Yesterday, a reader left a comment on the post It’s Not the Vaccines in which she noted (1) she is pregnant and (2) her husband has a “12 year old daughter from a previous marriage who has severe autism and mental retardation. When she was about 18 months old, she had the MMR and that evening had a severe reaction to it.” The reader, Christy, then asked me this question:
So, Dr. Chew, if you found yourself pregnant tomorrow, would you take any additional precautions to try to mitigate the risk of your unborn child developing autism?
I really have to thank Christy for asking me this, and for writing about what are some very, very personal matters here. My answer to Christy’s question is below, after some reflections about why vaccinations and children has become such an emotionally charged issue, and about why more parents have been deciding not to vaccinate.
The March 21st New York Times in fact reports that the number of parents seeking exemptions to laws requiring vaccinations for school-age children has been rising since the early 1990s:
Every state allows medical exemptions, and most permit exemptions based on religious practices. But an increasing number of the vaccine skeptics belong to a different group — those who object to the inoculations because of their personal beliefs, often related to an unproven notion that vaccines are linked to autism and other disorders.
California, Ohio, and Texas are among the twenty states that allow exemptions. Of interest in the New York Times article is how parents defend their decision not to vaccinate a child: Choosing not to inoculate a child is just that, a choice, and a personal one made in the interest of one’s own child, and in full knowledge of the potentially harmful effects that such a choice might have on public health.
“I refuse to sacrifice my children for the greater good,” said Sybil Carlson, whose 6-year-old son goes to school with several of the children hit by the measles outbreak here. The boy is immunized against some diseases but not measles, Ms. Carlson said, while his 3-year-old brother has had just one shot, protecting him against meningitis.
“When I began to read about vaccines and how they work,” she said, “I saw medical studies, not given to use by the mainstream media, connecting them with neurological disorders, asthma and immunology.”
Ms. Carlson said she understood what was at stake. “I cannot deny that my child can put someone else at risk,” she said.
It might also be said that a parent who decides not to have a child vaccinated is potentially putting their own child’s health at risk, as Alexandra Stewart, director of the Epidemiology of U.S. Immunization Law project at George Washington University, notes. Stewart also says that “many of these parents are influenced by misinformation obtained from Web sites that oppose vaccination”—-even though vaccine “exempters” have been found to be “well educated and financially stable.”
“Exempters” frequently refer to their need—their right—to make medical decisions for their children and themselves, based on their own research and often in opposition to the recommendations of doctors and other health professionals. That is, the reason often cited for not vaccinating a child is that an individual has the right to choose what to do; the advice and judgments of medical professionals are often regarded with suspicion. It was back in 1970 that the Boston Women’s Health Collective published a book called Our Bodies, Our Selves; the book helped to launch the women’s health movement and women—mothers—long used to trusting whatever doctors told them, started to ask questions and look for their own answers. Part of being a “good mother”—-a “good parent”—today is to show that you’ve done your research and are willing to take a stand on issues that directly touch you. And what can mean more than the health of your own child?
Alexandra Stewart, director of the Epidemiology of U.S. Immunization Law project, was cited above as saying that “Web sites that oppose vaccination” have been the source of much of “misinformation” regarding (for one thing) links between vaccines and autism. The internet is certainly a rich source of information, but one has to read carefully to sift claims from truths, speculations from science, rumor and innuendo from knowledge. Discerning these distinctions can become even harder when the issue is an emotionally charged one such as what causes autism—and discussions about a vaccine-autism link can quickly become as passionate and incendiary as any about abortion (and note how the notion of the “right to choose” what is best for the health of one’s own child is reminiscent of the notion of a “woman’s right to choose”).
One basic tenet of Our Bodies, Our Selves is this: Who knows one’s own body better than oneself?. Extend this notion to one’s family and to one’s own children: Who but a parent knows their own children best? I suspect that these notions are one reason that discussions about vaccines and autism become as emotionally charged, as fervent, as discussions about religion and, indeed abortion. Put it another way: When the subject is vaccines and autism, the personal and the political, and the scientific are fused, combined, and often just confused.
So here is my answer to Christy’s question about what I would do if I found myself pregnant tomorrow. Would I take “any additional precautions to try to mitigate the risk of [my] unborn child developing autism?” (And I will point out that I turn 40 at the end of this year, so if I were pregnant, I would be “at risk” for having a child with Down Syndrome or some other condition.)
I think that autism is genetic. When I consider some of the conditions or disorders (or whatever you might want to call them) in Jim’s and my own family history—-ADHD, OCD, anxiety, depression, various other things—-I have to say, Jim and I always figured that we’d have a child with “something,” though not necessarily with as severe of a condition as Charlie has. We both know that it’s certainly possible to live with ADHD etc. and manage these. That said, due to Charlie’s being autistic and our family health histories, if I had another child (and we are not going to), from the moment that child was born, we would be watching her or his development very closely. Not with a view to preventing autism, as I am not sure that this is possible, but in order to consider Early Intervention and other educational services as early on as we might.
Charlie being our first child—and us living in St. Louis when he was born, far from both of our families in California and New Jersey—-I had little idea of what a “typically developing” baby was “supposed” to do. Charlie was slow in his gross motor development, rolling over on his own at nine months and walking at 16 months. I nursed him until he was 13 months old and he never had a problem with this; he started solid foods around six months and took easily to this, and has always been a good eater. He slept through the night at two months. He loved being carried and cuddled and smiled and laughed and imitated Jim raising one arm over his head, but was not able to imitate Jim raising both arms. Looking back, I know that Charlie did not have joint attention and that he was too content to sit in one place and play with a tin of toys (the same toys) or his stacking cups.
It goes without saying that, were I to have a second baby, all eyes would be watching her or him and I’d have too many questions for the doctor and all the teachers and therapists that we know. We have autism in the family and, frankly, I would not be surprised if I had another autistic child. Vaccines would not be a worry to me. There’d be plenty else to worry about—getting services, lining up doctors’ appointments, reworking my work schedule, getting my parents to do double babysitting duties…. But knowing that we have been able to help Charlie, I think I might feel a bit less stressed.
Well, maybe just a bit. If I were expecting a second child (and, once again, I am not and will not be), vaccines would be the least of our concerns, but making sure that another child has what she or he needs to learn and and grow, and that Charlie does do: This will always be our chief concern.