry Freedom
America's ideal of freedom is questionable.
by Nikhil Jaikumar

Introspective
In Defense of Money
by Brad Hershbein

Salmagundi

The Back Page
Keeping Christmas
by Julia Silvis

When I saw the Folic Acid Awareness Week posters this fall, I was shocked. The posters encouraged students to take folic acid every day to prevent birth defects. Folic acid is a B Vitamin that prevents up to 75% of neural tube defects which affect the spine and can lead to retardation, paralysis and death. The March of Dimes estimates that approximately 2,500 babies are born each year with neural tube defects. In response to this situation, Harvard undergraduates formed Students for Healthy Babies (SHB) in the spring of 2000.

Their campaign message implies that female students are baby-vessels, and should treat their bodies accordingly. Is this message realistic? From what I have seen of female students at Harvard, few of us are preparing for pregnancy in the near future. Should we be?

According to Andrea Tao, Co-President of SHB, “we wanted to target the undergraduate community because that is the place where the most unplanned pregnancies occur…The basic idea behind the folic acid campaign is to target people who aren't looking to get pre-natal care.”

March of Dimes Representative Michele Kling also spoke with me about folic acid awareness. The March of Dimes is a national organization which works to improve infant health. One of their goals is to raise awareness about folic acid and decrease the number of neural tube defects in the United States. Kling emphasized that close to 60% of pregnancies in the United States are unplanned.While the March of Dimes and SHB are not explicitly affiliated, they have similar goals and strategies. Tao and Wendy Liu, the Co-Presidents of SHB, worked for the March of Dimes in high school and were inspired by their experiences to lead SHB.

At Harvard?

Tao and Kling's statements present two problems when applied to the Harvard community, where women are highly aware of their reproductive choices, and have easy access to health facilities. Tao and Kling rely on the assumption that women do not have control over their reproductive futures and must therefore prepare to become pregnant at any time. Second, Tao assumes that there are a high number of unplanned pregnancies and births in the Harvard community.

The questionable may-not-know assumption is the key justification for Folic Acid Awareness Week. Your body does not store folic acid. Women must take folic acid every day for 3 months preceding pregnancy, and every day during pregnancy, for the vitamin to be effective in preventing birth defects. Starting folic acid more than three months before pregnancy will not increase its effectiveness. Furthermore, if you take folic acid for all four years of college, but then stop taking it for some time before becoming pregnant, the risk of your baby having a birth defect will not decrease. Encouraging all female students to take folic acid implies that all female students should prepare for unplanned pregnancy in the next three months.

Kling says, “nobody can know when they are three months out from pregnancy.” This assumption of uncertainty ignores women's choices about sex, birth control, and abortion. Many women consider their views on abortion before becoming sexually active. While some may change their minds after becoming pregnant, it is not impossible for a woman to “know” that she will not give birth in the near future.

Tao asserted that the undergraduate community has more unplanned pregnancies than others. However, when I asked her how many of those pregnancies are aborted, how many end in miscarriages, and how many result in birth defects, she was unsure. Tao's assumption about the frequency of unplanned pregnancy and the correlation between unplanned pregnancies and births conflicts with the comments of Dr. Rosenthal, director of University Health Services (UHS).

This fall UHS gave SHB $600 for use in Folic Acid Awareness Week promotions. However, Dr. Rosenthal asserts that only “a small percentage” of Harvard students have unwanted pregnancies and that this percentage is “getting smaller each year.” He attributed the decreasing number of unplanned pregnancies to a rise in awareness about pregnancy and contraception, and noted that “a very large number” of students come to UHS to find out about getting on the pill. UHS also provides the morning-after pill and abortion referrals. When asked about the number of students giving birth at Harvard, he smiled and said, “I don't think that's why they came to Harvard….But there are some.”

While Dr. Rosenthal did not provide exact statistics, his comments coincide with my observations; few female students are choosing to give birth, but many are seeking to prevent unwanted pregnancies. Female students are aware of their options and take control of their reproductive futures.

Although UHS would not release statistics about abortion referrals, Dr. Rosenthal commented that $1 from each student's health fee went to subsidizing abortion and “you can do the math.”

