Template ecological analsyis of the narratives of partner’s and family member’s of women who consumed alcohol in pregnancy

Although there is increasing research on alcohol in South Africa, most of this work has an epidemiological focus. Very little research has explored alcohol use during pregnancy specifically from the perspective of the woman’s partner or family member or focused on contextual risk factors beyond the pregnant woman. This information is important to ensure that interventions are formulated based on the social contexts within which drinking in pregnancy takes place and in guiding interventions that aim to prevent prenatal alcohol use, thereby preventing the occurrence of FASDs. This study was guided by Bronfenbrenner’s Ecological Systems Theory to understand partners’ and family members’ perspectives of prenatal exposure within the actual environments in which alcohol use takes place. According to this theory, an individual exists within layers of social relationships: the family, intimate partners, friendships, and healthcare workers (microsystems), interactions among these microsystems, for example, interaction between healthcare workers and intimate partner and family and social workers (mesosystem), accessibility of alcohol in the neighbourhoods (exosystems), religion, culture and society (macro-systems) and changes of the individual and socio-historical context (chronosystem). The data were collected using a biographic narrative interpretive method of interviewing. Thirteen narratives interviews were conducted with partners and family members in a disadvantaged community in Buffalo City, Eastern Cape Province. The interviews were analysed using Template Analysis within the Ecological Systems Theory to interrogate the stories of partners and family members. According to participants, some of the reasons women consumed alcohol in pregnancy are: drinking habits before pregnancy that were difficult to break in pregnancy; women drank during the first trimester of their pregnancy because of unplanned pregnancy; women continued drinking throughout their pregnancies to cope with the emotional upset caused by the trauma of rape and losing loved ones, stress, receiving HIV-diagnosis in pregnancy, intimate partner violence, infidelity, rejection and denial of pregnancy from partners. After birth, some women continued drinking. Consequently, their children were taken away from them by social workers and family members because the parents were unable to care for the child due to alcohol use. There was lack of compliance of shebeens with liquor regulations, heavy drinking, high rates of alcohol use in pregnancy, and easy accessibility of alcohol within this study community. Pregnant women used religious coping beliefs to cope with their circumstances such as changes in their health, relationships and finances. Drinking during pregnancy is a complex problem that stems from multiple social and structural issues and interventions should therefore not only focus on the individual, but also on social networks and communities

I DRANK BECAUSE I WANTED TO DEAL WITH THE FRUSTRATION”: EXPLAINING ALCOHOL CONSUMPTION DURING PREGNANCY IN A LOW-RESOURCE SETTING – WOMEN’S, PARTNERS AND FAMILY MEMBERS’ NARRATIVES

Understanding the explanatory narratives that women, partners and family members provide for consuming alcohol during pregnancy is essential in interventions. This paper reports on the stories of 25 participants in a low-resource area. Explanations included lack of partner support (not providing financially, being unfaithful, denying paternity), stress (HIV diagnosis, unwanted pregnancy, poverty), trauma (rape, death and crime), and a drinking culture (unregulated taverns, availability of liquor, peer pressure). Interventions should work with the gender norms; provide services or referrals for trauma; provide non-judgmental counselling; and target drinking in general in the community so as to reduce drinking culture

The shame of drinking alcohol while pregnant: The production of avoidance and ill-health

In this article, we examine the operation of shame in the alcohol use habits of pregnant women and the responses of their families and associated institutions. Using a narrative–discursive approach, we interviewed 13 women, living in a low-resource setting in South Africa, who had consumed alcohol while pregnant. Narratives showed how both the act of drinking and “inappropriately” timed pregnancy (early and out of wedlock) were judged to be unacceptable. Women who engaged in these activities were positioned as bad mothers or promiscuous. Their actions were seen as resulting in the suffering of others—the future child, the family, and even the community. These narratives were underpinned by cultural and religious discourses. Women managed the shame accruing to them through avoidance and concealment; families instructed women to self-exclude or distanced themselves from the women’s behavior; and institutions subtly or overtly excluded women. The shaming of these women, and the mechanisms by which such shame was managed, did little to decrease drinking or to increase maternal health and welfare. Overall, this article demonstrates how the shame of drinking alcohol during pregnancy produces avoidance behavior, concealment, and exclusion, which are not constructive in terms of maternal health and well-being. The implications for a feminist narrative approach to drinking during pregnancy are outlined: moving beyond a focus on individual behavior change to locating personal stories within the meta-narratives and social discourses that shape pregnant women’s lives