Abstract
Background Heavy alcohol use in pregnancy is associated with poorer outcomes for babies, while evidence of harm from drinking at low levels is limited. UK guidance has been progressively strengthened, so that current guidance, underpinned by a precautionary principle, is to abstain from drinking alcohol if pregnant or planning a pregnancy. The aim of this study was to explore recipients’ and mediators’ awareness, experiences and reflections on the 2016 alcohol in pregnancy guidance. Methods Four focus groups explored the perspectives of policy makers, midwives, third sector advocates and new mothers. Transcripts were analysed thematically. Results Participants inferred a variety of lay programme theories to make sense of the precautionary principle, some of which may run counter to the intention of guidance developers. Participants also varied in their understanding of the role of message mediators, understandings included eliciting disclosures, communicating complexity, providing reassurance and contributing to social surveillance. Coherence of the guidance was challenged by paucity of underpinning evidence base, incongruence with the realities of pregnancy planning and a wider cultural norm of social drinking. Conclusions Improvements in efficacy may be achieved through recognition of guidance as a form of intervention in a complex system, underpinned by a logic model and with intended outcomes fully specified. Practical steps could be taken to nuance and layer communication of the underpinning evidence base. Communication strategies should carefully consider implications of ‘scope creep’ into pregnancy planning. Guidance could do more to address the role of partners and family members in supporting women’s decisions.
Guidance is an intervention: experiences and reflections of message mediators and message recipients for ‘alcohol in pregnancy’ guidance.
