Barriers and facilitators of alcohol abstinence during pregnancy

Ismail A. Rawoot, Chantelle J. Scott, Michael F. Urban

Abstract

Fetal Alcohol Spectrum Disorders (FASD) is a common and under-recognised health burden in South Africa. There is a limited understanding of why pregnant women drink in the South African context, particularly in rural settings, where the prevalence of FASD is highest. A purposive sample included eight women from a rural ante-natal clinic in the Northern Cape province of South Africa. Participants participated in a semi-structured interview. A process of thematic analysis was used to generate themes from the interviews. All participants were aware of the link between alcohol use during pregnancy and adverse fetal outcomes. Furthermore, most participants reduced drinking after pregnancy recognition. Participants described barriers and facilitators of alcohol abstinence. Barriers included social pressure, life stressors, and cravings and habits. Facilitators included the desire to avoid FASD, supportive relationships, availability of alternative activities. Addressing barriers at community and individual levels may aid women in reducing harmful drinking during pregnancy. (Afr J Reprod Health 2022; 26[8]: 53-65).

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References

Olivier L, Curfs LMG and Viljoen DL. Fetal alcohol

spectrum disorders: Prevalence rates in South Africa.

South African Medical Journal. 2016;106(6):103.

doi:10.7196/SAMJ.2016.v106i6.11009

Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley

D, Marais AS, Manning MA, Robinson LK, Adam

MP, Abdul-Rahman O, Jewett T, Chambers C, Jones

KL, Riley EP, Charness ME, Warren KR and May

PA. Updated clinical guidelines for diagnosing fetal

alcohol spectrum disorders. Pediatrics. 2016;138(2).

doi:10.1542/peds.2015-4256

May PA, Vries MM de, Marais A susan, Kalberg WO,

Adnams CM, Hasken JM, Tabachnick B, Robinson

LK, Manning MA, Lyons K, Hoyme D, Seedat S,

Parry CDH and Hoyme HE. The continuum of fetal

alcohol spectrum disorders in four rural communities

in South Africa: Prevalence and characteristics.

;159:207-218.

May P, de Vries M, Marais AS, Kalberg W, Buckley D,

Adnams C, Hasken J, Tabachnick B, Robinson L,

Manning M, Bezuidenhout H, Adam M, Jones K,

Seedat S, Parry C and Hoyme H. Replication of High

Fetal Alcohol Spectrum Disorders Prevalence Rates,

Child Characteristics, and Maternal Risk Factors in a

Second Sample of Rural Communities in South

Africa. International Journal of Environmental

Research and Public Health. 2017;14(5):522.

doi:10.3390/ijerph14050522

Popova S, Lange S, Probst C, Gmel G and Rehm J.

Estimation of national, regional, and global

prevalence of alcohol use during pregnancy and fetal

alcohol syndrome: a systematic review and meta-analysis. Published online 2017:290-299.

doi:10.1016/S2214-109X(17)30021-9

Waterman E, Pruett D and Caughey A. Reducing Fetal

Alcohol Exposure in the United States. Obstetrical

and Gynecological Survey. 2013;68(5):367-378.

doi:10.1097/00019616-200203000-00015

May PA, Gossage JP, Marais AS, Hendricks LS, Snell CL,

Tabachnick BG, Stellavato C, Buckley DG, Brooke

LE and Viljoen DL. Maternal Risk Factors for Fetal

Alcohol Syndrome and Partial Fetal Alcohol

Syndrome in South Africa: A Third Study.

Alcoholism: Clinical and Experimental Research.

;32(5):738-753. doi:10.1111/j.1530-

2008.00634.x

May P and Gossage J. Maternal risk factors for Fetal Alcohol

Spectrum disorders: Not as simple as it may seem.

Alcohol Research and Health. 2011;34(1):15-26.

May PA, Gossage JP, Brooke LE, Snell CL, Marais AS,

Hendricks LS, Croxford JA and Viljoen DL.

