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'Starting Off Right'

September 11, 1988

That all pregnancies should receive adequate prenatal and obstetrical delivery care, as advocated in the editorial "Starting Off Right," (Aug. 27) seems totally fair and reasonable. However, pregnancy is not a life event occurring in a vacuum separate and apart from other life events.

In order for the population to stay stable in terms of numbers, every couple needs to have a statistical fictional number of two-and-a-fraction children. The two children each replace the parents and the additional fractional child makes up for those who die prematurely as a result of accidents or childhood diseases and for those who choose not to have children or who can't have children. Therefore, it would seem reasonable for each couple to have up to three children or maybe four children.

If society plans to use its financial resources to ensure that all babies are "starting off right" by having their mothers be recipients of adequate maternity care, perhaps it would be reasonable to conclude then that society should have the right, within broad guidelines arrived at by consensus, to decide who has the right to be pregnant and how often. After all, is it right for society to subsidize maternity care when the newborn will not benefit from adequate nourishment, clothing, shelter, education and perhaps even love, because its mother is an unwed teen-ager abusing drugs or is a high-parity mother with eight other children all a year apart, or is a diabetic hypertensive with reduced life expectancy, or is an abusive parent?

Prenatal care alone is like shutting the barn door after the horse has gotten out. An ounce of preventive contraceptive care is worth far more than several pounds of newborn bouncing baby who has little positive to look forward to upon leaving the hospital's newborn nursery. Before starting of right, you need to be sure that you should start off at all and be sure that you can continue as well as you started.

SYLVAIN FRIBOURG M.D.

Panorama City

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