An interesting finding in regards to messages upon alcohol consumption during pregnancy is how women’s attitudes towards these messages differ in comparison to other health messages, for example, those regarding weight, exercise and supplements that should be taken, or foods that should be avoided during pregnancy. Tina highlighted the other changes that need to be considered when you become pregnant or are trying for a baby and how women consciously make these choices to ensure they are seen as responsible:
I was erm, very conscious about what I put inside my body...and tried to reduce my caffeine intake and eat healthier and have multivitamins or all that kinds of thing, I didn’t completely cut alcohol out, but I did reduce what I was drinking
Tina, 32, Edinburgh The women in this study appeared not to question some other health guidance for pregnancy such as banned foods or the recommendation to take folic acid, like they did around the recommendation for abstinence from alcohol during pregnancy. This
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was evident through the account of Yvette, who highlighted that she took folic acid for five years, and “then started to really cut down, really think about how much I was drinking as well”. It can be inferred from this that other messages are not queried by women in the same way the recommendation for abstinence from alcohol during pregnancy was. Alcohol was not discussed in the same manner as other health requirements that were made of women, for example food groupings women were told to avoid such as unpasteurised cheese and pate etc. These food items were considered to be “banned”, and in general all women spoke about avoiding these completely. Yet for some women their discussions around alcohol indicated that it is not categorised in the same manner. Wendy’s description reveals how there is a difference between things that women perceive to be prohibited versus things they should avoid;
Then I started taking folic acid and after that it took about four months, erm and I didn’t eat any of the things that are banned, like brie and pate.
Wendy, 33, Edinburgh The use of the word “banned” here invokes a strict idea; however it could be argued that the evidence-base behind this is stronger, and has also been around longer, there is inevitably a time lag between a recommendation and a behavioural change. Yet, how women interpret different guidelines is important in determining the recommendations that are given to them. Alcohol was not described as something that is “banned” during pregnancy, despite the new recommendation to abstain from it.It was therefore evident that some women felt that they had a choice to make with regards to choosing to consume alcohol during pregnancy or not. This choice was contrasted against other food sources or activities which were forbidden and things that you must take such as folic acid. Rhea mentioned, following the advice around food:
I took erm, I'm trying to think if I took the pregnancy advice about food and foods to avoid, erm I pretty much did, yeah erm I think you’re supposed to avoid
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The way in which women negate these different guidelines and see things as choice versus more compulsory changes, is significant for the ways in which future guidelines are set. This difference could be potentially because of differences between needs and pleasures and also the medical evidence behind the messages. Guidelines that have not changed for many years are more likely to be followed compared to advice upon things such as alcohol which are changing and are also different between different countries. A dissonance emerges between the guidance that is given to women, versus the rules that women must follow to achieve the best possible health for their unborn child.
There’s obviously the things that you’re not supposed to eat when you’re pregnant, which I had to cut out a lot of stuff that I like, cheeses and pate and err things like that
Neala, 30, Edinburgh Women can therefore actively see the benefits of taking supplements such as folic acid because they are undoubtedly aware of the medical facts behind the negative consequences of not doing these things. In comparison they contest and do not seem to believe the evidence behind the guidelines for alcohol. I would argue that this is because of the confusion around these messages and a longstanding theme that women do not see the message for abstinence as directed at them. Instead they see it as power over their bodies by an unknown authority. They simply do not trust some messages in comparison to others. We need to consider the impact of the government setting guidelines that are not backed up by robust scientific evidence and the consequence that doing this may lead to a lack of trust, as is reflected in some women’s interpretations and reflections upon the guidelines. Is it a case that women want alcohol and can do without other things or is it because the recommendations surrounding food have been in place for longer and that there is a lag in the uptake for abstinence? Alcohol was not seen as a ‘banned’ substance, in the same respect that other food items are. Is this because of the different notions of risk that are in place, or is it a case that women resent giving up alcohol because of the pleasure it brings? Women see the contradictory advice and are therefore sceptical of the advice they receive.
