Influences on drinking choices among Indigenous and non-Indigenous pregnant women in Australia: A qualitative study

Abstract

Despite women's awareness that drinking alcohol in pregnancy can lead to lifelong disabilities in a child, it appears that an awareness alone does not discourage some pregnant women from drinking. To explore influences on pregnant women's choices around alcohol use, we conducted interviews and group discussions with 14 Indigenous Australian and 14 non-Indigenous pregnant women attending antenatal care in a range of socioeconomic settings. Inductive content analysis identified five main influences on pregnant women's alcohol use: the level and detail of women's understanding of harm; women's information sources on alcohol use in pregnancy; how this information influenced their choices; how women conceptualised their pregnancy; and whether the social and cultural environment supported abstinence. Results provide insight into how Indigenous Australian and non-Indigenous pregnant women understand and conceptualise the harms from drinking alcohol when making drinking choices, including how their social and cultural environments impact their ability to abstain. Strategies for behaviour change need to: correct misinformation about supposed 'safe' timing, quantity and types of alcohol; develop a more accurate perception of Fetal Alcohol Spectrum Disorder; reframe messages about harm to messages about optimising the child's health and cognitive outcomes; and develop a holistic approach encompassing women's social and cultural context.

“The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

“…Two articles reported on the same study [ 33 , 34 ] and two articles used the same datasets as previously published research [ 35 , 36 , 37 , 38 ]. Of the 24 unique studies, seven were from Australia [ 29 , 30 , 35 , 39 , 40 , 41 , 42 ], five from the USA [ 33 , 43 , 44 , 45 , 46 ], two from the UK [ 47 , 48 ], two from South Africa [ 28 , 49 ], two from Switzerland [ 37 , 50 ], two from Brazil [ 51 , 52 ], one from France [ 53 ], one from India [ 54 ], one from The Netherlands [ 55 ], and a joint study from the UK and Sweden [ 56 ]. While several studies included partners of pregnant or parenting women, healthcare providers, or community members, this systematic review is only reporting on the pregnant and recently postpartum women who participated.…”

“…Six studies focused on women experiencing low SES ( n = 146 participants) [ 28 , 44 , 46 , 47 , 49 , 54 ], two reported low-to-medium SES (n = 34 participants) [ 43 , 51 ], and seven reported medium-to-high SES ( n = 197 participants) [ 37 , 42 , 48 , 50 , 52 , 55 , 56 ]. SES was not reported in seven studies ( n = 157 participants) [ 29 , 30 , 39 , 40 , 41 , 45 , 53 ] and was unclear in two studies ( n = 23 participants) [ 33 , 35 ]. Ethnicity was not reported in 13 studies ( n = 305 participants) [ 35 , 37 , 39 , 40 , 41 , 44 , 46 , 47 , 48 , 49 , 53 , 55 , 56 ].…”

“…Ethnicity was not reported in 13 studies ( n = 305 participants) [ 35 , 37 , 39 , 40 , 41 , 44 , 46 , 47 , 48 , 49 , 53 , 55 , 56 ]. The remaining 11 studies included participants that identified as Caucasian Australian ( n = 59) [ 30 , 42 ], Black or Coloured South African ( n = 24) [ 28 ], Caucasian American ( n = 24) [ 33 , 43 ], Santal or Munda in India ( n = 19) [ 54 ], non-Indigenous Australian ( n = 15) [ 29 ], Aboriginal and Torres Strait Islander in Australia ( n = 14) [ 29 ], Caucasian Brazilian ( n = 13) [ 51 , 52 ], Indigenous or African American ( n = 11) [ 45 ], Black Brazilian ( n = 10) [ 51 , 52 ], African American ( n = 7) [ 43 ], Mixed-ethnicity Brazilian ( n = 4) [ 51 , 52 ], Brazilian Other ( n = 1) [ 52 ], and Asian Australian ( n = 1) [ 30 ].…”

“…Qualitative study methods included combinations of interviews ( n = 21) [ 28 , 29 , 33 , 34 , 35 , 36 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 , 56 ], focus groups ( n = 8) [ 29 , 30 , 39 , 41 , 45 , 49 , 54 , 55 ], participant observation ( n = 2) [ 33 , 34 ], diary entries ( n = 2) [ 33 , 34 ], online chat room discussions ( n = 1) [ 53 ], and visual data production ( n = 1) [ 47 ]. The majority of studies adopted an individual behaviouralist focus when exploring women’s experiences concerning alcohol use during pregnancy [ 29 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 ,…”

“…To ensure quality, rigor and transparency in the coding process, three conceptually rich papers [ 28 , 29 , 30 ] were selected as index articles to inform initial development of the line-by-line codebook. These articles were considered conceptually rich due to their comprehensive understanding and coverage of diverse topics, including the impacts of the social and structural determinants of health on alcohol use in pregnancy, from the broader literature on alcohol use during pregnancy and FASD prevention.…”