Key words: Fetal alcohol syndrome; prevention research; indicated prevention; selective prevention; universal prevention; targeted prevention; mass media prevention approach; public service announcement; warning label; prevention effort directed at people at risk; prevention outcome.
D rinking during pregnancy, which can result in serious birth defects, remains a significant public health problem despite a variety of prevention efforts that have been implemented in recent years. The survey also assessed the prevalence of binge and frequent drinking i. Comparing data from and , the investigators found that binge drinking and frequent drinking remained "substantially unchanged. These findings are subject to at least three limitations, however.
First, BRFSS data are self-reported and might be subject to reporting biases, especially among pregnant women who are aware that alcohol use is not advised. Second, homeless women, women in homes without telephones, and women who were institutionalized were not surveyed.
Both of these limitations could have an impact on prevalence rates. Third, because the proportion of pregnant women who were drinkers was limited in this sample, these estimated prevalence rates are subject to statistical limitations.
Thus, the prevalence rates of drinking, frequent drinking, and binge drinking among pregnant women may actually be even higher than indicated in the BRFSS study. The potential consequences of drinking during pregnancy-the most serious of which are fetal alcohol syndrome FAS and other manifestations collectively called alcohol-related effects-are preventable birth defects.
After briefly describing the harmful effects of alcohol on the fetus, this article reviews the spectrum of FAS prevention efforts and summarizes recent research on FAS prevention activities. Alcohol ingested during pregnancy can have a range of deleterious consequences for the developing fetus. The most severe condition caused by prenatal alcohol exposure is FAS, which is characterized by a particular pattern of facial anomalies, growth retardation, and developmental abnormalities in the central nervous system that often include, but are not limited to, mental retardation.
ARBD can involve defects in several organ systems, such as the heart, kidney, vision, and hearing. In addition, some evidence indicates that prenatal exposure to alcohol increases the risk for internalizing disorders, including depression and negative self-cognitions e.
Furthermore, prenatal alcohol exposure may result in long-term neurocognitive disorders, such as problems with executive functions e. Finally, adults who had been prenatally exposed to alcohol frequently suffer from mental disorders and maladaptive behaviors that make it difficult for them to be self-sufficient and independent Streissguth and O'Malley Unfortunately, it is not uncommon for prenatal alcohol exposure to result in such severe deficits.
Estimates of the prevalence of FAS in the U. Rates of FAS surpass this prevalence in high-risk populations. For example, reported rates of FAS are 9. The range in prevalence results from differences in the populations at risk being studied and in the methods used to identify affected people.
Analyses based on medical records often underestimate the rates of FAS and alcohol-related effects compared with more aggressive case-finding approaches that include examinations of people living in the community May and Gossage ; Stratton et al. FAS can be prevented if a woman abstains from alcohol consumption at conception and throughout pregnancy. Universal prevention of maternal alcohol abuse. These interventions attempt to educate the broad public about the risks of drinking during pregnancy.
These universal efforts might be geared toward pregnant women or women of childbearing age and often include public service announcements, billboards, pamphlets in physicians' offices, and media advertisements.
The alcohol beverage warning label is an example of a universal intervention that has been extensively studied. Selective prevention of maternal alcohol abuse. These interventions target women who are at greater risk for having children with FAS or alcohol-related effects-that is, all women of childbearing age who consume alcohol.
One example of selective prevention measures is the screening of all pregnant women for their alcohol use, followed by counseling of all drinkers regarding fetal risk or, if warranted, referral to specialized treatment. Indicated prevention of FAS. These measures are directed at high-risk women, including women who have previously abused alcohol while pregnant or while at risk for conception, or women who drink and have delivered an infant with FAS, ARND, or ARBD.
This level of prevention includes alcoholism treatment of pregnant women or women who are likely to become pregnant as well as measures to encourage prevention of pregnancy. The following sections describe each of these major types of FAS prevention efforts and summarize research on their effectiveness.
