'Why take chances?' Advice on alcohol intake to pregnant and non-pregnant women in four Nordic countries

In this article we explore the construction of risk in government guidelines on alcohol intake during and before pregnancy in four Nordic countries given that there is no sound evidence linking a low level of alcohol intake during pregnancy to foetal harm. In the article we draw on two sources of data to examine the rationale behind the advice given to pregnant women: health education materials and other government documents, such as guidelines for professionals. We found that in all the four countries the government guidelines advised pregnant women to completely abstain from alcohol consumption, but there was some variation between the countries in the advice for non-pregnant women. The guidance in the four countries also differed in the extent to which they discussed the lack of evidence behind the abstinence advice and the precautionary approach on which the advice was based. In all the four countries the printed and widely circulated health education materials did not explain that the abstinence advice was not based on actual evidence of harm but on a precautionary approach. The other government documents adopted varying strategies for justifying the abstinence advice including not offering information about the uncertainty of the knowledge base, implying that there was evidence that low alcohol consumption was harmful to the foetus, acknowledging that a safe level of alcohol intake during pregnancy could not be specified and explaining the precautionary approach to risk. In this article we argue that the shift from 'estimation of risk' to the 'precautionary principle' is a part of a wider socio-cultural push towards broader employment of the precautionary principle as a strategy to manage uncertainty, and in the context of pregnancy, it is a part of the symbolic struggle to protect the purity of the foetus and construct the 'perfect mother'.