Factors influencing women's decisions to drink alcohol during pregnancy: Findings of a qualitative study with implications for health communication

© 2014 Meurk et al.; licensee BioMed Central Ltd. Background: Despite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy.Methods: Semi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34-39, drawn from the Australian Longitudinal Study on Women's Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not.Results: Women generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption.Conclusions: The significance of alcohol to women's identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a " healthy" choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered

Public understandings of addiction: where do neurobiological explanations fit?

Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the extent that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect

What does 'acceptance' mean? Public reflections on the idea that addiction is a brain disease

Public responses to the dissemination of neuroscientific explanations of addiction and other mental disorders are an interesting sociocultural phenomenon. We investigated how 55 members of the Australian public deliberated on the idea that 'addiction is a brain disease'. Our findings point to the diverse ways in which the public understands and utilises this proposition. Interviewees readily accepted that drugs affect brain functioning but were ambivalent about whether to label addiction as a 'disease'. Contrary to the prediction of neuroscientific advocates and social science critics, acceptance of a neurobiological conception of addiction did not necessarily affect beliefs about addicted persons' responsibility for their addiction. We discuss the theoretical and applied implications of these findings. Theoretically, we examine the complexity surrounding how people adopt new knowledge and its role in reshaping ethical beliefs. We also discuss the implications of these findings for the ethics of communication of neuroscientific information to reduce stigma and enhance social support for the treatment of addicted individuals

Exploring practices and perceptions of alcohol use during pregnancy in England and Sweden through a cross-cultural lens.

Background: Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden. Methods: Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in Örebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis. Results: The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks. Conclusions: Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not

Greening Waipara: a ‘grape roots’ project to include biodiversity in the wine experience

It is no secret that New Zealand’s developed landscapes have lost most of their biodiversity - indigenous plants, habitats and wildlife. Biodiversity is a defining element in a district’s sense of place and there seems to be a growing sense of this in the Waipara wine-growing area of North Canterbury. This is a land of rich, sometimes boney soils and dry summers, but it includes microclimates that avoid the worst of the drought and frost. Land use has been transformed from hunting and gathering by the Tangata Whenua as well as their cultivation of kumara and other crops, to extensive and intensive sheep grazing and mixed farming and then to forestry or horticulture - including viticulture

Greening Waipara

The Greening Waipara project stems from initiatives by Lincoln University, local wine growers, the Hurunui District Council, and Landcare Research. Lincoln University is running a public-good research programme funded by FRST called Biodiversity, ecosystem services and sustainable agriculture; LINX 0303. This programme is calculating the value of nature’s services in the arable, pastoral, and horticultural sectors, and enhancing it by using what is sometimes called “ecological engineering”. The former approach is telling us such things as what a worm is worth – i.e. the value of earthworms in Canterbury arable agriculture, while the engineering approach is increasing the contribution of nature’s services, and their associated dollar value. The Greening Waipara project has always been supported and underpinned by research. Most of the vineyard companies and other operators in the district have now joined the project

Relative bodies of knowledge: Therapeutic dualism and maternal-foetal individuation

A strong body of knowledge attests to the fact that Australian women are using complementary and alternative medicine (CAM) at increasing rates. However, use of CAM in the context of maternity care is variable and distinctive because of heightened sensitivity to risk and the complexities that arise in managing maternal and foetal well-being concurrently. Drawing on qualitative interviews with 40 women who had recently given birth residing in a major city in Australia, we trace their use of CAM and biomedicine through a sequence of important health-care events during their pregnancies and up until the point of labour. We show that these women's engagement with CAM and biomedicine depicts a pattern whereby CAM is used to ensure the women's well-being while biomedicine is used to ensure a safe and healthy baby. We employ the concept of therapeutic dualism to analyse how this form of medical pluralism reproduces contemporary forms of pregnant embodiment - specifically the ontological separation of mother and foetus. However, we also highlight how this dualism is inexact. That is, bodies of medical knowledge may be separated and combined at specific points during pregnancy, and so too can the foetal and maternal body. © 2014 Macmillan Publishers Ltd

Networks of knowledge or just old wives' tales?: A diarybased analysis of women's selfcare practices and everyday lay expertise

Complementary and alternative medicine is increasingly popular in Australia and particularly among women. While existing research provides some understanding of women's engagement with complementary and alternative medicine and biomedicine, there has been comparatively little examination of the day-to-day character of their experiences. In this study, we utilise solicited diaries with women aged 60-65 years drawn from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health to capture the temporal dimension of their therapeutic engagement. Focusing on 30 active complementary and alternative medicine users, we explore women's experiences of managing their health, illness and well-being over a 1-month period. The themes that emerge from their diaries illustrate the day-to-day enactment of lay expertise through informal knowledge networks, practices of self-trialling and experimentation and the moralities underpinning self-care. The diaries provide unprecedented temporal insight into the (often problematic) enactment of lay expertise at the nexus of complementary and alternative medicine and biomedicine. They also point to the value of longitudinal techniques of data collection for augmenting more traditional sociological ways of exploring therapeutic pluralism. © The Author(s) 2013