Lisa Schölin, PhD Liverpool John Moores University Absolute Abstinence? A mixed methods study of alcohol use during pregnancy among parents and midwives in England and Sweden Lisa Schölin, PhD Liverpool John Moores University

2016 2008 NICE CG6 (2003) 2003 Department of Health (2016)

What are the prevalence, perceptions and approaches to prevention in England and Sweden, and are there any differences/similarities?

Mixed Methods – Parallel convergent design 1 STUDY 1 Survey with 347 parents (218 women) 2 STUDY 2 Semi-structured interviews with 44 parents Main themes Meta themes 3 STUDY 3 Semi-structured interviews with 16 midwives

Key messages There are significant differences in prevalence of prenatal alcohol use between England and Sweden, and perception of risk more nuanced in England Context of drinking was often in social settings, most commonly “a glass of wine”, and midwives noted might women may find it difficult not to not drink at special occasions Type of advice differed in the two countries, though midwives in both countries promoted complete abstinence as the appropriate advice LIMITATIONS: Small, non-representative sample; primarily high education; selection bias; recall bias; social desirability bias 1 2 3

Nuances in level of risk 1 44% of English women reported any alcohol use in pregnancy, compared to 4% of Swedish women (p<0.001) The foetus as person The baby can’t choose. They just get it (alcohol) in them. […] no that is so not okay (Swedish woman) Women’s autonomy I don’t think that it helps women to be public property (English woman) Responsibility If you are to be drinking and stuff when you are pregnant then maybe you shouldn’t have children (Swedish partner) Nuances in level of risk If it’s in moderate you know it is their decision (English woman) !

2 “sophistication of wine” and perceptions of acceptability with controlled drinking (Ford, 2013) 60% drank after first trimester No trend in drinking only at typical or special occasions I was just always of the opinion that I just wouldn’t have anything but then when I actually got pregnant I did slack in a little bit and like “ah I don’t think the odd glass of wine is not going to matter too much” English Woman 5

3 The odds for any alcohol use was more than four times greater if the advice was that small amounts was okay OR Clear message about abstinence in Sweden, varied/contradicting information given to parents in England ! ? All midwives believed abstinence was the best advice, and the advice they gave to all women (important to tailor to the individual)

3 I think the Government should be saying “don’t drink” […] I think that we should all be singing from the same hymn sheet English midwife 7

Thank you for listening! Supervisory team: Dr Lorna Porcellato (LJMU), Prof Karen Hughes and Prof Mark Bellis (Public Health Wales), Prof Charli Eriksson (Örebro University) Thank you to: Regional and local maternity services in Liverpool and Örebro, Children’s Centres in Liverpool, midwives, parents, Dr Kate Fleming (LJMU) @lesaangelica