“It's better for me to drink, at least the stress is going away”: Perspectives on alcohol use during pregnancy among South African women attending drinking establishments

• Published in: Social science & medicine (1982) 2014-09, Vol.116, p.119-125
• Main Authors: Watt, Melissa H., Eaton, Lisa A., Choi, Karmel W., Velloza, Jennifer, Kalichman, Seth C., Skinner, Donald, Sikkema, Kathleen J.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcohol; Alcohol Abuse; Alcohol Drinking - psychology; Alcohol use; Alcoholism; Alcoholism - epidemiology; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Coping; Drinking Behavior; Drunkenness; Emotions; Female; Females; Fetal Alcohol Spectrum Disorders - prevention & control; Fetal alcohol syndrome; Health care; Health Knowledge, Attitudes, Practice; Humans; Interpersonal Relations; Intervention; Interviews as Topic; Medical sciences; Mental health; Miscellaneous; Pregnancy; Pregnant Women - psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk assessment; Social Environment; Social sciences; South Africa; South Africa - epidemiology; Stress; Toxicology; Young Adult
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2014.06.048

The Western Cape of South Africa has one of the highest rates of fetal alcohol spectrum disorders (FASD) globally. Reducing alcohol use during pregnancy is a pressing public health priority for this region, but insight into the experiences of women who drink during pregnancy is lacking. Convenience sampling in alcohol-serving venues was used to identify women who were currently pregnant (n = 12) or recently post-partum (n = 12) and reported drinking during the pregnancy period. In-depth qualitative interviews were conducted between April and August 2013. Interviews explored drinking narratives, with textual data analyzed for themes related to factors that contributed to drinking during pregnancy. All but one woman reported her pregnancy as unplanned. The majority sustained or increased drinking after pregnancy recognition, with patterns typically including multiple days of binge drinking per week. Analysis of the textual data revealed five primary factors that contributed to drinking during pregnancy: 1) women used alcohol as a strategy to cope with stressors and negative emotions, including those associated with pregnancy; 2) women drank as a way to retain social connection, often during a difficult period of life transition; 3) social norms in women's peer groups supported drinking during pregnancy; 4) women lacked attachment to the pregnancy or were resistant to motherhood; and 5) women were driven physiologically by alcohol addiction. Our data suggest that alcohol-serving settings are important sites to identify and target women at risk of drinking during pregnancy. Intervention approaches to reduce alcohol use during pregnancy should include counseling and contraception to prevent unwanted pregnancies, mental health and coping interventions targeting pregnant women, peer-based interventions to change norms around perinatal drinking, and treatment for alcohol dependence during pregnancy. Our findings suggest that innovative interventions that go beyond the boundaries of the health care system are urgently needed to address FASD in this region. •Drinking during pregnancy is motivated by a variety of social and contextual factors.•Alcohol venues are important sites to target women at risk of drinking in pregnancy.•Interventions beyond the health system are needed to address maternal drinking.