Understanding pregnant women’s alcohol consumption in Brazil
By Júlia Lustosa Martinelli and Débora Gusmão Melo
Even low levels of prenatal alcohol exposure can harm embryofetal development. There is no known safe amount of alcohol use during pregnancy or while trying to conceive, and there is no safe time for alcohol use during pregnancy. All types of alcoholic beverages, including wine and beer, are dangerous for babies. Alcohol is a small molecule that crosses the placental barrier, and the fetus is exposed to alcohol concentrations that are very similar to maternal ones. Alcohol use during pregnancy can cause many different problems, including several types of disabilities such as hyperactive behavior, learning disabilities, and intellectual disability. These disabilities are known as fetal alcohol spectrum disorders (FASD). FASDs are totally preventable if a baby is not exposed to alcohol before birth. Despite that, pregnant women’s alcohol consumption is common in many cultures, including Brazil.
To bring to light elements that enhance the understanding of why women drink during pregnancy, we carried out a qualitative study supported by the São Paulo Research Foundation (FAPESP 16/07530-3). We interviewed 14 adult women who lived in the city of São Carlos, São Paulo, Brazil, and were identified as alcohol consumers during pregnancy. The data were analyzed through a thematic content analysis approach.
The results showed that alcohol consumption during pregnancy was associated with three groups of interconnected issues: (1) subjective and individual issues (such as expectations, motivations, and women’s difficulty in identifying their own consumption as risky); (2) sociocultural and environmental issues (such as alcohol's cultural value, easy access, and influence from relatives, friends, and partners); and (3) misinformation, inconsistent opinions publicized through media, and a lack of technically addressing the subject during prenatal care.
Women expressed both positive and negative expectations related to alcohol consumption. Positive expectations associated alcohol use with relaxation, fun, and social facilitation. Thus, this type of expectation was linked to social and enhancement motives. Concerning negative expectations, damage to general health was broadly cited. There was an association between alcohol intake and other drug consumption, including tobacco. Furthermore, there was the expectation that parental alcohol intake would influence children's habits.
We also found some specific motivations for drinking during pregnancy. The gestational period was understood as a period of less fun, and low self-esteem was mainly associated with body changes. Many women reported drinking at home to compensate for less social interaction. Coping with social prohibitions—from family members or partners—was also reported as a drinking motive. For some participants, maintaining the habit of drinking was a way to reaffirm their independence. Besides, some women cited alcohol cravings while pregnant as a reason for drinking.
Finally, there was a lack of information during prenatal care and an absence of clear guidance from health professionals. In many cases, friends and family recommended both abstinence and alcohol consumption in small amounts, believing it would be harmless. This variety of information confused the participants. Some participants believed they drank “a little bit” and did not identify themselves as abusive alcohol consumers. And there was a dichotomy between “moderately drinking”, which was perceived as not stigmatizing and socially accepted, and “abusive drinking”, which was socially blamed.
Our study reveals both individual or psychological aspects and collective or sociocultural aspects related to alcohol consumption during pregnancy. Based on these findings, we recommend health education actions aimed at the general population through media campaigns, explaining the risks and negative effects of alcohol consumption during pregnancy associated with advice on alcoholic beverage labels, something that is not done regularly in Brazil. An educational approach that does not focus only on pregnant women seems important so that their social contexts can have a positive impact on the women's decision to abstain.
Thereby, we recognize that Brazilian health professionals need training on the subject, especially because they must be able to investigate women’s real habits of alcohol intake before and during pregnancy. It is worth emphasizing that it is never too late to stop alcohol use during pregnancy. Stopping alcohol use will improve the mother’s and baby’s health and well-being.
Article Details
Alcohol Consumption During Pregnancy in Brazil: Elements of an Interpretive Approach
Júlia Lustosa Martinelli, Carla Maria Ramos Germano, Lucimar Retto da Silva de Avó, Bruno José Barcellos Fontanella, and Débora Gusmão Melo
First published online June 24, 2021
DOI: 10.1177/10497323211023443
Qualitative Health Research
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