Maternal risk factors for fetal alcohol syndrome in

the Western Cape Province of South Africa: A

population-based study. American Journal of Public

Health. 2005;95(7):1190-1199.

doi:10.2105/AJPH.2003.037093

Morojele NK, London L, Olorunju SA, Matjila MJ, Davids

AS and Rendall-Mkosi KM. Predictors of risk of

alcohol-exposed pregnancies among women in an

urban and a rural area of South Africa. Social Science

and Medicine. 2010;70(4):534-542. doi:10.1016/j.socscimed.2009.10.040

Peltzer K, Davids A and Njuho P. Alcohol use and problem

drinking in South Africa: findings from a national

population-based survey. 2011;1:30-37.

Cloete L and Ramugondo E. “I drink”: Mothers’ alcohol

consumption as both individualised and imposed

occupation. South African Journal of Occupational

Therapy. 2015;45(1). doi:10.17159/2310-

/2015/v45no1a6

Choi KW, Watt MH, MacFarlane JC, Sikkema KJ, Skinner

D, Pieterse D and Kalichman SC. Drinking in the

context of life stressors: a multidimensional coping

strategy among south african women. Substance Use

& Misuse. 2014;49(1-2):66-76.

doi:10.1016/j.neuron.2009.10.017.A

Watt MH, Eaton LA, Choi KW, Velloza J, Kalichman SC,

Skinner D and Sikkema KJ. “It’s better for me to

drink, at least the stress is going away”: Perspectives

on alcohol use during pregnancy among South

African women attending drinking establishments.

Social Science and Medicine. 2014;116:119-125.

doi:10.1016/j.socscimed.2014.06.048

Watt MH, Eaton LA, Dennis AC, Choi KW, Kalichman

SC, Skinner D and Sikkema KJ. Alcohol Use During

Pregnancy in a South African Community:

Reconciling Knowledge, Norms, and Personal

Experience. Maternal and Child Health Journal.

;20(1). doi:10.1007/s10995-015-1800-4

Cloete L. Developing Appropriate FASD Prevention

Initiatives within a Rural Community in SA.

University of Cape Town; 2012.

Meurk CS, Broom A, Adams J, Hall W and Lucke J.

Factors influencing women’s decisions to drink

alcohol during pregnancy: Findings of a qualitative

study with implications for health communication.

BMC Pregnancy and Childbirth. 2014;14(1).

doi:10.1186/1471-2393-14-246

Holland K, McCallum K and Walton A. ‘I’m not clear on

what the risk is’: women’s reflexive negotiations of

uncertainty about alcohol during pregnancy. Health,

Risk and Society. 2016;18(1-2):38-58.

doi:10.1080/13698575.2016.1166186

Fletcher O v, May PA, Seedat S, Sikkema KJ and Watt MH.

Attitudes toward alcohol use during pregnancy

among women recruited from alcohol-serving

venues in Cape Town, South Africa: A mixed-

Rawoot et al. Factors affecting alcohol abstinence during pregnancyAfrican Journal of Reproductive Health August 2022; 26 (8): 64methods study. Social Science and Medicine.

;215(August):98-106.

doi:10.1016/j.socscimed.2018.09.008

Falletisch LA. Understanding the legacy of dependency

and powerlessness experienced by farm workers on

wine farms in the Western Cape. 2008;(March).

About Occupational Therapy | WFOT. Accessed August

, 2020. https://www.wfot.org/about/aboutoccupational-therapy

Sibanda-Moyo N, Khonje E and Kyerewaa Brobbey M. A

COUNTRY IN CRISIS 2017 Centre for the Study of

Violence and Reconciliation.; 2017.

www.csvr.org.za

Perry EC and Jaggernath J. Violence against women,

vulnerabilities and disempowerment: Multiple and

interrelated impacts on achieving the Millennium

Development Goals in South Africa.

https://doi.org/101080/101309502012674280.

;26(1):20-32.

doi:10.1080/10130950.2012.674280

Graaff K and Heinecken L. Masculinities and gender-based

violence in South Africa: A study of a masculinitiesfocused intervention programme.

http://dx.doi.org/101080/0376835X20171334537.

