Alcohol during pregnancy - the media narrative

Background

Advice for pregnancy-related health issues regarding lifestyle choices has been given for a long while, so in a sense there is no true start to this story. The issues discussed here relate to the previous NICE guidelines issued in 2003, which advised caution, but not complete abstinence towards alcohol, and which did not differ too much in style and content to the advice issued by the Department of Health at the same time.

In May 2007, the Department of Health published its latest edition of the “pregnancy book”, which advised that pregnant women should abstain completely, because there is no evidence where the safe limit really lies, while in October 2007 NICE released a draft of the new guidelines which were to be released in March 2008. The draft guidelines do not differ substantially to the ones from the earlier guidelines, advising caution, but not abstinence.

The reports in the national press
After the NICE draft guidelines were shown to the press around 11th October 2007 almost every UK broadsheet picked up on the apparent contradiction between the advice given by the DoH and NICE. Interestingly, apart from the Daily Mail, the story was not picked up by the tabloids.

In the Daily Telegraph the story was headlined as “A daily tipple is safe for women”, and starts by summarising the advice from the draft NICE guidelines, but then pointing to the contradictions with the DoH advice. It highlights the fact that the DoH guidelines themselves have recently been changed “amid fears that women were either ignoring advice that they could consume a little, had various ideas of what the recommended amount was, or were being given different advice in different parts of the country.” Therefore the contradicting advice itself is explained as a recourse to the precautionary principle, rather than discussed in terms of conflicting messages.

As a contrast, the Guardian reports the confusion as the main message of the story, headlined “Confusion over advice on alcohol for pregnant women”, and launching straight into the fact that the two agencies have issued conflicting advice. Interesting here is their own interpretation of the NICE guidelines: even though these guidelines were carefully worded so that they still suggest that alcohol should best be avoided (see above), the Guardian's interpretation was to extrapolate from that and emphasise the advice in a way in which it probably was never intended: "In practice, this would mean the green light for women to drink one small glass of wine a day, or half a pint of 5% lager or strong cider, or a bottle of alcopop. "

Here as well the article points to the precautionary principle being applied to the same set of evidence. They quote a consultant obstetrician from UCL, Pat O'Brian, explaining the thinking behind the DoH advice: "There was some evidence at that time that some women were drinking more than the recommended allowance. They took that stance because they felt that in population terms it was the best way of deterring women from drinking too much in pregnancy."

The Times similarly highlights the conflicting advice in their highly sarcastic headline “Pregnant women told glass of wine a day is fine - and too dangerous”. It starts by outlining the new NICE guidelines, followed by an explanation of their reasoning. The actual advice however gets slightly distorted in a way that highlights the difference to the DoH advice and disregards NICE's actual assessment of the available evidence: “The experts [at NICE] concluded women should avoid alcohol only during the first trimester, but said drinking led to a slightly higher risk of miscarriage.” In fact the original report also states that the evidence for a higher risk of miscarriage is “limited and of poor quality” (NICE 2007: 103). Also, the original wording of the NICE advice was that “women should limit their alcohol intake [after the first trimester] to less than one standard drink” (ibid, my emphasis), where here the actual emphasis suggests much more caution than the Times paraphrases.

The article also concludes with expert quotes, this time from the Royal College of Obstetricians and Gynaecologists and the BMA, both of which highlight the precautionary principle in a similar manner to the DoH. Especially the BMA report was quoted as expressing “concern that any relaxed guidelines could be misinterpreted, as the varying alcoholic strengths or standard measures of different beers and wines can make it difficult for women to tell how many units they are consuming”, thereby explaining some of the reasoning behind the DoH's application of the precautionary principle.

The Daily Mail also focuses on the confusion. The reporting follows similar lines to the other newspapers quoted above: highlighting the conflict, possibly slightly misleading quotation similar to the Times (by omitting the comments on the quality of the evidence), closed by comments from experts and charities, some of them stressing the reasoning behind the DoH advice. This article is different from the other ones in that it also includes a quote on the reasoning behind the NICE guidelines: [Dr David Williams] said: 'I think the NICE advice is accurate according to the data we have got – a total ban is not a good thing. Most claim research shows that even very small amounts of alcohol can damage the health of the unborn child.

What is remarkable about this quote is that it is followed immediately by reasoning which counters the point – this could possibly be a result of a typo because the quotation marks that open Williams' quotation do not close, and therefore the second part of the quotation above only makes sense if seen to be outside. Therefore, even though the Mail article is the only one so far to quote somebody sympathetic to NICE's reasoning, the actual quotation gets distorted and immediately contradicted.

The dissemination of this and similar stories through opinion articles and responses to them

While there was no extensive op-ed coverage following the NICE story, several opinion pieces in the national press were already published as a reaction to the DoH's advice in May 2007, which contradicted the previous DoH advice. Several newspapers, such as the Daily Mail and the Times invite public comments, blog-style, to react to the story on their websites. The discussion in these forums followed the discussions in the earlier comment pieces both in style and substance (bearing in mind, however, that the Mail heavily edits the comments to comply with their editorial stance).

The main argument of a Guardian op-ed on the 25 May 2007 was that the new DoH advice was patronising to most responsible mothers, because with the lack of conclusive evidence for safe doses, the precautionary advice was only really aimed at “the 9% of women who still drink above the previous recommended levels” (Curtis 2007 ). The Times report, also of the 25 May invited comments that made similar arguments to the ones made by Curtis and her commentators.

Commentary usually fell into several categories: opinions can of course be divided into for and against the precautionary advice. But also there are several themes that occur several times: one is the argument that drinking alcohol is a choice (unlike for example passive smoking, or, as in one particular comment to the Curtis article, stepping into a car – the extent to which the latter was necessary or a choice then became an interesting side-discussion). This argument can even take on very moral tones, as some commentators have argued that alcohol is bad for you in any case - why should potential harm to a child be tolerated for the sake of an already wasteful and even immoral activity?