title: Alcohol Use During Pregnancy in a South African Community: Reconciling Knowledge, Norms, and Personal Experience.
abstract: OBJECTIVE
  Due to high rates of fetal alcohol spectrum disorder (FASD) in South Africa, reducing alcohol use during pregnancy is a pressing public health priority. The aim of this study was to qualitatively explore knowledge and attitudes about maternal alcohol consumption among women who reported alcohol use during pregnancy.
  
  
  METHODS
  The study was conducted in Cape Town, South Africa. Participants were pregnant or within 1 year postpartum and self-reported alcohol use during pregnancy. In-depth interviews explored personal experiences with drinking during pregnancy, community norms and attitudes towards maternal drinking, and knowledge about FASD. Transcripts were analyzed using a content analytic approach, including narrative memos and data display matrices.
  
  
  RESULTS
  Interviews revealed competing attitudes. Women received anti-drinking messages from several sources, but these sources were not highly valued and the messages often contradicted social norms. Women were largely unfamiliar with FASD, and their knowledge of impacts of fetal alcohol exposure was often inaccurate. Participants' personal experiences influenced their attitudes about the effects of alcohol during pregnancy, which led to internalization of misinformation. The data revealed a moral conflict that confronted women in this setting, leaving women feeling judged, ambivalent, or defensive about their behaviors, and ultimately creating uncertainty about their alcohol use behaviors.
  
  
  CONCLUSIONS
  Data revealed the need to deliver accurate information about the harms of fetal alcohol exposure through sources perceived as trusted and reliable. Individual-level interventions to help women reconcile competing attitudes and identify motivations for reducing alcohol use during pregnancy would be beneficial.
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Eaton
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Dennis
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.|Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.affiliation: Unit for Research on Health and Society, Stellenbosch University, Cape Town, South Africa.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.|Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000401:mortality / Q000523:psychology*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D036301:Qualitative Research; D057566:Self Report / Q000592:standards; D012919:Social Behavior; D013019:South Africa / Q000453:epidemiology
keywords: Alcohol; Fetal alcohol syndrome; South Africa; Women