Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women’s Needs?
2. Understanding Women’s Reasoning about Alcohol Use during Pregnancy
3. Exploration of Polish Women’s Reasoning about Alcohol and Pregnancy
- Being a good mother is equally important for all women, regardless of their attitudes and behaviors regarding alcohol consumption during pregnancy. Women accepting (small amounts of lighter) alcohol during pregnancy seem just as committed (future and current) mothers as those who completely reject drinking alcohol during pregnancy. They associate pregnancy with healthy lifestyle, family, time of change and expectation.
- Locus of control over the pregnancy (me versus my doctor).
- “First of all, do no harm”—characterize the dominating approach toward care of the unborn child and pregnancy of women definitely rejecting alcohol during pregnancy. Not surprisingly, this harm avoidance perspective includes alcohol abstinence and makes the mother the key health agent.
- “Medical” factors are crucial—women accepting small amounts of alcohol during pregnancy underlined the importance of good medical care (regular visits to the doctor and adherence to recommendations, ultrasound examination, etc.). This suggests a shift in the responsibility for the outcome of pregnancy from the mother to the medical staff.
- No evidence of harmful effects of moderate drinking has different meaning for women accepting or rejecting small amounts of alcohol during pregnancy. In general, an opinion prevails that there is no clear evidence that small amounts of light alcohol are harmful to the foetus, so:
- For women who accept drinking alcohol during pregnancy, this means that there is no evidence of harmful effects and you can drink (a little).
- For women who do not accept drinking alcohol during pregnancy, this means that there is no evidence of harmlessness, so you can’t drink.
- “FAS (fetal alcohol syndrome) occurs in pathological families”. Among women who accept drinking during pregnancy, there is a strong emotional distancing from the threat of FAS by identifying it (only) with the children of mothers who are alcoholics, drink compulsively or get drunk regularly. This seems to reflect media “bombshells” (for example about “drunk newborns”).
- “I wouldn’t tell the doctor” for fear of his/her reaction. Women think that it is easier to talk with a friend or write in internet about alcohol and pregnancy than to talk openly with a doctor. They expect criticism, e.g., “Oh, what have you done!?” or disregard, as one respondent said: “It’s if I asked about the FAS, she [the doctor] would say to me: “Madam, madam … —she would look at me—No, this does not apply to you.” Psychologist and fortune teller in one”. It should be noted that there were also respondents who, although did not deny the general opinion about doctors, emphasized that they are extremely lucky because they can talk to their doctor about everything.
- Mental rationalizations among women who accept alcohol consumption or drink alcohol during pregnancy to convince or reassure themselves in respect of threats to the child related to prenatal alcohol exposure:
- “Pregnancy is not a disease”—this very well known in Poland slogan is interpreted as encouragement to maintain in pregnancy the same lifestyle (including alcohol use in moderate amounts) as before.
- There are other, not avoidable teratogens-e.g., air pollution, some medicines with unknown impact on fetus.
- Alcohol abstinence during pregnancy is a „new-fashioned” exaggeration and dictatorship of bans and orders
- Pregnant women are constantly threatened and criticized—„No matter what I do, it will be considered as wrong”
- Medical recommendations (in general) are not stable in time and probably those regarding alcohol use in pregnancy would be changed soon.
4. Opinions and Expectations about Information Campaigns on Drinking Alcohol and Pregnancy
- Avoid criticizing or stigmatizing alcohol consumption during pregnancy, because pregnant women/mothers feel beleaguered by social criticism, so they often respond to it with some kind of defiance resulting from helplessness.
- Avoid excessive “scaring”—because pregnant women/mothers feel “constantly threatened” and scaring can give effects opposite to the intentions and cause rejection of threatening information.
- What may have the potential is showing real life stories (testimonials), which document that FASD can happen in a “normal” family, where the mother is not an alcoholic, but drank moderately during pregnancy or before knowing she is pregnant. Presentation of a case-a child with FASD would have high emotional load and therefore may have a tremendous influence on one’s attitude towards drinking during pregnancy. Due to emotionality and rooting in everyday life, this communication direction should also be effective in case of people who rely rather on tradition and life experience than “science”.
- Since there is no evidence of the harmful effects of exposure to small amounts of alcohol on the fetus, the campaigns should reveal the irrationality of the applied mental strategies (e.g., “If you saw someone crossing the street outside the crosswalk and not being run over, does it mean that such crossing is not associated with risk?”).
- The message should be simple, clear and not leaving any room for different interpretations. As a good example may serve campaigns on drink driving, in which nobody discuss that a small amount of alcohol in the blood is acceptable. Similarly, in reference to pregnancy any doubts concerning different harmfulness of prenatal alcohol exposure due to individual differences between woman or the stage of pregnancy should be omitted.
- The best remembered are “strong” messages, exemplified by social campaigns against cigarette smoking during pregnancy, as cited by one of the respondents: “Do not turn your belly into a gas chamber”.
- Communication channels that may have potential are for example blogs (mothers-bloggers are perceived as close and reliable). Besides, also midwives could be educators for women (perceived as being nearer to “real life” and thus more reliable than doctors).
5. Public Awareness Campaigns on FAS/FASD in Poland
6. (Dis) Accordance of Polish Public Awareness Campaigns on FAS/FASD with Quality Standards
- “They precisely identify the target group of the campaign.
- They are based on a solid theoretical basis.
- The messages employed are designed on the basis of strong formative research.
- They strongly connect with other existing drug prevention programmes in the home, school and community.
- They achieve adequate exposure of the target group for a long period of time.
- They are evaluated systematically.
- They target parents, as this also appears to have an independent effect on the children.
- They are aimed at changing cultural norms about substance use, educating about the consequences of substance use and/or suggesting strategies to resist substance use.”
- The key message to women who do not accept even moderate alcohol use during pregnancy should strengthen their attitude (saying: Yes, you are right, keep doing) and, eventually promoting abstinence (or moderate drinking) when planning the pregnancy and/or encouraging use of effective contraceptive measures to avoid unplanned pregnancy.
- In case of women accepting moderate alcohol use during pregnancy, probably effective would be warning about the health hazard associated with exposing the fetus to moderate doses of alcohol (Like: Is the momentary pleasure of drinking a glass of wine worth worrying about your child’s health for the rest of your life?).
- Women with alcohol related problems may probably benefit from a campaign based on the CHOICES model [35,36,37] underlying that it’s never too late to stop/moderate your drinking (Although sooner is better) or to prevent getting pregnant. (Just because you have an alcohol problem doesn’t mean you can’t be a good mother. Take the first step and seek support).
7. Public Health Response to the Belief That There Is no Evidence That Moderate Drinking Is Harmful during Pregnancy
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
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|Research Design||Reject Alcohol Use during Pregnancy||Think That (Total) |
Abstinence from Alcohol during Pregnancy is not Necessary
|Pregnant women||FGI 1.||FGI 3.|
|Not pregnant women||FGI 2.||FGI 4.|
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Okulicz-Kozaryn, K. Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women’s Needs? Int. J. Environ. Res. Public Health 2022, 19, 4552. https://doi.org/10.3390/ijerph19084552
Okulicz-Kozaryn K. Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women’s Needs? International Journal of Environmental Research and Public Health. 2022; 19(8):4552. https://doi.org/10.3390/ijerph19084552Chicago/Turabian Style
Okulicz-Kozaryn, Katarzyna. 2022. "Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women’s Needs?" International Journal of Environmental Research and Public Health 19, no. 8: 4552. https://doi.org/10.3390/ijerph19084552