title: "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.
abstract: 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.
authors.affiliation: Duke University, Duke Global Health Institute, Durham, NC 27708, USA. Electronic address: melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: University of Connecticut, Department of Human Development and Family Studies, Storrs, CT, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Eaton
authors.affiliation: Duke University, Department of Psychology and Neuroscience, Durham, NC, USA.
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.affiliation: Duke University, Duke Global Health Institute, Durham, NC 27708, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Velloza
authors.affiliation: University of Connecticut, Department of Psychology, Storrs, CT, USA.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.affiliation: Stellenbosch University, Unit for Research on Health and Society, Tygerberg, South Africa.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Duke University, Duke Global Health Institute, Durham, NC 27708, USA; Duke University, Department of Psychology and Neuroscience, Durham, NC, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D000437:Alcoholism / Q000453:epidemiology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol; Fetal alcohol syndrome; Pregnancy; South Africa