EXPERT REACTION: Pregnancy warning labels on alcohol
Organisation/s: The University of Queensland, Monash University, Public Health Association Australia, Curtin University, The University of Sydney
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Changes to the labelling of products containing alcohol to make consumers aware of the dangers to pregnant women will now become mandatory. Agreement has been reached with ministers from Australia and New Zealand to implement these changes in as short a time frame as is practicable.
Pregnancy warning labels have been a recommendation since 2011 and the producers of up to 75% of alcoholic beverages are already doing the right thing. Notably, some products like premixed drinks have been slow to take up the recommendations which were previously not legislated requirements.
It is anticipated that the warnings will be in both the written form and diagrammatic representation to make sure the message is easily understood by all pregnant women including those for whom English is not the primary language.
Currently, around one third of all Australian women drink at least some alcohol during pregnancy.
This may well just represent the fact that more than 50% of all pregnancies in Australia are unplanned and women are not aware of their pregnancy status, especially in the first trimester. For this reason, associated education programs to make young women aware of the potential problems caused by alcohol consumption during pregnancy must become an important adjunct to product labelling.
Alcohol has a number of deleterious effects on the developing fetus. An affected child can have an abnormal appearance with a small head, characteristic facial features as well as intellectual impairment, behavioural difficulties and problems with hearing and sight. Based on international studies, it has been proposed that Fetal alcohol spectrum disorder (FASD), affects around 2-5% of the general population but figures as high as 12% have been reported in some high risk indigenous communities.
Not only can alcohol affect the child whose mother drinks, but because it causes a direct and permanent genetic effect, these adverse changes will be passed on to future generations as well.
Unfortunately, we already know that people with FASD are disproportionately represented in those having interaction with the criminal justice system and child protection authorities.
FASD is not currently recognised as a disability in Australia meaning access to early intervention programs which have been shown to help psychological development and improved behaviour are difficult to access and not necessarily covered by the NDIS.
Increasing awareness of the dangers of drinking while pregnant will hopefully lessen the burden of suffering those affected and their families will have to endure.
In 2012, the House of Reps Standing Committee on Social Policy and Legal Affairs held an inquiry into fetal alcohol syndrome, and recommended the introduction of mandatory warning labels advising women not to drink while pregnant or planning a pregnancy. The Committee recommended that the Commonwealth government should implement these warning labels by 1 October 2013.
The fact that it has taken 5 years to get any action on mandatory alcohol warning labels reflects the power of the alcohol lobby, which prioritises profits over Australia’s children. What else can explain 5 years of inaction? Women contemplating pregnancy deserve clear information about how to reduce lifelong risks to the health of their children. The Commonwealth Government should get on with it. If the alcohol industry doesn’t want Australian women to drink while pregnant, then what possible objections could they have?
The Public Health Advocacy Institute (PHAIWA) based at Curtin University welcomes the decision of the Australia and New Zealand Ministerial Forum on Food regulation to enforce mandatory pregnancy labelling on alcohol, in a bid to reduce harm to unborn babies and newborns.
While the prevailing social norm is for women to avoid alcohol during pregnancy, some believe that consuming small amounts of alcohol occasionally during pregnancy may be not considered harmful.
Fetal Alcohol Spectrum Disorder (FASD) is the most common and preventable cause of serious brain injury in children in Australia. There is no cure for FASD, so prevention is everything.
The new mandatory labels will ensure that all alcohol producers must comply with the system and will give consumers a more effective warning of the risks of drinking alcohol. PHAIWA recommends that the labelling should coincide with a comprehensive national public education campaign.
This is an important outcome. Preventing fetal alcohol spectrum disorders is a critical public health goal for all Australians. Providing critical health information at a key point - on alcohol packaging - informs those most at risk.
Evidence indicates that more people will become aware of risks of drinking during pregnancy and this important step can be part of an effective integrated strategy to prevent unborn children being exposed to alcohol related problems that stay with them for life. The Ministerial Forum should be congratulated.
This is welcome news and hopefully the first step in a broader range of warnings that should be included on alcohol labels. In the USA the labelling system is much more extensive than the system proposed for Australia. USA labels warn about the range of cancers that are associated with alcohol consumption, and violence as well as other diseases that have been causally associated with alcohol use. The situation where Australian companies selling alcohol in the USA have warning labels, but the same company selling the same form of alcohol in Australia contains no warning, needed to be addressed.
A recent review of relevant research noted that, for a number of diseases, there is a dose response association between alcohol consumption and adverse health outcomes. Thus a new aspect of the warning regime is to emphasise that only targeting moderate to heavy consumption is not consistent with the evidence. It is important here to anticipate the response of industry who argue that 'normal' consumption is safe, only excessive consumption leads to health problems.
Alcohol use is harmful in a variety of ways and, on the best evidence we have, the overall level of harm following moderate levels of consumption is greater that the harm associated with high levels of consumption, simply because of the greater numbers who consume at moderate levels.
For women who are planning a pregnancy, are pregnant or are breastfeeding, not drinking is the safest option. Alcohol puts not only the women at risk but also their babies. We don’t know how much (if anything) women can actually drink without putting their babies in risk. There are limitations in the available scientific evidence, which makes it difficult to have a ‘safe’ or ‘no-risk’ drinking level during pregnancy.
However, some recent studies have started to show that the risks to the fetus from low-level drinking (such as one or two drinks per week) during pregnancy are likely to be low. It is important to point out that most studies have investigated short outcomes such as fetal malformations at or soon after birth, but we need to also think about the long-term consequences.
So a conservative approach has been taken in recommending that ‘not drinking alcohol is the safest option’. It is important that women are referred to the appropriate services and seek further advice from health professionals.
The ministers who have agreed to this reform should be congratulated with particular recognition to WA Health minister Roger Cook who initiated this action. It’s important to provide Australian women who are pregnant, or considering pregnancy, with clear and accurate advice about the risks of drinking during pregnancy, with Foetal Alcohol Spectrum Disorder (FASD) being the most significant.
This is a small but helpful step in tackling Foetal Alcohol Spectrum Disorder, however more work on this terrible scourge is needed, particularly in some remote communities where incidence is very high.
The new mandatory labels will ensure that all alcohol producers must comply with the system, and will give consumers a more effective warning of the risks of drinking alcohol.
The next logical step for alcohol warning labels is for Australia to follow Ireland’s lead and introduce mandatory labels which warn of the risks associated between drinking alcohol and developing cancer.
Having pregnancy warning labelling developed and implemented by our national food regulation body, Food Standards Australia New Zealand (FSANZ), and not industry, is the result we lobbied for and have achieved.
Credit should be given to the McGowan Government, all the advocacy groups and researchers who have worked to ensure this positive outcome to support pregnant women all over Australia.
This move is vital to maintain constant education and awareness of the risks of drinking during all stages of pregnancy. The commitment to place this warning front of label as standard practice is highly commendable.
It’s critical that the messaging and imagery to be used on the label is developed according to the best and most up-to-date evidence available. There is now an abundance of high quality research available to underpin clear and effective messaging that we can’t ignore going forward.
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