This document summarizes a presentation on guidelines for alcohol intake during pregnancy in Nordic countries. It finds that all four countries (Finland, Denmark, Sweden, Norway) recommend abstinence from alcohol for pregnant women. Denmark was the only country that openly communicated the lack of evidence of risk from low to moderate alcohol intake. The rise of the precautionary principle, in which risks are prevented in the absence of scientific proof of harm, appears to justify the abstinence guidelines. Further, symbolic moral views of protecting fetal purity and defining the ideal mother may influence the messaging to pregnant women.
‘No drinking’ policy and advocacy: perspectives from Europe
1. www.helsinki.fi/yliopisto
The rise of the precautionary principle:
advice on alcohol intake to pregnant
women in the Nordic countries
Dr Anna Leppo
Department of Social Research, University of Helsinki
Policing Pregnancy, -conference, London April 13th
2016
21.04.16Faculty of Social Sciences 1
2. www.helsinki.fi/yliopisto
A. Leppo, D. Hecksher, K. Tryggvesson:
”Why take chances?” Advice on alcohol
intake to pregnant and non-pregnant
women in four Nordic countries
Health, Risk and Society 2014, 16, 6, 512-529
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3. www.helsinki.fi/yliopisto
• Government guidelines on alcohol intake during pragnancy
to pregnant women and health professionals in four Nordic
countries
Finland, Denmark, Sweden, Norway
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4. www.helsinki.fi/yliopisto
• Risks are not only scientifically calculated but also
socially molded and negotiated
• Social perception of risks is linked to cultural values
and morality
Sociological approach to risk
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• At the time of our data collection there was no
strong evidence of harm from low-to-moderate
alcohol intake
• Studies showed diffusion of abstinence message
Background
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• What are the guidelines about alcohol intake during
pregnancy in the Nordic countries?
• How are the guidelines justified? How is scientific
knowledge used?
Research question
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• Data collected in 2011-2012 (Finland, Denmark,
Sweden and Norway)
• Government health education materials to pregnant
women
• Other government documents
Data
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• Abstinence message to pregnant women
• Abstinence or ”do not get drunk” message to
”women planning pregnancy”
• The lack of strong evidence for the abstinence
message was typically not mentioned
• A misleading message about the factual risks of
low/moderate level alcohol intake
Findings: advice to pregnant
women
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• Denmark was the only country where the lack of
evidence of risk was openly communicated and the
precautionary principle was explained
Findings: guidelines to
professionals
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• Advising abstinence when there is no evidence of
harm
The rise of the precautionary principle
• Conventional risk management is grounded in
evidence of harm and probability of adverse
outcomes
• Precautionary logic justifies risk-preventative actions
in the absence of scientific proof
Discussion
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• ”Making uncertainty certain” (Lowe & Lee 2010)
• ”Old-fashioned paternalism” (Gavaghan 2009)
• Withholding information reduces the chances of
making informed choices
Discussion
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• On a symbolic level, the abstinence message
protects the purity of the foetus and and the ideal of
the perfect mother
• Pregnant women are held to higher standards of risk
management (Kukla 2010)
Discussion
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• Recent extension of abstinence advice also to
breast-feeding women (Keane 2013)
• A broader cultural shift in which women are asked to
devote accumulative attention to maximising of
foetal and infant health
• How far can precaution be taken? How people deal
with growing demands for precaution? Can the
growing demands for precaution backfire?
Discussion
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• Bourgois’ and Friedman & Alicea’s dystopian
depiction of repressive OST
• Gomart’s optimistic view of OST as enabling action
• Frazer & valentine’s study of how neoliberal policies
have undermined quality of OST from clients’
perspective
Previous qualitative studies on client
experience of OST
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‒ Increased role of pharmaseutical industries in
defining health, illness and treatment
‒ Increased role of pharmaseuticals in national
health strategies and policies
‒ Increased tendency to manage psychological
and somatic problems with pharmaseuticals
Pharmaseuticalization
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A tired-looking middle-aged man in dark clothes, enters the
cubicle and says ”Hi”. Nurse replies: ”Hi”. She recognises the
patient and doesn’t ask his name; she says the patient’s surname
aloud so that the other nurse hears it and can type it in the
computer. The nurse at the window looks for the patient’s
notebook in a big pile and places it on the counter in front of the
patient. The patient signs the notebook. The practical nurse walks
the few steps to the pump and when she presses a small button,
the methadone is automatically poured into a white plastic cup.
The nurse hands the methadone over to the patient through the
hole in the window and says “65 ml”. The man drinks the
methadone, asks for a drink of water and a xylitol tablet. The man
says “Ok, thanks” and the practical nurse replies in a pleasant
manner: “Bye now! Have a good day!” The patient leaves the
cubicle after spending a little over one minute there.
Example 1 (fieldnotes)
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A patient in the waiting area knocks on the door of the cubicle. The patient in the
cubicle shouts: “Stop banging the door! Stop it!” The patients keep coming into the
cubicle one after another. At times there is no queue and the cubicle is empty for
a few minutes. There is only one cubicle in use because of shortage of staff: two
nurses have to be in the backroom making the takeaway-bottles ready for Friday
and one nurse is dealing with a big order from the pharmacy. A young handsome
man in his early 30s in a bright white t-shirt, seems to know the elderly nurse at
the computer and complains to her: ”Hey you, I had to wait in the queue for over
ten minutes! I’m not saying you are not doing your best here but how can it take
so long? I was talking to the workers in the “living room” and they said there is not
enough of them there today. Even the doctor is away!” Nurse: “Well, Antti, do you
know why that is?” Antti: ”Tell me.” Nurse: ”It all comes down to money.” Antti: ”I
see.” The nurse gives a quick dry laughter which expresses her dismay at the
situation. They exchange a few more words and after Antti has left the cubicle the
nurse says to me: “I could not help myself, I had to have a little chat with Antti as
he is such a nice boy but see what happened! I’ve made a mess of the paper
work, I should not open my mouth.” She is unsure if she has clicked all the
necessary things in the electronic patient records and she needs to double-check
everything which seems to annoy her. (October 2013)
Example 2
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Growing trend: understanding drug problems as brain-based; treatment of drug problems with pharmaseuticals fairly new in the Nordic context; OST has became widesperad in Finland during the last 10 years. OST: daily dispensing of methadon at specialised clinics
Dispensing methadone through a window and OST that consists mainly of medication is new in the Finnish context
Ethnographic fieldwork at a methadone clinic in Finland. A large clinic; so called ”harm reduction” clinic: the aim is to reduce harms of drug dependence but not help clients quit use this is a new treatment modality; the political motivation behind it is to save costs and that way make OST available for more clients
Ethnographer’s first impressions: the large amount of time that workers spent on a daily basis taking care of the many obligatory tasks around the dispensing of methadon there was very little time left for interaction with clients; many clients complained that they needed more professional support (councelling, practical help, activities, medical appointments etc)
Methadone itself seemed to ”call” people into action and have an active influence on the daily life of the clinic; analysis was inspired by Latour’s ANT: taking seriously human and non-human actors
Harm reduction OST: focus on dispensing methadone not much contact between clients and staff, scarce resources, shortage of staff
Multiple dispensing windows (no privacy), constant flow of clients (rush), changing staff (anonymity) minimal contact between clients and staff creates distance between clients and staff
Is this care? Is this a dystopia of care? What does care mean in this context? How does this modality of care enable or constrain the clients’ agency?
