Reducing harm caused by alcohol


NICE Guidelines on FASD: Surveillance or Support?

NICE’s consultation on new guidance on preventing Fetal Alcohol Spectrum Disorders (FASD) has made headlines, with disagreement on whether health data can and should be shared. How can we ensure people with FASD get support while supporting women’s health?

The National Institute for Clinical Excellence (NICE) is consulting on guidance which calls for data on mothers’ alcohol consumption in pregnancy to be shared with GPs and other health practitioners. The British Pregnancy Advisory Service (BPAS) has voiced concerns about how mothers’ consent to data sharing will be managed under the proposals, while Adoption UK argued problems identifying people with FASD and supporting them requires systematic action.

We know from international data that without early identification and support, people with FASD can experience profound difficulties: one third have been imprisoned as adolescents, 94% experience mental health issues and life expectancy without support is just 34 years. Clearly we need to make sure that FASD is identified and people with FASD are supported from early in their lives.

FASD isn’t the only possible consequence of drinking during pregnancy. Alcohol-exposed pregnancy carries higher risks of wider health issues for mothers and babies such as miscarriage, premature, low birth-weight and longer-term developmental harm.  But in a country where most people consume alcohol and 45% of pregnancies are unplanned there’s a real risk of people drinking without knowing they are pregnant.

Broadly speaking there are two ways we can help avoid alcohol-exposed pregnancies. First is helping people avoid getting pregnant if they choose, and second is helping them stop drinking when they are pregnant.

Scotland’s National Preconception Framework is currently being developed to help this situation. Better access to family planning services and contraception is one element of the framework. Another is ensuring that family and friends can help support healthy choices, for example by not drinking around someone who is pregnant, or trying to get pregnant.

Working with Women

Working with women is vital. Everyone wants their child to lead a happy, healthy life. But parents are people too, and many people in Scotland experience problems with drinking. If someone finds themselves pregnant and struggling with their drinking they should be able to access proper support for themselves, and the pregnancy if they choose to continue it.

Problems with alcohol come about for many reasons and recovery needs support. Access to alcohol services was a problem before COVID, with a 2014 report suggesting only 1 in 8 people living in Scotland accessed support for an alcohol problem. But with the crisis causing many people to increase their drinking, there is a real possibility those services will be squeezed even further.

Women who struggle to stop drinking during pregnancy need support to help them regain their lives – good support can transform people’s situations. There needs to be respect for women’s own needs and rights; before, during and after pregnancy. Recovery starts with respect and women facing pregnancy at the same time as an alcohol problem should expect nothing less.

General Prevention

We know there is no safe amount of alcohol to consume during pregnancy. This isn’t to panic people, it’s to recognise the importance of planning contraception and helping people to stop drinking if they choose to get pregnant.

A lot of the media coverage of the NICE guidelines focussed on women’s capacity to make their own decisions – as we said above, that’s something that healthcare has to preserve and respect.

Making healthy decisions means having access to good information. Recent research by the Alcohol Health Alliance UK found that while many products included a pictorial warning, only 15% of alcohol products provided a written explanation of the risks of drinking during pregnancy, and all of these were illegibly small.

So while we know there’s no safe amount to drink during pregnancy, we need alcohol producers to ensure their products give people information to help encourage healthy decisions.

Helping women plan their own lives with healthcare that works for them is crucial. But just as women should be able to rely on excellent healthcare tailored to them, we should all expect alcohol producers to promote health, not just profit. That can start with labelling.


23 September 2020.