One of the first steps in universal prevention efforts is to increase the public's knowledge of the consequences of alcohol use during pregnancy, particularly FAS.
Various methods can be used to increase knowledge, including news reports, articles in the popular press, public service announcements, billboards, and the alcohol beverage warning label. With the exception of the research on the warning label, few studies have assessed the effectiveness of these efforts on knowledge of FAS, attitudes about drinking during pregnancy, and women's actual alcohol consumption during pregnancy. Lemmens and colleagues reviewed the coverage of alcohol-related issues in five national newspapers i.
Out of 1, articles examined, only 23 dealt with alcohol and pregnancy. Similarly, Golden reviewed national network evening news broadcasts between and for ABC, CBS, NBC and found that alcohol and pregnancy was a topic in only 36 of the newscasts. These particular newscasts often coincided with the announcement of government warnings, the discovery of scientific evidence linking alcohol to birth defects, and other incidents associated with alcohol abuse deemed newsworthy, such as the firing of a bartender and waitress who refused to serve alcohol to a pregnant woman.
Warning posters to be placed where alcohol is sold have been required in some States as early as As of , 18 States, 14 cities, and 2 counties required the display of such posters. Prugh examined the impact of posters warning about drinking during pregnancy in New York City.
Prior to the posters, 54 percent of respondents mentioned birth defects as a result of drinking while pregnant. A year after the posters were introduced, 68 percent mentioned birth defects as a consequence of drinking. Among those seeing a sign or poster, 56 percent recalled a warning about alcohol and birth defects. The investigators also reported that the level of knowledge of the risks associated with drinking during pregnancy increased with an increasing number of different message sources e.
Among the women in the survey who had been pregnant in the past year, 86 percent saw 1 or more messages about drinking while pregnant. Finally, 70 percent of the women who had been pregnant reported that they did not drink alcohol while pregnant Kaskutas and Graves One study has tracked the level of knowledge of FAS over time using data from the National Health Interview Surveys that involved interviews with 19, people ages 18 to 44 in and with 23, people in Dufour et al.
Over the 5-year period between the two surveys, the proportion of respondents reporting that they had heard about FAS increased significantly, from 62 percent to 73 percent among women and from 49 percent to 55 percent among men. Among women who had heard of FAS, the number of those who correctly defined the condition as a birth defect increased significantly from 25 percent to 39 percent.
Among men, the percentages also increased significantly from 24 percent in to 36 percent in Although this study did not test the effectiveness of particular universal interventions, the findings suggest that general knowledge of FAS has increased over time. Effectiveness of the Alcohol Beverage Warning Label. In , the U. Congress passed the Alcoholic Beverage Warning Label Act requiring that effective November 18, , a warning label must be attached to all containers of alcoholic beverages.
The first part of the warning reads: "Government Warning: According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. In general, the studies concluded that although awareness of the alcohol beverage warning label increased after the implementation of the law, this awareness has attenuated over time. Furthermore, the warning label's impact on drinking during pregnancy has been modest. For a comprehensive review of the impact of the alcohol warning label on perception of risks including drunk driving, birth defects, and health problems; and drinking behavior in a variety of situations, see Mackinnon For example, Greenfield and Kaskutas examined exposure to the warning label among a national probability sample of adults using annual cross-sectional telephone surveys.
In a cross-sectional design, each participant is interviewed only once and a new sample is created for every year of the survey. For that study, interviews were conducted in , , , , and that included a total of approximately 8, respondents.
In , 6 months after the implementation of the label, 21 percent of respondents said they had seen the warning label during the past 12 months. By exposure to the label had reached a plateau, according to the investigators, with 51 percent of respondents reporting that they had seen the label in the past 12 months. As part of a cross-sectional and longitudinal study of the effects of alcohol beverage warning labels, Kaskutas and colleagues conducted a phone survey of a national representative sample of pregnant women from through Exposure to the warning label fluctuated over the course of the study 7 percent saw the label in , 27 percent in both and , 58 percent in , and 42 percent in [no data was collected in ].
