"Face the facts of life,” exhorts the male voice-over in two paid public-education TV messages from the Ontario ministry of community and social services which are saturating the airwaves until the end of March over every commercial TV station in the province. One 30-second spot features the naked abdomen of a pregnant woman; the second focuses on a howling infant: in both the message is a warning to pregnant women that indulging in alcohol, drugs, junk food or tobacco can lead to delivery of a mentally defective child. “Most mental retardation can be prevented,” claims the announcer, in this $320,000 kickoff to the International Year of the
Child which aims to reach 90 per cent of Ontario’s television audience.
“I think the message is slightly skewed,” says Dr. Daune MacGregor, a pediatric neurologist at Toronto’s Sick Children’s Hospital. “The way it comes across, it sounds like if you don’t drink or smoke during pregnancy, then 50 per cent of mental retardation will disappear. Shock tactics are of dubious value even when the facts are absolutely certain—and they’re not at all certain in this case. There’s still a lot of dispute in medical circles about the so-called social causes of mental retardation.”
The ministry has rushed in where doctors fear to tread. Lately, even the statistical incidence of mental retardation is under debate, let alone the causes. MacGregor, just back from a year of study on the subject at Harvard, estimates that up to 15 per cent of the population may be regarded as mildly retarded or borderline cases, with severe cases making up about one or two per cent. The high figure for the mildly affected—until recently, three per cent was generally accepted—reflects a new medical awareness of social factors in the development of individual intelligence.
So Minister of Community and Social Services Keith C. Norton discomforted many people who work with the mentally handicapped when he introduced his ministry’s ads at a news conference by saying, “Fifty per cent of mental retardation could be prevented.” Pat Meyer, a co-ordinator with the National Institute on Mental Retardation, had problems with two parts of Norton’s short sentence. “I think the 50-per-cent figure is inflated,” she said, “and also I’m concerned that all this talk about prevention makes it easy to overlook the fact that services are still needed for those already affected.”
“We deliberately made the message very strong,” says David V. Rudan, manager of public relations planning in the ministry’s communications branch. “We wanted to grab the attention of the young women out there between 18 and 35, and convince them to get to a doctor just as soon as they know they’re pregnant. If you wanted to make someone move from the path of a speeding car, you’d shout, wouldn’t you?”
Mental retardation experts have declined to rally to the speeding car theory, because a car at least is identifiable. There is certainly no harm in urging pregnant women (or anyone else) to sober up, straighten out and see their doctors. But neither is there any guarantee that these steps alone mean a bright, healthy baby. There are some 200 known causes of retardation, according to Prevention of Mental Retardation, a manual put out by the National Institute on Mental Retardation (NIMR) and
being distributed 6,000-strong to Ontario physicians as a backup to the commercials. But only the severe cases can be recognized immediately at birth with disorders such as Down’s syndrome (mongolism) and Tay Sachs disease, or accounted for by exposure early in pregnancy to German measles. Amniocentesis—in which a sample of the fluid surrounding the fetus is drawn off for analysis—is one proven method of diagnosing some potential handicaps, but neither the funds nor the facilities are readily available in Ontario for such tests on all risky pregnancies.
In the grey area of possible causes, it seems that the one worst mistake a mother-to-be can make is to be poor.
“Poverty is related to poor nutrition, poor health care, inadequate child care, supervision and stimulation, and to an environment that is full of extra hazards,” warns the NIMR manual.
Preventing mental retardation, like ending poverty, is an extremely complex proposition, and it’s an open question how much good will be achieved by a vague, scary warning to pregnant women. Although the social affairs ministry operates centres and services for the handicapped, critics argue that its priorities should be in concrete preventive measures such as immunization and newborn-screening programs.
Plans for more prevention messages await the comparison of surveys before and after the current media blitz each involving 500 interviews. “This research on whether awareness can be raised will be very helpful,” says Rudan. “How do you promote social services? Most people just don’t want to know about them.” Responding to the suggestion that it’s hard to tell what the 30-second spots promote, he shrugged: “Maybe what we’re doing is wrong. We’ll find out through public feedback.”
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