‘No drinking’ policy and advocacy: perspectives from Europe

www.helsinki.fi/yliopisto

The rise of the precautionary principle: advice on alcohol intake to pregnant

women in the Nordic countries

Dr Anna LeppoDepartment of Social Research, University of

HelsinkiPolicing Pregnancy, -conference, London April 13th 2016

02.05.23Faculty of Social Sciences 1


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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• 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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• 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



• 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



• Data collected in 2011-2012 (Finland, Denmark, Sweden and Norway)

• Government health education materials to pregnant women

• Other government documents

Data



• Qualitative content analysis of key documents

Methods



• 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



• 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



• 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



• ”Making uncertainty certain” (Lowe & Lee 2010)

• ”Old-fashioned paternalism” (Gavaghan 2009)

• Withholding information reduces the chances of making informed choices

Discussion



• 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



• 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



Thank you for your attention!

02.05.23Valtio-tieteellinen tiedekunta / Anna Leppo / [email protected] 15


• 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


www.helsinki.fi/yliopisto 02.05.23Valtio-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi 17


‒ 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




Pharmaseutical treatment of drug problems

Opiate substitution treatment with methadone




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)



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



Education

‘No drinking’ policy and advocacy: perspectives from Europe