Devising and communicating public health alcohol guidance for expectant and new mothers: a scoping report

Abstract:

Methods

Document analysis of the new CMO guidance and supporting literature was undertaken. Key findings from this review were then discussed with four stakeholder focus groups.

Findings

The new guidance for alcohol in pregnancy is underpinned by a precautionary principle. This principle contrasts with the informed-choice approach that underpins alcohol advice for the general population. The rationale for this different approach is not articulated clearly in the guidance documents.

In consequence, users rationalise for themselves. Some conclude that the guidance is intended to provide an extra layer of protection to the foetus. Some conclude it is intended to protect more vulnerable and less educated women who lack the capacity to interpret the evidence wisely. Some believe that it is meant to provide a strong message about alcohol consumption at a ‘teachable moment’, leading to longer-term health benefits.

Others conclude that the guidance is an example of overreach, legitimising social surveillance of pregnant women, while failing to take account of the social and well-being cost of not drinking. Midwives noted that 5 the guidance was congruent with a normalised directive approach to communicating with women in pregnancy.

Key recommendations

1. Communicate underpinning principles. Underpinning principles for a decision to develop a precautionary message rather than taking an informed-choice approach to specific guidelines should be transparent in the guidance document itself and in supporting information. Principles of honest communication and clear risk presentation should underpin communication strategies intended to deliver the guidance.

2. Layer explanations. Where the evidence base is not straightforward, users vary in the extent to which they value clarity or accuracy. Communication strategies should take account of this variation and should include opportunities for users to engage with the complexity underpinning a precautionary message. This could be achieved by taking a layering approach to evidence presentation, enabling users to access information to a depth that suits their own needs. Health professional bodies and third sector organisations should consider strategies to facilitate this approach to communication.

3. Ensure congruence with reality of pregnancy planning. Public health guidance for women in pregnancy should be congruent with the lived experience of ‘pregnancy planning’ and should reflect the reality that pregnancy occurs in the context of a spectrum of ‘planning’ behaviours.

4. Set out intended mechanisms and avoid social shaming. Intended mechanisms underpinning guidance communication strategies relating to women in pregnancy should be clearly specified. Those responsible for devising communication strategies should reflect on the role of social shaming and social policing as an intended or unintended mechanism for change, and alternative mechanisms should be considered. Strategies could include providing professionals with tools for managing layered conversations with women and family members and for re-framing the guidance in the positive – emphasising that there are no benefits to baby from drinking and that there may be benefits of abstention to mother and her partner.

5. Consider a social network message. Consideration should be given to extending the guidance to include family members and partners with respect to the influence of their own behaviour and the benefits of temporary abstinence, both for social support and for personal health reasons. This recommendation needs to be considered in the light of recommendations above to avoid exacerbating social shaming behaviours or further restricting maternal choice.

6. Research social impact of message as part of guidance development. Although a consultation on guidance communication took place, qualitative research on with target audiences is also recommended, including pre-testing of messages to identify perceived validity in ‘real-world’ social drinking, pregnancy planning and pressured parenting contexts. Unintended negative effects and alternative message framing should be considered.