;34(5):622-634. doi:10.1080/0376835X.2017.1334537

Mpani P and Nsibande N. Understanding Gender Policy

and Gender-Based Violence in South Africa.; 2015.

Accessed August 15, 2020.

https://www.soulcity.org.za/campaigns/gbv/resourc

es/understanding-gender-policy-and-gender-basedviolence-in-south-africa-a-literature-review

Willig C. Introducing Qualitative Research in Psychology.

Educational and Psychological Measurement.

;64(2):266. doi:10.1177/0013164403258451

Todres L. Qualitative research in Health Care. In:

Holloway I, ed. BMJ. Vol 1. 1st ed. Open University

Press; 2005:104-122.

de Bruin W and van Wyk N. Kareeberg Municipality

Integrated Development Plan 2017-2022.; 2017.

Statistics South Africa. Carnarvon Census 2011. Published

Accessed December 7, 2019.

http://www.statssa.gov.za/?page_id=4286&id=6956

van Wyk N and Manuel M. Kareeberg Municipality

Integrated Develoment Plan 2017-2022 - 2nd Review

- 2019/20.; 2019.

doi:http://www.kareeberg.co.za/Docs/doc/IDP/KAR

%20IDP%202017-2022%20-

%20Review%202%20-%202019-

%20Final%20to%20Council%20May_2019%20

V3.pdf

Braun V and Clarke V. Using thematic analysis in

psychology. Qualitative Research in Psychology.

;3:77-101.

Yanos PT and Ziedonis DM. The Patient-Oriented

Clinician-Researcher: Advantages and Challenges of

Being a Double Agent. Psychiatric Services.

;57(2):249-253. doi:10.1176/appi.ps.57.2.249

Brody H and Miller FG. The Clinician-Investigator:

Unavoidable but Manageable Tension. Kennedy

Institute of Ethics Journal. 2003;13(4):329-346.

doi:10.1353/ken.2004.0003

Hay-Smith EJC, Brown M, Anderson L and Treharne GJ.

Once a clinician, always a clinician: a systematic

review to develop a typology of clinician-researcher

dual-role experiences in health research with patientparticipants. BMC Medical Research Methodology.

;16(1):1-17. doi:10.1186/s12874-016-0203-6

Onsongo KJ and Musundi MS. A Guide to Gender -

Sensitive Research Methodology The Forum for

African Women Educationalists (FAWE) and the

Norwegian Agency for Development Cooperation

(Norad) A Guide to Gender-Sensitive Research

Methodology Prepared. 2013;(April).

Leduc B, Gurung MB and Diederik P. Guidelines for

gender sensitive training. The International Centre

for Integrated Mountain Development.

;(November):5.

Karnieli-Miller O, Strier R and Pessach L. Power Relations

in Qualitative Research. Qualitative Health Research

Qualitative Health Research. 2008;19(2):279-289.

Blackstone A. Principles of Sociological Inquiry:

Qualitative and Quantitative Methods. Published

online 2002:236.

Nowell LS, Norris JM, White DE and Moules NJ. Thematic

Analysis: Striving to Meet the Trustworthiness

Criteria. International Journal of Qualitative

Methods. 2017;16(1):1-13.

doi:10.1177/1609406917733847

O’Brien BC, Harris IB, Beckman TJ, Reed DA and Cook

DA. Standards for reporting qualitative research: A

synthesis of recommendations. Academic Medicine.

;89(9):1245-1251.

doi:10.1097/ACM.0000000000000388

Tong A, Sainsbury P and Craig J. Consolidated criteria for

reporting qualitative research (COREQ): A 32-item

checklist for interviews and focus groups.

International Journal for Quality in Health Care.

;19(6):349-357. doi:10.1093/intqhc/mzm042

Chavez PR, Nelson DE, Naimi TS and Brewer RD. Impact

of a new gender-specific definition for binge

drinking on prevalence estimates for women.

American Journal of Preventive Medicine.

