‘Why take chances?’ Advice on alcohol intake to pregnant and non-pregnant women in four Nordic countries

Abstract

In this article we explore the construction of risk in government guidelines on alcohol intake during and before pregnancy in four Nordic countries given that there is no sound evidence linking a low level of alcohol intake during pregnancy to foetal harm. In the article we draw on two sources of data to examine the rationale behind the advice given to pregnant women: health education materials and other government documents, such as guidelines for professionals. We found that in all the four countries the government guidelines advised pregnant women to completely abstain from alcohol consumption, but there was some variation between the countries in the advice for non-pregnant women. The guidance in the four countries also differed in the extent to which they discussed the lack of evidence behind the abstinence advice and the precautionary approach on which the advice was based. In all the four countries the printed and widely circulated health education materials did not explain that the abstinence advice was not based on actual evidence of harm but on a precautionary approach. The other government documents adopted varying strategies for justifying the abstinence advice including not offering information about the uncertainty of the knowledge base, implying that there was evidence that low alcohol consumption was harmful to the foetus, acknowledging that a safe level of alcohol intake during pregnancy could not be specified and explaining the precautionary approach to risk. In this article we argue that the shift from ‘estimation of risk’ to the ‘precautionary principle’ is a part of a wider socio-cultural push towards broader employment of the precautionary principle as a strategy to manage uncertainty, and in the context of pregnancy, it is a part of the symbolic struggle to protect the purity of the foetus and construct the ‘perfect mother’.

Keywords:

• pregnancy
• risk
• alcohol
• abstinence
• uncertainty
• precaution

Acknowledgements

The authors want to thank Karl-Harald Søvig in Norway for his kind and generous assistance in providing data for this article, Nordens Välfärdscenter in Finland for financial assistance for the travel required by the collaboration and the anonymous reviewers of this journal and the editor, Andy Alaszewski, for constructive comments and criticisms.

Notes

1. Low-to-moderate alcohol consumption was defined as maximum 84 grams of alcohol per week, which in the United Kingdom is up to 10.4 ‘standard units’ per week and in the United States up to 7 ‘standard drinks’ per week. The UK standard unit contains 8 grams of alcohol and in the United States 12 grams (Gray et al., 2009).

2. In this study moderate consumption was defined as 30–40 grams of alcohol per occasion and 70 grams per week. In the United Kingdom this would equal 4–5 ‘standard units’ per occasion and almost 9 ‘standard units’ per week.

3. New findings on the effects of low-to-moderate alcohol intake during pregnancy are published all the time. For the purposes of this study it is, however, sufficient to sketch out what was known about the effects of low-to-moderate consumption at the time when the government documents that form the basis of our analysis were published.

4. Karl-Harald Søvig provided the data from Norway.