Exposure to signs or posters also varied over the study period from a high of 28 percent in to a low of 13 percent in , 21 percent; , 17 percent; , 17 percent. Advertisements about drinking during pregnancy were seen by 81 percent of women during , , and , but by fewer women in and 65 percent and 58 percent, respectively. Finally, 84 percent of women had conversations about drinking during pregnancy in both and , and 87 percent in , but only 74 percent in and 58 percent in These data suggest changes, and in some cases, decreases in the proportion of women exposed to these media messages over time.
Seventy-five percent of the women reported not drinking, whereas 21 percent had one or two drinks and 4 percent admitted drinking at least three drinks on any single day during pregnancy. Several other studies have tracked the awareness of warning labels in various populations, as follows:.
A Detroit study using a probability sample of 1, women found that 39 percent of the women had seen a warning label in the past 12 months. Among abstainers, 18 percent had seen a warning label, compared with 52 percent of women who drank.
Seventy-seven percent of those who had seen the label recalled that it mentioned birth defects Hankin An Indiana study evaluated knowledge of the warning label among 1, 12 th grade students in the fall of i.
The study found that in the fall of , 26 percent reported having seen alcohol warning labels compared with 41 percent in the fall of In , 65 percent of respondents who reported seeing the label also reported that it mentioned birth defects, 2 2 Reports of having seen warning labels before the labels actually existed are not uncommon.
Another study tracked changes in label awareness from May through June among 7, inner-city African American women seeking prenatal care. Over the month study period, the level of label awareness continued to increase through December , when it reached the maximum of about 80 percent Hankin et al. Using the same inner-city prenatal clinic, Hankin and colleagues examined the impact of the warning label on drinking during pregnancy.
This study involved 21, pregnant African American women using the prenatal clinic between and Controlling for patient characteristics and the unemployment rate, 3 drinking began to decline 8 months after the implementation of the warning label Hankin et al.
For example, pregnant women may drink more when they have fewer resources and support. Furthermore, when unemployment is high, choices for prenatal care are limited, and more poor pregnant women may turn to the prenatal clinic where the study was conducted. Hankin and colleagues hypothesize that pregnant women may drink more when unemployment is high.
They were unable to find any study that specifically examined this relationship. However, the following studies show that alcohol consumption, binge drinking, alcohol problems, and alcohol-related diseases are related to unemployment rates: Crawford, A. Unemployment and drinking behavior: Some data from a general population survey of alcohol use. Economic change, alcohol consumption, and heart disease mortality in nine industrialized countries.
However, this decline was only modest i. Thus, by , the women's alcohol consumption rose again and by , pregnant women had become accustomed to the message.
Selective prevention targets all women in their reproductive years who drink alcohol although most studies target heavy drinkers. One randomized trial assessed the impact of a brief intervention on drinking during pregnancy in this population Chang et al. Women who score two or more points are considered risk drinkers. Sokol et al. The brief intervention consisted of a minute session with a physician and included the articulation of drinking goals while pregnant, identification of risk situations for drinking and alternatives to drinking, and the recommendation of abstinence during pregnancy from the Surgeon General and the Secretary of Health and Human Services.
The study investigators then interviewed women once they had given birth about their alcohol consumption since the original assessment. Women in both groups reduced their alcohol consumption during pregnancy, and no difference existed between the two groups in the decrease in average number of drinks per drinking day.
Accordingly, Chang and colleagues concluded that screening alone may be related to a reduction of drinking during pregnancy. The study also attempted to identify patient characteristics that predicted greater success of the intervention approach.
For example, the brief intervention appeared most successful for women who had been drinking alcohol in the previous 6 months but who had been abstinent in the 90 days prior to their first prenatal visit. Among current drinkers at baseline in the brief intervention group, women who articulated specific drinking goals for specific reasons were more likely to reduce alcohol consumption or abstain from alcohol during pregnancy than were women without such goals Chang et al.
