An in-depth exploration of women's perspectives on alcohol consumption during pregnancy

Abstract

Background and Aim: Prenatal alcohol consumption can be associated with a range of adverse fetal effects, collectively known as Fetal Alcohol Spectrum Disorders. However, the ‘safe’ upper limit of prenatal drinking is unknown. Consequently, policy and practice in the UK is unclear. This lack of clarity is compounded by a failure to understand pregnant women’s decisions regarding alcohol consumption. This research aims to address this by exploring pregnant women’s own understanding of their choices regarding alcohol use. Methods: A systematic review of qualitative literature concerning women’s views about alcohol use in pregnancy and; in-depth interviews with pregnant women to develop an understanding of their alcohol related views and behaviour. Results and Discussion: Lupton’s concept of reproductive citizenship was utilised to illuminate the findings of both strands of work. There was a relative lack of importance of biomedical ‘expert’ discourses. Health professionals’ guidance was frequently unmentioned; professionals either didn’t discuss alcohol or delivered advice in a confusing manner. Within the interviews, narratives focussed upon accounts of ‘always knowing’ how pregnant women should drink. Thus, pregnant self-regulation is more complex than currently understood. Risk narratives were prevalent throughout, but were not communicated in biomedical terms. Rather, they illuminated the wider discourses of reproductive citizenship. The need to feel and be seen as a good mother was universal but how this was expressed varied according to drinking status. Good motherhood was a powerful yet malleable discourse, drinkers were still able to claim the identity of good mothers. Prenatal drinking was contextualised within the context of prior drinking in the interview data but not in the systematic review. The need to contextualise pregnancy focusses on the need to understand pregnancy as part of the life-course and calls into question the fetus-centric approach to public health messages regarding alcohol use in pregnancy.