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The only other health recommendation, except from alcohol that was slightly contested by some women, was the ‘breast is best’ campaign. This was in general by women who had struggled with breastfeeding and had negative experiences with members of the medical profession putting undue pressure on them to breastfeed due to its health benefits for the child. Yvette actively questioned the messages that pregnant women receive, querying the way in which policies are handed out en mass to women, with no consideration for women as individuals. Her narrative revealed the idea that women did reject and question the recommendation for abstinence from alcohol during pregnancy as a ‘one size fits all’ policy in isolation. Other health related recommendations were also questioned and scrutinised as Yvette highlights how strong messages around breastfeeding aimed at women, sometimes rebound and actually lead women to resist the messages that they are carrying:
So I think the breastfeeding propaganda actually backfired in my case and I know quite a few of the other mums I’ve spoken to feel similar
Yvette, 35-44, Edinburgh Messages were therefore seen as misinformation and as very strong messages that lacked an awareness of women as individuals. The way in which women viewed the recommendations as ‘authoritarian’ had strong resonance with links to debates in public domain around breastfeeding. Women are aware that there is some level of debate within the public domain over which health behaviours women should follow. Yet Catriona feels that there is no longer a debate about breastfeeding, and instead feels that women are forced into breastfeeding. Feeling that this advice is “authoritarian”, she consequently finds it “hard to dissect”:
It’s pretty much stated in the public kind of domain that your should breast-feed, erm, but the reality of it is that most people don’t actually do that or they don’t do it for very long. I suppose in some ways that is out of sync with what people actually do erm, but, erm, maybe it has to be like that because maybe otherwise people wouldn’t even bother if there wasn’t sort of an authoritarian take on it...erm so I don’t think there’s a debate.
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Catriona resists the advice and questions its merit against other behaviours or substances which could prove harmful to the unborn child, seeing these authoritarian health messages as taking choice away from women. In relation to the consumption of alcohol whilst breastfeeding some women reported receiving a lack of information on what level of alcohol consumption is safe during breastfeeding, and in turn found this confusing:
What’s confusing about the messages that women get, or certainly what I got, I got no advice about alcohol and breastfeeding erm because I think there is a big emphasis on not drinking while you’re pregnant, and then it, it’s as important if not more important to not drink, or to drink very small amounts when your breastfeeding and I didn’t erm, I didn’t really, erm I didn’t kind of get any advice about that really,
Rhea, 35, Edinburgh Rhea was not the only women to mention feeling confused about alcohol consumption during breastfeeding. Catriona also stated feeling confused by this:
Erm, and in fact I found that all thought that period and in fact still through breastfeeding that the advice is so confused about what your meant to do
Catriona, 29, Edinburgh Neala however reported being aware that you’re not supposed to drink during breastfeeding, but this was seen as something that was recommended and not an absolute that must be strictly followed:
Going back to the drinking thing I know if your breastfeeding you’re not really supposed to drink, they don’t recommend it, erm but again I’m not really drinking...but I know you’re not really supposed to drink if your breastfeeding
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4.5.CONCLUSION
The importance of lay knowledge surrounding women’s choices on alcohol during pregnancy was evident as several interviewees questioned the recommendation by challenging the effect that alcohol had upon the health of the unborn child. It was evident that women received inconsistent advice during pregnancy, both from medical professionals, peers, family and the media. It is also clear that not all professionals are ’singing the same tune’ and that it is equally important how messages are given to women.
The previous recommendation given to women was that it was reasonable to drink a small amount of alcohol when pregnant; women inferred that as there was no concrete evidence to show otherwise, following this would still be reasonable. Women therefore are aware that there are risks of drinking a large amount of alcohol but question the risks posed by lower consumption. Across their narratives women called the recommendation for abstinence being pursued by health authorities into question, and even called the authority who gives out these messages into question. Frequently participants had recalled being advised that drinking before they knew they were pregnant was unlikely to have caused any harm to their child. This also led the participants to be suspicious of the idea for absolutes as it is contradictory to the message for abstinence. Again this impacted the importance women gave to their own lay knowledge and that of their peers as they spent time researching the effects of alcohol during pregnancy for themselves. The mothers in this study showed a keen desire to form their own opinions, and not just willingly accept health guidance and recommendations without understanding the reasons behind it and the health benefits or gains that they will receive from it. This reveals that women do not want to be coerced into particular health behaviours which may or may not make a difference to the health of their unborn child. They do not resist this advice in order to put the health of their unborn child at risk; instead they do so to take control over their own choices and their bodies and seek to do ‘what feels right’ for them. The implications that this has for the way in which recommendations should be made to pregnant women is important. An examination of health promotion (Tannahill, 1985) found that knowledge did not necessarily influence behaviour; however women were aware of the risks of heavy drinking, and therefore did not drink heavily during their
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pregnancies. They were aware that there is confusion surrounding what harm can be caused by low levels of drinking during pregnancy and the inconsistent messages they received led them to be less trusting of the message to abstain.
Finally, othering appeared to be an influential theme emerging from this research, especially when there is no conclusive link between drinking small quantities of alcohol and harm. The women simply did not feel the messages were aimed at them directly and this was influenced by the policy being broad and ‘one size fits all’. The difference the recommendations for alcohol are followed in comparison to the way other recommendations are followed, for example dietary recommendations, reveal how women’s attitudes differ to the messages around alcohol in comparison to other health messages they are receiving.
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