I found myself doing something out-of-the-ordinary while watching Witnesses, the Euro-noir six-parter set in France and recently screened on British TV.
It features the usual key protagonists with messy personal lives, including Sandra, the lead detective with a troubled past whose ‘bloke’ Eric is cheating on her. To complicate matters she discovers early on in Episode 3 that she is two-weeks pregnant.
Just three minutes after this revelation a scene shows Sandra on the balcony of her apartment smoking a cigarette, and sure enough she has worked her way through an entire packet before downing her first glass of red wine in Episode 4. As Witnesses progressed I felt sure Sandra would survive anything. I couldn’t say the same about her unborn child.
FASD Awareness Day
I don’t make a habit of monitoring the personal habits of fictional detectives, but Sandra was an exception. Having just read an excellent article on Fetal Alcohol Syndrome Disorders (FASD) written by Dr Carolyn Blackburn for Special World the topic was uppermost in my mind. Why, I wondered, wasn’t Sandra behaving more responsibly and why weren’t the programme makers more concerned about the example she was setting. Was ignorance or Gallic obstinacy to blame?
Ignorance seemed unlikely. Wednesday marks the 16th FASD (Fetal Alcohol Syndrome Disorders) Awareness Day. It’s on the ninth day of the ninth month each year for obvious reasons. And according to an online article FASD prevention has been in the public eye in France since 2004 when ‘Four women who had given birth to children with FASD accused the government of not having informed them about the potential dangers of drinking alcohol during pregnancy.’
The ensuing campaign meant that from October 2007 all alcoholic beverages in France were legally required to have a warning label either in the form of a pictogram or a sentence explaining that consuming alcoholic beverages during pregnancy, even in small quantities, can have serious consequences for the health of a child. Almost all opted for the pictogram. The eagle-eyed among you will have seen it incorporated into the labels on the back of most of their alcoholic beverages.
French vintners, it seems, were none too pleased. A report for news organisation NPR suggested some campaigners believed the opposition they faced was due to the totemic position wine occupies in French culture; others, that wine producers were reluctant to accept that there were circumstances in which wine could be as harmful as spirits.
But it would be misleading to single out France for criticism when it comes to labelling. On the contrary, in making it a legal requirement that all alcoholic beverages contain a warning about drinking during pregnancy France blazed a trail that other European countries simply refused to follow. In countries like the UK the drinks industry opted for self-regulation and the French pictogram can now be found on most wine bottles. Nonetheless the overall picture across Europe remains very patchy.
A study published by the European Union in 2014 audited the use of five different types of health-related messages on alcoholic beverage labels, including those warning of the risks of drinking during pregnancy. Analysing 25,730 alcoholic beverage labels it found that fewer than one in five (17%) contained a health-related message in addition to the alcohol content information mandatory in each country. Wine labels most often carried health-related messages (19%), with messages less frequently found on spirits (15%) and beers (14%).
Thanks to France’s pioneering legislation all of its beverages contained health-related messages. Elsewhere there were substantial variations. Those with the highest proportion were Belgium (35%), Portugal (30%), the Netherlands (29%) and Germany (21%). In contrast, the lowest were found in Greece (5%), Ireland (5%), Romania (6%) and the UK (7%).
The good news is that the most common health-related message on labels (17% ) was a warning about drinking alcohol during pregnancy. All other message types were present on less than 5% of labels.
As for the US, the Alcoholic Beverage Labeling Act (ABLA) enacted in 1988 requires all alcoholic beverages to carry a general health warning that states, ‘According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.’
So why haven’t more countries passed legislation requiring that alcohol warning labels (AWLs) appear on all relevant packaging? One answer, according to a recent literature review undertaken by researchers at the British Columbia Centre of Excellence for Women’s Health, is that their effectiveness for changing drinking behaviour is limited.
Researchers looked at the five steps involved in bringing about behaviour change: individuals being made consciously aware of an issue via a warning label; seeing and understanding the warning as conveyed; being able to accurately recall the message; allowing the message to shift their judgements and beliefs; and allowing these changes to affect behavioural choices. Overall they found that while AWLs might influence light drinkers they were unlikely to effect regular drinkers. Even in France it seems many women continue to ignore AWLs with a 2010 report claiming that over 25% of French women continue to drink occasionally during pregnancy, with 6% drinking more than two drinks in the same day.
But the debate doesn’t end there.
Critics of current labelling argue that for AWLs to be more effective they need to be bigger, brighter and more graphic. The Canadian report also notes that: ‘Experience with alcohol and tobacco warning labels suggests that consumer attention is maximized and sustained when the warnings are larger, more colorful, and contain graphics or images (including “graphic” images of harm), and when warnings are rotated to introduce variation in the messaging.’
Is this likely to happen with AWLs about drinking when pregnant? I doubt it. While many of us will have witnessed the way in which warnings about smoking and drinking while driving have become ever more graphic over the years, there are two key reasons why the same is unlikely to happen to AWLs warning of the dangers of drinking when pregnant.
The first is that there continues to be conflicting evidence as to whether occasional, light drinking harms the unborn child. This ‘grey zone’ has been seized on by some, like author Linda Geddes, to argue that the ‘don’t drink at all’ camp risks alienating women who have ‘a glass or two of bubbly at a wedding reception’.
The second is the possible impact more graphic warnings might have on women who have already drunk alcohol before discovering they are pregnant. As the Canadian study notes: ‘In particular, the language of these messages must be chosen carefully, so as not to cause unintended stress in women who consume low levels of alcohol in the time between conception and becoming aware that they are pregnant. If warnings about drinking in pregnancy are worded to imply that any alcohol use can cause serious harm to the fetus, there is some fear that women who drink lightly during the first few weeks of their pregnancy may choose to abort, even though the chances of serious birth defects are very small.’
Shifting social norms
So is there any more we can do to reduce the risk of FASD, which many experts see as one of the most common causes of developmental and intellectual disabilities in children?
While the Canadian research questions the efficacy of AWLs used in isolation it nonetheless concludes that, ‘AWLs can help shift social norms over the long term when they are combined and integrated with other educational, policy and programmatic initiatives.’
This is why, among other initiatives, Wednesday’s FASD Awareness Day is an important opportunity to help educate the public – and women of child-bearing age in particular – of the risks associated with drinking during pregnancy. Now may be a little late to plan a major initiative for 2015 but there are lots of small scale ideas to be found on the International FASD Awareness Day website and there are lots of ways in which you can join in events being organised by national FASD campaigning organisations.
Shifting social norms has been compared to turning the Titanic but who knows maybe even actors and programme makers will join in one day and when I sit down to watch the next series of Witnesses even Sandra will say, ‘Non, merci’ to that glass of red wine.