An ongoing randomized clinical trial is extending these selective prevention efforts by applying them to an indicated prevention program. In this trial, recruitment focuses on a high-risk population of pregnant women who are currently drinking, drank during a previous pregnancy, or drank at least one drink daily prior to current pregnancy.
In this study, the investigators, led by Chang, are comparing the results of an assessment-only condition with an enhanced brief intervention that involves a support partner chosen by the pregnant woman.
Handmaker and colleagues piloted a study to evaluate the results of motivational interviewing with 42 pregnant problem drinkers. Women reporting any recent drinking were randomly assigned either to the experimental group that received a 1-hour motivational interview focused on weighing drinking against the risk of birth defects, or to a control group that received a letter explaining the risks of drinking during pregnancy and recommending the woman talk to her obstetrical provider about the risks.
Women in both groups had significantly reduced their alcohol intake at followup 2 months later. Women who self-reported the highest levels of blood alcohol concentrations had the greatest decrease in alcohol consumption if they were in the experimental group compared with the control group.
Blood alcohol concentrations were estimated using computer projections that were based on self-reports of estimated number of drinks, alcohol content of drinks, length of drinking episodes, the woman's weight, and an average rate of alcohol metabolism for women.
Another selective prevention approach that was part of the Developing Effective Educational Resources DEER project examined the exposure and reactions to warnings about drinking during pregnancy in samples of pregnant Native Americans and African Americans living in the Northern California Bay area and Los Angeles. In this study, Kaskutas found that although the women were frequently exposed to warning messages, they were uncertain about the impact of FAS. Specifically, only about a quarter of the women could name at least one birth defect associated with FAS and only one-fifth knew that FAS was related to alcohol consumption.
Moreover, the emphasis is not on structural elements shaping 'outcomes' such as poverty and unemployment but individual behaviours. Individuals are thus required to self-monitor and regulate their behaviour or be subject to sanctions, from strong disapproval in the case of infringements such as smoking whilst pregnant Oaks , to criminalisation for more serious breaches Arthur Consequently, this framework allows us to analyse media discourses about behaviour during pregnancy as part of a broader moralizing agenda.
It will show similarities and differences to those frames identified by Connolly-Ahern and Broadway and so identify the particular features of moralizing narratives in British newspapers. It will also argue that although critiques of the new abstinence position are common, they do not necessarily undermine the moralizing messages that promote self-regulation as a solution to this social issue.
Methodology 5. The database has archives that go back to the mid s although different newspapers have joined Lexis-Nexis at different points in time. All weekday newspapers have been included since , and Sunday newspapers since In addition, a search was carried out on alcohol and pregnancy as major mentions to ensure a comprehensive database was established. Using these search terms potential articles FASD , alcohol and pregnancy were identified. The articles retrieved were initially screened to remove duplicate articles [3] and articles which appeared in Irish editions of the papers [4].
They were then screened for relevance to the study. In the dataset arising from the search on the term FASD, articles were excluded if they only mentioned FASD in passing for example a story on patient records found in a disused hospital where one was of a patient with FAS. In the wider alcohol and pregnancy search, articles were added to the FASD dataset if they mentioned the possible impact drinking alcohol had on the development of the foetus. For example, articles which stated that alcohol could cause birth defects or intellectual impairments were included, whereas articles discussing the impact on conception or miscarriage were not.
The articles were all read by at least two of the research team and a thematic coding scheme was developed. Particular attention was paid to the 'triggering event', any narratives or templates that could be identified, the 'experts' whose opinions were drawn on, and the broader context situating the story. Patterns of reporting 6. Although some of this is to be expected, as not all the newspapers were in the database before , even since then interest has grown.