In the state of Massachusetts, there were 29,293 legal abortions performed in 1996. Women between the ages of 20 and 24 obtained 8,230 abortions. Women in the 18-19 age group obtained 2,857 abortions. In the entire country, 1,221,585 legal abortions were performed in 1996. Of these, 80.4% were sought by unmarried women.

These figures show that many unmarried, college-age women do take advantage of their legal right to choose, rather than follow through with an unplanned pregnancy. I don't point this out to advocate abortion in the case of possible birth defects, but rather to point out that women do have options that help them evaluate whether or not they need to be preparing for pregnancy. The may-not-know message of SHB alienates female students by ignoring their knowledge and their decisions. Women at Harvard have greater health concerns than preparing for pregnancy. SHB should recognize the priorities of female students and shape their message accordingly.

An Alternative Approach

I explained to one of my male friends my reservations about Folic Acid Awareness Week, as we passed by yet another green poster. “Wow!” he said, “I didn't think anyone could be against Students for Healthy Babies….I guess you are though.”

I'm not against SHB. It is an organization led by students who genuinely care about the welfare of children. If SHB prevents one birth defect in a baby born to a Harvard student, that will be an achievement. But by changing their message about folic acid, SHB could empower female students while presenting a realistic understanding of their priorities.

While approximately 2,500 birth defects occur each year that may be preventable by folic acid consumption, the American Anorexia Bulimia Association notes that approximately 5 million women and men in the United States suffer from eating disorders. Few female students are preparing for pregnancy, but many worry about nutrition and body image. An Eating Concerns Hotline Outreach (ECHO) counselor reports that this fall ECHO has gotten “a record high number of calls and drop-ins.” She estimates that each week, four to five students call or drop-in to ECHO for their first time. SHB's campaign would attract more students by addressing the widespread concern about healthy eating.

The recent SHB campaign emphasized multi-vitamins, with promotions giving away free Centrum. However, when I asked Liu about the success of these promotions, she explained that after taking all the pills in the sample bottle (one per day for fifteen days) “people don't have the motivation” to go out and buy another bottle. However, Liu asserts that multi-vitamins are critical because “in order to get enough folic acid from your spinach you'd have to eat three pounds a day.”

But you don't have to eat just spinach to get folic acid. You can eat fruits, and green leafy vegetables. In 1996 the FDA required that most grain products be fortified with folic acid. A two cup serving of Cheerios contains 100% of your recommended daily allowance of folic acid. Reporter Rebecca D. Williams of FDA Consumer magazine asserted that “anyone who follows the USDA Food Pyramid Guide, which suggests three to five servings of vegetables, two to four of fruits and six to eleven servings of grains daily, can easily get 400 to 500 micrograms of folate each day.” By encouraging both male and female students to eat healthy, SHB could ameliorate a broad range of health problems while encouraging behavior that would lessen birth defects should a student decide to carry an unplanned pregnancy to term.

Another way to make the SHB campaign more effective would be to expand to communities that have a greater need for their services. Liu pointed out that SHB is involved in the Teen Parent Mentorship Program at Cambridge Rindge and Latin School. This program works with teen parents to provide them with “companionship” and “connect them with the resources they need.” Liu emphasizes that SHB volunteers are not in the program to tell teen parents how to live their lives. I expect that this approach is more effective than the SHB campaign to target Harvard students. Since the Teen Parent Mentorship Program works with a community of women who are focused on parenting, there is no uncertainty about whether an infant health campaign is relevant to these students. By helping women find the resources they seek, this program acknowledges and responds to their needs.

Unfortunately, the SHB campaign to reach Harvard students has done the opposite. There is no empirical evidence that indicates the need for every female student at Harvard to be taking folic acid, as SHB encourages us to do. SHB has ignored the choices that women do make at Harvard, and tells us what choices we should make. The SHB campaign implies that we should be preparing to give birth in the case of an unplanned pregnancy. This message alienates women who have decided not to give birth in the near future, and provides little service to the community. Women need health services that address their concerns and acknowledge their choices. They do not need a health service that ignores their situation while dictating their values.

Questions? Comments? Please contact perspy@hcs.harvard.edu