The rise of the total abstinence model. Recommendations regarding alcohol use during pregnancy in Finland and Denmark
AIMS - Adverse effects of alcohol on the fetus are currently defined as a serious public health problem in all western countries. Exposure of the fetus to alcohol may result in a spectrum of adverse effects, referred to collectively as fetal alcohol spectrum disorders (FASD). Different countries vary in terms of policy regarding alcohol consumption during pregnancy. This paper sets out to examine and compare official recommendations on alcohol intake during pregnancy in Finland and Denmark since the 1970s. In addition, the paper analyses the rationale behind these recommendations. METHODS AND DATA - The method used is qualitative content analysis. The data consists of 1) health education material for pregnant women and 2) reports and guidelines produced by government health authorities. The data comes from Finland and Denmark and covers the period between the 1970's and today. RESULTS - The article demonstrates how the official Finnish and Danish recommendations regarding alcohol intake during pregnancy have in the last decades fluctuated between a more permissive and a total abstinence approach. Both countries have recently adopted a total abstinence message. This policy line is not, however, based on research evidence pertaining to the harmfulness of a small-to-moderate alcohol intake during pregnancy but rather on the principle of precaution. The Finnish data contains very little information about the background of the changing recommendations whereas the Danish trajectories are explained in policy documents and expert debates. The paper suggests that the recent adoption of a total abstinence message in Finland and Denmark is closely linked to a change in the social and cultural climate regarding FASD. Moreover, it is argued that the adoption of the total abstinence model in Finland and Denmark is part of a wider international trend. CONCLUSIONS - The knowledge gap with regards to the fetal effect of low-to-moderate levels of alcohol consumption combined with an urge to protect the fetus makes the formulation of health education messages complicated. The paper discusses problematic features in the current Finnish and Danish policy arguing that the recommendations to pregnant women contain contradictory elements. Future research should focus on women's and health professionals' risk perceptions and international trends with regards to the total abstinence model.