Pregnant women’s understanding and conceptualisations of the harms from drinking alcohol: a qualitative study

Abstract

20Background: Despite women's awareness that drinking alcohol in pregnancy can lead to lifelong 21 disabilities in a child, it appears that an awareness alone does not discourage some pregnant women 22 from drinking. 23Objectives: To explore influences on pregnant women's decision making around alcohol use in a 24 population with frequent and heavy peer drinking (i.e. in two Indigenous Australian communities) 25 and another of non-Indigenous pregnant women attending antenatal care in a range of 26 socioeconomic settings. 27Methods: Individual and group discussions were held with both Indigenous Australian and non-28 Indigenous pregnant women attending a variety of antenatal care models, including two Indigenous 29 maternity services in Australia. Data were analysed using inductive content analysis. 30 Results: A total of 14 Indigenous Australian and 14 non-Indigenous pregnant women participated 31 in this study. Analysis identified five main influences on pregnant women's alcohol use: the level 32 and detail of women's understanding of harm; women's information sources on alcohol use in 33 pregnancy; how this information influenced their choices; how women conceptualised their 34 pregnancy; and whether the social and cultural environment supported abstinence. 35 Conclusions for practice: This study provides insight into how Indigenous Australian and non-36 Indigenous pregnant women understand and conceptualise the harms from drinking alcohol, 37 including how their social and cultural environments impact their ability to abstain. Strategies for 38 behaviour change need to: correct misinformation about supposed 'safe' timing, quantity and types 39 of alcohol; develop a more accurate perception of Fetal Alcohol Spectrum Disorder; reframe 40 messages about harm to messages about optimising the child's health and cognitive outcomes; and 41 develop a holistic approach encompassing women's social and cultural context.42 Page 3 43 Introduction 44 Current research suggests that alcohol use in pregnancy continues to be prevalent despite antenatal 45 guidelines advising against drinking. The 2009 Australian National Guidelines to Reduce Health 46Risks from Drinking Alcohol recommend that it is safest for women to abstain from drinking 47 alcohol completely throughout the duration of their pregnancy [1]. However, data from two large 48 national surveys of Australian women aged 18 to 45 years found that 34 to 49% of women 49 consumed alcohol in pregnancy [2, 3], and that despite women's awareness that drinking alcohol in 50 pregnancy can lead to lifelong disabilities in a child, nearly one third intended to drink alcohol in a 51 future pregnancy [2]. Whilst knowledge of the potential harms of alcohol consumption during 52 pregnancy is important, it is apparent that an awareness alone does not discourage some women 53 from drinking when pregnant. The relatively high prevalence of alcohol consumption during 54 pregnancy has also been reported in other high-income countries. An international cross-cohort 55 comparison of the...

‘We do what we can as soon as we can’ Alcohol and Other Drug workforce perspectives on preventing and responding to prenatal alcohol exposure

“…Participants reflections on the factors that predispose and exacerbate AOD use in pregnancy include individual influences such as treatment effects and environmental influences found in previous research with pregnant women including persuasive drinking environments (Gibson et al, 2019), and inconsistent messages and information (Crawford-Williams et al, 2015b). Participants were exceptionally mindful of the consequences of these influences describing the impacts on how they work and the women they work with.…”