Absolute abstinence? A mixed methods study of alcohol use during pregnancy among parents and midwives in England and Sweden

This thesis explores alcohol use during pregnancy in relation to guidance, attitudes and social norms. The research was conducted in England, where at the time of the study pregnant women were advised to abstain but limit their intake if they chose to drink, and Sweden, where complete abstinence was endorsed. Alcohol use during pregnancy can have harmful effects on the developing foetus, yet there is an unsettled debate as to whether a safe limit exists. In some countries more than half of pregnant women report drinking and while factors such as age, socio-economic status, and pre-pregnancy drinking habits may influence continued drinking, there is a lack of research addressing wider socio-cultural factors, drinking occasions, and partner drinking. A greater understanding of why women drink during pregnancy can inform policy and practice to prevent alcohol-related birth defects. A mixed methods research study was undertaken, comprised of a survey, completed by 347 parents, and interviews with 44 parents and 16 midwives, aimed at exploring cross-cultural differences in prenatal alcohol use from a socio-ecological perspective. Data from the three strands were synthesised and contrasted using triangulation and mapped into meta-themes. The findings showed that English women were significantly more likely to drink during pregnancy than Swedish women. Partner drinking did not appear to influence women’s decisions around alcohol. Moral values underpinned the discourses of whether prenatal alcohol is acceptable; Swedish parents advocated for the rights of the foetus whilst English parents weighed that right against the woman’s right to autonomy. Consistent communication of an abstinence message was evident in Sweden, whereas English parents’ experiences varied, some even reported conflicting advice. In contrast, all midwives advised pregnant women to abstain. The findings suggest that clear communication of an abstinence message may contribute to shared social norms against drinking during pregnancy. However, a lack of clear evidence as to the effects of low level drinking was interpreted differently in the two countries