Since 2016, the UK Chief Medical Officers’ (CMO) ‘Low Risk Drinking’ Guidance recommends those who are pregnant or ‘could become pregnant’ to abstain from alcohol. This was a change from the ‘low risk’ approach in the previous guidelines, where pregnant women were advised to limit their intake (if they chose to drink). This precautionary approach recognised uncertainty of exactly when and how much alcohol is linked to negative outcomes. This has been adopted in subsequent policy frameworks including major public bodies (Scottish Intercollegiate Guidelines Network, National Institute of Health and Care Excellence) and government departments and their agencies (Department of Health and Social Care and Public Health England).
But how is the precautionary message within the guidelines perceived by those who are, or could become, pregnant? We are two researchers from different disciplines (public health and medical law and ethics) with one common interest – the communication of risk related to exposures to teratogens (substances that can impact the development of a foetus if used during pregnancy). As there has to date been limited qualitative research seeking to understand how the CMO guidelines and subsequent policies are interpreted in relation to pregnancy, we set out to explore this topic on an online parenting forum.
Online forums are invaluable tools for researchers, as it offers an opportunity to explore naturally occurring discussions on seemingly ‘taboo’ pregnancy topics. Those who post may do so honestly and can share their thoughts and experiences anonymously. In traditional qualitative research, such as interview studies, so-called social desirability bias might influence participants to respond in a way they feel is socially acceptable rather than their actual experience or views. There is a growing discipline which explores how aspects of motherhood are both talked about and constructed in online spaces, where posters can speak under a guise of anonymity.
We therefore developed a project which had two aims: 1) to explore what posters discuss when talking about alcohol and pregnancy; and 2) how posters discuss these topics. In brief, our project draws on data collected from a sample of threads from Mumsnet from 2016 to 2021 which we analysed using discourse analysis.
We found that posters value a range of different sources of evidence when discussing alcohol and pregnancy. Personal anecdotes, specifically, were the most frequently cited source of information. Posters trusted the experience of others and found them reassuring to evaluate their own situation against. On the other hand, explicit mentions of official guidelines on alcohol use when pregnant or trying to get pregnant were infrequent but the abstinence message was implied within the discussions and understood as the current advice.
Generally, the precautionary approach was addressed from two different ways. First, some posters felt the precautionary approach reflects a lack of certainty about risk and should therefore be followed. Posters of this view, who were more vocally supportive, considered it a “sensible recommendation”, as if a certain amount of alcohol was to be ‘allowed’ then women may “push the limits”. Second, others felt that the guidance was a way of telling women “what to do”. Those critical of the approach rejected the guidance and described it as “scaremongering” or “unhelpful”. Rejection was also based in the perception that the guidance ‘changes all the time’ and that different advice is given in different countries.
Mumsnet posters brought their own ideas – particularly around risk and what type of drinking in pregnancy should be considered risky – to how they interacted with evidence. Many posters used language that either ‘maximised’ (attributing risk to any amount of alcohol) or ‘minimised’ risk (only attributed to larger amounts of alcohol). More often than not, these views were expressed without reference to any ‘official evidence’ and were bolstered by anecdotal evidence.
Unpicking the discussions further, posters engaged with language that indicated that they want to be seen as ‘responsible’ and making the right decisions when it comes to alcohol in pregnancy. Regardless of whether posters agreed with the official guidance, they leant on conceptions of responsible behaviour when taking their stance. As such, being responsible did not always mean following the official guidance. For some it meant rationalising risk and making the decision which was best for themselves and their pregnancy. For these posters, it seemed, the guidance had limited impact.
Our research shows that the abstinence guideline is not universally adopted or understood. The abstinence message is both accepted and rejected within discussions online, with nuance in the interpretation of what a universal abstinence recommendation means in practice. We found two groups of posters who expressed anxiety over alcohol consumption. One group was while trying to conceive and in the ‘two-week-wait’. Unintended exposure in these periods were, however, common, and peer-to-peer support often reassured those who were concerned. The other group was anxious about consuming no/low alcohol products, as they believed they contained some alcohol and were worried they had therefore exposed their foetus to risk.
So, what does all of this mean? Our findings show that since the CMO guidelines were published there is mixed interpretation of risk associated with alcohol use. Whilst an abstinence message, in theory, is clear, the rationale is questioned by some. Others are anxious over unintended exposure, even when in very low amounts or as no/low alcohol products. It signals that we need more research into how these guidelines can be communicated better through relevant channels to reach the intended target audience, which this research shows is not a homogeneous group.
Written by Dr Lisa Schölin, Research Fellow, University of Edinburgh, and Rachel Arkell, Research and Project Officer, British Pregnancy Advisory Service.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.