Table 1 sets out how the volume of coverage has grown over time in the daily newspapers. More detail about the number of stories in the papers can be seen in Tables 2 and 3. They were divided into 4 main categories: news, feature, medical advice, or letter to the editor. Stories were coded into the news category if the story was mainly the reporting of 'facts' about FASD. This could be as a major element such as a report about a new piece of research into the impact of alcohol on pregnancy, or changes in official drinking guidelines.
Stories were coded as a mention in a news item if FASD was referred to, but was not the main focus; for example, a story on smoking rates and pregnancy where alcohol was also mentioned. Articles were coded as features if they were editorials or lifestyle pieces. Features were subdivided into 3 categories: main focus, mention or case study.
In a similar divide to that used for news articles, main and mentions were categorised in relation to the focus of the article. For example a main article would be an opinion piece about government guidelines, and a mention would be a general lifestyle piece on pregnancy where FASD was mentioned.
Case studies were stories focusing on the lives of a carer or person or both with FASD. The third main category, health advice, contained items written by the newspaper's 'in-house' medical professionals. This could be in 'health' pages or in response to particular health questions posed by readers.
The final category contained letters to the editor following the publication of particular articles on alcohol and pregnancy.
This type of mention was typical of the s where newspapers reported on a conference or other research-related activity. The reports were sporadic, with notably no secondary articles or discussion generated. The other type of coverage in the s occurred in health advice. This seemed to be triggered by two events in the US, the introduction of warning labels on alcoholic drinks, and coverage of the Thorp case. In this case, a whiskey distilling company was being taken to court in a case brought on behalf of a child with FASD for failing to warn people about the dangers of drinking during pregnancy see Golden for a fuller history.
The coverage remained sporadic in the s, although more follow up or discussion pieces often linked to news stories of FASD began to emerge. Two trends can be identified in these stories. First, heavy drinking was always deemed to be the main risk, with women constantly reassured that low alcohol consumption was not something to be concerned about. The second trend was that the abstinence position in the US was considered unnecessary and linked to that country's 'litigation' culture, rather than a response to any real risk.
This is illustrated by the following extract from a feature in the Guardian: The case for abstinence is not based on evidence. It is based on the logic of better safe than sorry.
It is tempting, especially for an expectant mother, to say that any risk, however small or theoretical, is too great. But that is absurd. Everything about light drinking during pregnancy makes it the kind of theoretical risk that Americans are unlikely to evaluate sensibly.
This timeframe coincides with the formation of UK based FASD organisations lobby groups that seek to raise awareness of FASD and promote alcohol abstinence in pregnancy ; the first debate in Parliament on the issue ; and the moves to introduce warning labels on alcohol containers in the UK.
The coverage at this time also included reports about and discussion of the changes to the official guidance on the recommended level of alcohol consumption during pregnancy.
In the DH for the first time advised 'pregnant women' and those 'planning to become pregnant' to 'avoid alcohol' see Lowe and Lee Articles debated the differences between the advice given by different official bodies, and critiques began to emerge on the abstinence position now promoted by the government. Individual papers did not seem to take a particular stance on the issue; instead commentators could support either position. The report did not discuss the advice, with the implication that drinking alcohol should be seen as potentially harmful to the foetus.
The following day it carried a longer feature challenging the new advice with the headline 'How much booze is bad for your baby? Although the article stated 'experts don't agree', the experts quoted in the feature supported the view that there was no medical evidence that justified the complete abstinence position.
Consequently readers of the Sun could have received either or both pieces of health information depending on how often they read the paper.
The first frame to arise was the extent to which alcohol is a problem in society; the second was about the advice or warnings given to women; and the final frame centred on policing pregnancy. Quotations used to illustrate the themes are representative of the emerging themes, unless otherwise stated.
