Alcohol consumption during pregnancy - an important but sensitive topic, with challenges for researchers

By Dr. Annette Binder

Consumption of alcohol is common in many societies and related to various occasions, especially in the context of leisure and festivities. As gender roles have changed, women's consumption patterns have become similar to men's in many countries. In case of deviant behavior, such as drunkenness in public, women are criticized more harshly, and stigmatization is experienced more frequently. This is also mirrored in higher self-stigmatization among women with alcohol dependence in comparison to men. This is also of great relevance with regards to health services and health services research, as we have shown at the example of alcohol consumption during pregnancy.

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorder (FASD). From this point of view, complete abstinence is recommended during pregnancy in order to minimize risks for the foetus. Research shows that the public stigma is particularly intense when it comes to alcohol consumption during pregnancy and that there is evidence that health professionals often do not address alcohol use for fear of stigmatizing women.

In order to develop tailored public health interventions to prevent alcohol use in pregnancy, it is important to understand why and in which situations pregnant women use alcohol, so that psychosocial support for abstinence can be targeted precisely there. This is a challenge for researchers due to the taboo and stigmatization of the topic. Especially when using qualitative approaches, where data is often generated in a social interaction between researchers and participants, such as interviews.

In our study, we therefore tried to shed light on the question of what opportunities and challenges two different methods of data collection offer. In the context of a stigmatized subject area, it is particularly important to compare data generated in interaction with researchers and data generated independently of a research process. We used existing discussions from online forums and interviews as data sources and conducted a grounded theory analysis for each of them. Then a discursive comparison of the results was performed with focus on the following: (1) sampling issues, (2) comparability and (3) risks for participants and researchers.

Our results show that both data sources can be used to obtain similar thematic results on reasons for consumption and situations in which alcohol was used. However, it became clear (1) that significantly more effort and prior knowledge was required for the recruitment of interview partners, while the so-called natural data from the online forums had emerged independently of the research process and were therefore already available. (2) Differences between the data sources occurred particularly in the type of communication. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. In addition, (3) it became clear that the efforts to recruit for interviews on this sensitive topic can already pose risks or at least burdens for potential participants. This may be due to the fact that people with potentially stigmatized behavior such as alcohol consumption during pregnancy may fall into self-stigmatizing thought patterns when confronted with the topic. In the recruitment phase, it is not always possible to offer relief or support to the potential participants, as we observed that the stress in our study ended with potential participants breaking off contact to the research team. In addition, for both types of data, we found burdens on researchers during the data collection and analysis phases, although it varied by data type. In the analysis of the forums, especially the confrontation with extreme opinions and information about consumption of burdened women was difficult for the researchers. While in the process of conducting the interviews, maintaining the neutral role was difficult when it came to self-deprecation, which was especially true for researchers who also work therapeutically.

Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.

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Article Details
Researching Alcohol Consumption During Pregnancy. Opportunities and Challenges With Two Methods of Data Acquisition
Annette Binder, Christine Preiser, Sara Hanke, Meryem Banabak, Clara Huber, Kay Uwe Petersen, and Anil Batra
First published online August 25, 2022
DOI: 10.1177/10497323221119005
Qualitative Health Research

About the Author

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Dr. Annette Binder is a Medical Doctor working at the University Hospital for Psychiatry and Psychotherapy, Department of General psychiatry and psychotherapy with polyclinic, Section of Addiction research and Addiction Medicine of the University Hospital Tübingen, Germany. Her overall research interests are Health Services Research in the field of addiction research and Qualitative Research Methods. Consistent with these interests, some of her specific research areas are as follows: With regard to alcohol consumption during pregnancy, her current research focuses on the effects of current public health measures on women, especially negative effects such as stigmatization, and the development of effective preventive measures. Previously, the focus was on reasons for use during pregnancy, situations of use, and the role of health professionals. Another research focus is the addiction medicine care of patients with ethyl-toxic cirrhosis and the indication for liver transplantation. In particular, she investigates the addiction-specific care structures in Germany and ethical aspects within the framework of the laws regarding the allocation for liver transplantation. On a methodological level, an important goal is researching and developing qualitative research approaches that can be applied in the field of addiction research to stigmatized and sensitive topics. In doing so, research ethics aspects are also an important concern for her.