;40(4):468-471. doi:10.1016/j.amepre.2010.12.008

Institute on Alcohol Abuse N. NIH. Turning Discovery Into

Health ® National Institute on Alcohol Abuse and

Alcoholism Alcohol Facts and Statistics.

ABInBev. Guide to our beers | Tap Into Your Beer.

Accessed June 15, 2020.

https://www.tapintoyourbeer.com/guide-ourbeers?rg=rg4

Urban MF, Olivier L, Louw JG, Lombard C, Viljoen DL,

Scorgie F, and Chersich MF. Changes in drinking

patterns during and after pregnancy among mothers

of children with fetal alcohol syndrome: A study in

three districts of South Africa. Drug and Alcohol

Dependence. 2016;168:13-21.

doi:10.1016/j.drugalcdep.2016.08.629

Choi KW, Abler LA, Watt MH, Eaton LA, Kalichman SC,

Rawoot et al. Factors affecting alcohol abstinence during pregnancy

African Journal of Reproductive Health August 2022; 26 (8): 65

Skinner D, Pieterse D and Sikkema KJ. Drinking

before and after pregnancy recognition among South

African women: the moderating role of traumatic

experiences. BMC Pregnancy and Childbirth.

;14(1):97. doi:10.1186/1471-2393-14-97

Chersich MF, Urban M, Olivier L, Davies LA, Chetty C

and Viljoen D. Universal prevention is associated

with lower prevalence of fetal alcohol spectrum

disorders in Northern cape, South africa: A

multicentre before-after study. Alcohol and

Alcoholism. 2012;47(1):67-74.

doi:10.1093/alcalc/agr145

Marais S, Jordaan E, Viljoen D, Olivier L, de Waal J and

Poole C. The effect of brief interventions on the

drinking behaviour of pregnant women in a high-risk

rural South African community: A cluster

randomised trial. Early Child Development and

Care. 2011;181(4):463-474.

doi:10.1080/03004430903450392

McBride N and Johnson S. Fathers’ Role in AlcoholExposed Pregnancies. American Journal of

Preventive Medicine. 2016;51(2):240-248.

doi:10.1016/j.amepre.2016.02.009

van der Wulp NY, Hoving C and de Vries H. Partner’s

Influences and Other Correlates of Prenatal Alcohol

Use. Maternal and Child Health Journal.

;19(4):908-916. doi:10.1007/s10995-014-1592-

y

Helman R and Ratele K. Everyday (in)equality at home:

complex constructions of gender in South African

families. Global Health Action. 2016;9(1):31122.

doi:10.3402/gha.v9.31122

Segalo P. Gender, social cohesion and everyday struggles

in South Africa. Psychology in Society.

;(49):70-82.

doi:http://dx.doi.org/10.17159/2309-

/2015/n49a6

Rockliffe L, Peters S, Heazell AEP and Smith DM. Factors

influencing health behaviour change during

pregnancy: a systematic review and meta-synthesis.

Health Psychology Review. 2021;15(4):613-632.

doi:10.1080/17437199.2021.1938632/FORMAT/EP

UB

Olander EK, Smith DM and Darwin Z. Health behaviour

and pregnancy: a time for change. Journal of

Reproductive and Infant Psychology. 2018;36(1):1-

doi:10.1080/02646838.2018.1408965

Olander EK, Darwin ZJ, Atkinson L, Smith DM and

Gardner B. Beyond the “teachable moment” - A

conceptual analysis of women’s perinatal behaviour

change. Women and Birth. 2016;29(3):e67-e71.

doi:10.1016/j.wombi.2015.11.005

Flannery C, Fredrix M, Olander EK, Mcauliffe FM, Byrne

M and Kearney PM. Effectiveness of physical

activity interventions for overweight and obesity

during pregnancy: a systematic review of the content

of behaviour change interventions.

doi:10.1186/s12966-019-0859-5.

Hrynaszkiewicz I, Norton M, Vickers A and Altman D.

Preparing raw clinical data for publication: guidance

for journal editors, authors, and peer reviewers.

Trials. 2010;11(9). doi:10.1186/1745-6215-11-9

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