Factors influencing women’s decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication

Abstract

BackgroundDespite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy.MethodsSemi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34–39, drawn from the Australian Longitudinal Study on Women’s Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not.ResultsWomen generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption.ConclusionsThe significance of alcohol to women’s identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a “healthy” choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered.

Pregnancy as a transition: First‐time expectant couples′ experience with alcohol consumption

“…Our findings have important implications for guiding health professionals to address the issue of alcohol consumption during pregnancy. Contrary to an Australian qualitative study [23], women in our study rarely mentioned health professionals as important resources for helping them manage anxiety and guilt. This is consistent with a Swiss study indicating that one-third of women did not receive any information regarding alcohol consumption during pregnancy from health professionals [35].…”

“…Women described different consumption practices that avoided guilt or frustration. Similar to other studies, some women became strictly abstinent, while others defined their own limits of alcohol consumption . Such responses to risk, labelled as ‘responsible drinking practices’ by the women themselves, have been found in other studies .…”

“…Third, despite strong social norms in favour of abstinence, our findings confirm that pregnant women may be subject to peer pressure to drink, especially when the pregnancy is not yet visible. This is consistent with studies that highlight the difficulty of being abstinent within the context of a drinking culture [13,23], and show that pregnant women are confronted with contradictory social norms regarding their alcohol consumption [12]. We have identified a fourth struggle, which is that some women missed the taste of alcohol and the pleasure associated with it, admitting that such feelings challenged their willingness to abstain.…”

Caution! Warning Labels About Alcohol and Pregnancy: Unintended Consequences and Questionable Effectiveness

“…The main effect of alcohol warning labels is that they lead to enhanced awareness of the messages they convey (Wilkinson and Room 2009). However, increased awareness and upholding of the belief that women should not drink alcohol while pregnant have not necessarily translated to behavioral change (Meurk et al 2014), as approximately 8% of U.S. women continue to drink throughout their pregnancy (Centers for Disease Control and Prevention). Indeed, warning labels do little to change drinking patterns among heavy users, that is, those at greater risk of having a child affected with FASD.…”

Letter to the Editor: Why do pregnant South African women drink alcohol? A call to action for more qualitative investigations

“…Qualitative studies conducted in Australia and the United Kingdom have indicated that some pregnant women perceive alcohol as important to their social lives and did not consider consumption of self-defined "acceptable" levels of alcohol (one glass of wine once or twice a week) as enough to pose a risk to their child's development and well-being (Meurk, Broom, Adams, Hall, & Lucke, 2014;Raymond, Beer, Glazebrook, & Sayal, 2009). Many of these women felt the positive benefits obtained from alcohol drinking (e.g., stress relief) outweighed the potential risks (Raymond et al, 2009).…”