Commentary: Pregnancy, partners and alcohol warning labels

Chikritzhs, T., Dangardt, F., and Pettigrew, S. (2020) Pregnancy, partners and alcohol warning labels. Addiction

Research and public health messaging about harms to others from substance use may contribute to stigma for vulnerable groups, including pregnant women. A more restorative public health discourse could be achieved by widespread reframing of substance use during pregnancy as a responsibility shared by parents, family, friends and communities alike.

Wilkinson & Ritter [1] provide a thought‐provoking commentary on substance use harm to others (HTO) research, policy and stigmatization of vulnerable populations. Of particular interest was a detected challenge of sorts, apparently aimed at researchers and advocates engaged in public health alcohol policy. The challenge appears in relation to alcohol policy and its role in the uneven experience of stigma by vulnerable groups. One of two examples provided concerned alcoholic beverage warning labels about drinking during pregnancy (warning labels). Framed as a ‘mark’ on alcohol policy, the rebuke is subtle, but the implication is that warning labels contribute to stigma experienced by pregnant women who drink alcohol.

For some, extending this line of thinking will lead to the conclusion that potential for perpetuating stigma is a rationale for pulling back or halting progress on warning labels or information dissemination on risks of alcohol use during pregnancy. In our view, this would be a dangerous conclusion—especially when the stakes are so very high. Even when motivated by the best intentions, limiting or withholding access to health information undermines self‐determination, reduces health literacy and perpetuates confusion. Public policymakers would be remiss if they failed to prioritize the most vulnerable in their efforts to increase access to easily understandable, evidence‐based health information.

That said, the challenge warrants a closer look for three reasons: first, although Wilkinson & Ritter do not cite evidence of stigma associated with warning labels, we are aware of one study suggesting they may lead some women to avoid prenatal care and have worse pregnancy outcomes [2]. Secondly, for reasons we expand on below, efforts aimed at reframing prenatal alcohol exposure from a ‘women‐only’ issue to a responsibility shared by partners, families, friends and communities [3] could bring major gains in behaviour change. Thirdly, in July of this year, the Australia New Zealand Food Standards Code was amended to mandate specific pregnancy warning labels for all alcoholic beverages [4]. Acclaimed as a long overdue victory for public health, more than 150 organizations weighed in to back the policy, including the National Closing the Gap Committee and the Australian Human Rights Commission [5]. The alcohol industry has 3 years to get its house in order but, not surprisingly, having been allowed to dictate their own ‘voluntary’ labelling terms for many years, vested interests have made their grievances with the new code widely known.

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