Alcohol as a problem? In this theme, we can see a marked shift over time. The early coverage of FASD in British newspapers indicated that it was a problem elsewhere, particularly the US, and that concerns about it are reactionary, unnecessary and even perhaps bizarre. In many of these articles, discussion considers the proliferation of warnings about drinking alcohol in general, and the emergence of the concept FASD is deemed to be part of this development. For example in an article published in the Independent starts by outlining the case of two US waiters who lost their jobs after a pregnant woman complained about their attitude towards her ordering alcohol.
It links this issue to a wider concern that alcohol consumption was becoming viewed as always problematic: 'So, be warned. Similar warnings about neo-prohibition are to be found in The Times. These articles, while not denying that excessive alcohol can lead to congenital problems in the foetus, represent the heightened attention paid to alcohol consumption in pregnancy as an extreme reaction within a broader anti-alcohol context. Over time, articles in our database which extol the virtues of alcohol decline, but the notion that FASD is being constructed as a disproportionate risk also emerges in the other frames.
Articles discussing this idea are found particularly in the Broadsheet papers and the emphasis is on FASD as an outcome of social and economic deprivation within the context of history. Poor and marginalised communities such as Native-Americans and Inuit are described as being 'blighted' by alcohol, with large numbers of FASD cases. Consequently, FASD in these types of articles is a problem of the 'other', and whilst they do provide descriptions of the 'victims' of FASD as found by Connolly-Ahern and Broadway , the impact is less powerful in UK reporting as the problem is overtly located elsewhere.
As others have noted, from the late s media coverage begins to name binge-drinking Measham and women's drinking Day et al as growing social problems. Foetal Alcohol Spectrum Disorder begins to be identified as one of the concerns that we should have about alcohol consumption in general.
In the majority of cases in this frame, the 'story' is a reported rise in alcohol consumption and alcohol-related crime or health issues, with FASD mentioned as a potential problem.
It sets out a huge range of health issues that it links to alcohol consumption including brittle nails, weight gain, heart disease and cirrhosis of the liver. Within this article it states that alcohol can cause 'brain damage and learning disabilities' and that 'another risk' is FAS. The separation of FAS from other alcohol-linked congenital anomies is unusual, but apart from that, this article is typical of the way in which FASD is evoked as part of the 'problem' of alcohol consumption.
In these articles, although a brief description is given, FASD is rarely discussed in any detail. As such the implications of FASD are left implicit rather than being made explicit. In these, the implications of FASD are named and clearly linked to alcohol abuse. Many of the case studies mention adopted parents or carers rather than birth mothers. Here we can see both the 'dangerous women' and 'victim' themes that emerge in Connolly-Ahern and Broadway's study.
Many of the cases are repeated in different papers. For example, 'Dominic's story' is related by his foster mother. Birth mothers appear less frequently, and their alcohol consumption is discussed more sympathetically. The case studies both describe alcohol as a social problem and lay out detailed implications for the direct 'victims', those with FASD and the struggles of those that care for them. However case studies form a minority of FASD stories.
Women warned? Often these are without commentary, and convey the 'message' of the original source of the story. Some of these reports are very similar in different papers, suggesting that they are written from press releases.
For the majority of the earlier reports, the tone of reporting is not judgemental against pregnant women who drink, but sets out health guidance that it is argued they may need to consider, as the following examples show: Pregnant women who drink just four glasses of wine a week are putting the health of their babies at risk.
Research presented at the annual conference of the British Psychological Society in Belfast yesterday showed that drinking, even in moderate amounts, is just as harmful to the unborn child as smoking. This can be seen in most clearly in the quote from the Independent in which the danger from smoking is seen as a common reference point for the new information.
Some of the reporting emerges from press coverage of events or campaigns that are initiated or supported by FASD organisations for example, coverage of conferences e. In a similar way to the reports discussed above about new research, articles of this kind do not usually challenge the claims made by lobby groups, nor is their stance on the issue advocating alcohol abstinence brought into question.
