NICE’s proposal to record pregnant women’s alcohol consumption ignores potential detrimental effects

Olivia Miller
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In response to the announcement that the National Institute for Health and Care Excellence (NICE) is considering the introduction of a Quality Standard to record pregnant women’s alcohol consumption on their child’s medical records in England, Professor Ellie Lee, Director of Kent’s Centre for Parenting Culture Studies, said:

‘The proposition in this Quality Standard is to establish a system of ongoing monitoring and recording of the detail of any and all alcohol consumption on the part of all pregnant women through the Health Service, which is then carried forward into a child’s health record once born. The basis on which this system of surveillance of the entire population of pregnant women will bring the significant advantages to children and families who may be impacted by fetal alcohol spectrum disorders (FASD), remains currently unclear.

‘It is readily apparent from evidence submitted to NICE, and in the wider discussion and literature on the subject, that the main group seeking greater support for the impact of childhood disability are parents, carers and children involved with adoption. The inadequacies of present support including in educational provision are very serious and must be addressed, and full and due consideration should be given to much more specific and targeted approach. This is not what the Quality Standard proposes.

‘Unfortunately, in what is proposed instead, the potentially detrimental effects for pregnant women are ignored. The problematic implications of using resources to establish a system directed at the general population of pregnant women need to be subjected to proper examination. Precautionary advice to avoid alcohol should not be translated into the message to women, backed up by a recording system set out in the Quality Standard, that low levels of alcohol consumption is the cause of a wide variety of childhood disabilities. To do so is to:

  1. Depart radically from the necessity of communicating the basis for precautionary advice as what it is, which is an absence of evidence of a causal relation between childhood disability and all consumption of alcohol before and during pregnancy.
  2. Deny to women their autonomy in assessing this risk and making judgements regarding pregnancy on the basis of accurate information provided to them.
  3. Cause unnecessary anxiety, worry and self-blame during pregnancy and after birth about child health and development, which is already recognised to be a significant burden to women.
  4. Generate specific anxiety regarding the policing character of interactions with health care professionals who women look to, to help them.
  5. Waste valuable time in appointments where woman have many other concerns they would prefer to seek help for and spend time discussing.’

Ellie Lee is Professor of Family and Parenting Research and Director of the Centre for Parenting Culture Studies. Ellie researches, publishes and teaches in the areas of the sociology of reproduction, of health, and of the family. Her research and teaching draws on constructionist theories of social problems and sociological concepts such as risk consciousness and medicalisation to analyse the evolution of family policy and health policy.