WRISK was funded by the Wellcome Trust to explore women’s experiences of risk messaging in pregnancy, and develop recommendations to align public health messages with women’s needs and lived experiences. Principal Investigator Clare Murphy talks to the SSA’s Natalie Davies about the potential unintended consequences of ‘abstinence-only’ messages for pregnant women, and why public health messages for pregnant women need to be re-calibrated.
The WRISK project was a collaboration between the British Pregnancy Advisory Service and academics from Cardiff University, that ran between November 2018 and June 2021. The project emerged from a growing concern that public health messages for women who are planning a pregnancy or who are pregnant:
- do not always fully reflect or explain the evidence base underpinning them
- can make weighing up and evaluating different sorts of risks in pregnancy confusing, overwhelming, and disempowering
- can negatively affect women’s experiences of pregnancy and motherhood
- can contribute to wider culture of parenting that tends to blame mothers for all less-than-ideal outcomes in their children
Clare Murphy, Principal Investigator of WRISK and Chief Executive of the British Pregnancy Advisory Service (BPAS), spoke to the SSA in September about some of the negative experiences reported by women that inspired the group to help improve public health messages around risk in pregnancy.
Unintended consequences of risk messages
BPAS has been supporting women’s rights to make their own decisions in and around pregnancy for 50 years, and provides a range of services through its network of reproductive healthcare centres, from abortion advice and treatment, to pregnancy testing, counselling, screening for sexually transmitted infections, and contraception. Clare said that BPAS had “long been aware through presentations of women with unplanned pregnancies about the way that some risk messages played out for women”.
“We saw women who were coming who felt this wasn’t necessarily the right time in their life to have a pregnancy. But, what was really tipping them over into considering an abortion was concerns they had about their alcohol consumption before they knew they were pregnant. So I suppose that was one aspect that made us question some of the ways in which we communicate risk in pregnancy.”
She explained that these women’s fears could be attributed, at least in part, to the “shift that we’ve seen to the abstinence message in recent years”; to “the idea that no alcohol in pregnancy is safe”.
UK drinking guidelines for pregnant women changed in around 2016 – from advising women about how to reduce their risk of harm if they drink, to advising women that they should abstain from alcohol altogether because the potential for harm is too great. This change in tone from an informed choice approach to a precautionary approach was not due to new evidence about the risks of light to moderate drinking in pregnancy, but rather a change in the way experts interpreted and applied the evidence.
For Clare and colleagues, public health messages around alcohol in pregnancy were clearly being delivered “with all the right reasons”, but they were potentially having serious unintended consequences, particularly for women who have unplanned pregnancies.
“BPAS was seeing some of the very real concerns, practical concerns, of what happens when women’s own health needs aren’t necessarily always taken into account, and risk isn’t communicated in an effective way. That was what we brought to the table with the WRISK project.”
In the UK, around half of pregnancies are unplanned. For women in this situation, there will be a gap (typically of several weeks) between when they conceive and when they find out they are pregnant. During this time, they may have been drinking, which is a normal activity for many adults in the general population. Although public health experts might say that abstinence-only advice still applies – that women should stop drinking as soon as they know they are pregnant – for women at the receiving end of the advice, they may think that they have already risked (or caused) immense and irreversible harm to their pregnancy.
What can we expect from the WRISK project?
As the WRISK website explains, “Women who are planning a pregnancy or who are pregnant receive many public health messages that are intended to guide their decision making. […] These messages are intended to improve outcomes for babies and mothers. However, there is growing concern that messages do not always fully reflect or explain the evidence base underpinning them”.
Over the last two years, Clare and colleagues from WRISK have been working to gather women’s voices and stories, consider the lessons that can be learned, and develop recommendations for better risk communication in pregnancy. Clare told the SSA that they expect to publish their findings in the next six months, and are optimistic that this work will help to bring about changes in the way risk in pregnancy is communicated to women:
“The WRISK project was really looking at mapping the risk journey of how pregnancy messages get constructed – where the pinch points are – and actually, working together to establish how we can improve those messages. How we can ensure women get evidence-based information that they can act on.”
“We really hope that our findings help us to recalibrate some of these messages, and start thinking about the consequences of when we don’t get risk messaging right. And hopefully help us develop more woman-centred messages that enable us to do as we all want, which is to ensure that women have the healthy pregnancies that they want.”
“We all want the same thing”, said Clare, “which is to give women the information and capacity to protect their own health and that of their pregnancy.”
To hear some of the emerging findings and conclusions from WRISK, watch this three-minute video:
Clare Murphy is the Principal Investigator of WRISK, and Chief Executive of the British Pregnancy Advisory Service (BPAS), which is an independent healthcare charity that supports women’s rights to make their own decisions in and around pregnancy. In 2019, BPAS established the Centre for Reproductive Research & Communication (CRRC), which aims to develop and deliver a research agenda that furthers access to evidence-based reproductive healthcare and choices.
This article was published as part of The Pregnancy Edit for September 2021. If you are interested in writing a blog or participating in an interview about alcohol-related harm in pregnancy for the SSA website, please contact Natalie Davies at natalie@addiction-ssa.org.
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