Reporting rarely refers to any other prior coverage on the issue or to wider debates. Although some articles are more forceful than others in the way they report about the 'danger' of alcohol, the implicit message in them all is that there is a new, important 'warning' that 'responsible' women need to take on board. Two issues emerge in newspaper stories of this kind. First, it is argued that the level of uncertainty about the 'correct' advice that should be given to women is problematic, and that there needs to be clarity on the issue.
The second issue is that of the 'nanny-state'; that in general terms, the government should refrain from telling people what to do in their private lives. Clearly, there is a conflict between these two ideas. A standard policy would be a state-sponsored directive about an area of personal life, and interestingly both positions were sometimes argued for in a single newspaper although not usually in the same article.
To illustrate this phenomenon, examples have been used from the Daily Mail , but similar conflicting positions could be seen in other papers: Women should not drink at all during pregnancy to avoid harming their baby, according to the latest government advice.
The Department of Health has warned that pregnant mothers should stop drinking alcohol altogether. The first quote reports on the change, but introduced conflict in the story by picking up on the 'non-harm' that apparently resulted from the previous guidance.
This introduces the idea that clarity in the guidance is preferable and uncertainty is to be avoided. The second article, which followed a few days later, links the advice to the 'nanny-state' discourse, suggesting that no guidance is required. This wider discourse is part of a broader critique by commentators that governments should not interfere with the 'private' lives of its citizens see Cottam for a wider debate on the 'nanny-state' critique of public health measures.
This contradiction continues in later articles in the Daily Mail , which focus on the difference between the DH guidance, and that from NICE which did not recommend abstinence in but then did so in revised guidance published in Confusion over whether women can safely drink during pregnancy deepened yesterday with new guidance stating a small glass of wine a day is okay.
Then they said pregnant women could have a glass every so often. And after months of confusion, you might hope the health watchdog's latest advice on alcohol for expectant mothers would finally clear things up.
But is seems nothing is that simple. The undertones of the Nanny State in these endless, sermonising utterances from public officials who need to find some means of justifying their existence is becoming increasingly wearisome to the public.
The stories which referred to 'conflict' or 'confusion' in different guidance rarely drew attention to this as a possible outcome of uncertainty or a lack of evidence.
Both of these stances in the newspapers also highlight the way in which health issues can become politicized. As Boyce has shown in the MMR debate, media stances on health stories can be focused on support or challenge to a particular government, and as such debate about health implications per se can become a secondary issue. These often refer to the wider discourses of 'binge-drinking'. Yet these articles can also illustrate the extreme differences in the numbers claimed to be affected; the Sun reported a claim of 'up to 18,' babies a year in the UK based on 'a new study', yet the evidence presented to the Sunday Times found 'at least 9' a year in Scotland.
The scale of the disparity between these two figures means that it is highly unlikely to be an outcome of geographic distribution. They are more likely an outcome of the difference between cases actually diagnosed by medical professionals, and estimates provided by FASD organisations.
Consequently, these articles implicitly or explicitly assume that the role of women during pregnancy is to minimize any potential risk to the foetus this has been explored more fully elsewhere, for example see Lowe and Lee The focus on the primacy of foetal well-being, which can be linked to trends in broader parenting culture, is also a feature in the final theme found in the articles, and it is to this we now turn.
Pregnancy policed? General advice on pregnancy is a regular feature of many newspapers. Sometimes this is communicated through letters and advice columns written by medical professionals, but there are also often newspaper features that outline current health information, and many of these discuss FASD.
Many of these raise the issue of the policing of pregnancy, commenting on the ways in which the advice increasingly given to pregnant women can lead them to have restricted lives, and that it raises anxiety levels unnecessarily. This type of article was more frequently published in broadsheets than tabloid papers, but did feature in both. If the health police aren't careful, they'll make pregnant women too terrified to breathe. And that wouldn't do the baby much good either. No, I am not a chain-smoking binge drinker but I do enjoy the occasional glass of wine.
I drink coffee, eat seafood and, may God call me a sinner, I also wear make-up and go to the hairdressers for a regular cut and colour.
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