Ipsos Social Research Institute (Ipsos SRI)
The objective of this research is to establish awareness levels and the current practice of health professionals in relation to the National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol (Alcohol Guidelines).
The Alcohol Guidelines were revised significantly in 2009, with one of the revisions being the removal of a recommended level of alcohol consumption for pregnant or breastfeeding women. The awareness and use of the guidelines for pregnant and breastfeeding women (Guidelines 4a and 4b) are the focus of this research.
Views on the risks of alcohol and pregnancy/breastfeeding
When asked about the risks of alcohol consumption in pregnancy most of the health professionals (70%) identified Fetal Alcohol Spectrum Disorders (FASD) as one of the main risks. When asked about the risks of alcohol consumption while breastfeeding, the answers provided by health professionals were less specific and often related to the baby consuming alcohol indirectly (44%) as well as the impact of alcohol on the mother’s parenting (24%), such as neglect, putting the baby at risk of harm and not being able to properly care for the baby if intoxicated.
Views about the amount of alcohol that can be consumed during pregnancy were generally consistent with the Alcohol Guidelines with 86% of health professionals indicating that for no risk to the fetus, no amount of alcohol could be consumed during pregnancy. This was consistent across all of the professions included.
Discussion of alcohol with patients
The majority of health professionals indicated that they do discuss alcohol consumption with patients/clients who are pregnant for the first time (83%) and those who are pregnant for the second or subsequent time (75%). This proportion dropped for patients who are planning pregnancy (68%) and breastfeeding patients/clients (64%), particularly among General Practitioners (GP) and obstetricians/gynaecologists.
Seven out of ten health professionals said that their usual practice is to assess how much alcohol their pregnant patients/clients consume (70% do so with every patient). Over half (54%) said that they do not use any tools or Foundation for Alcohol Research and Education (FARE) Health professionals’ use of the Australian Alcohol Guidelines – Baseline survey | May 2014 | Page 5 questionnaires to assess levels of alcohol consumption (use of assessment tools was lowest among midwives and obstetricians/gynaecologists), and 14% used CAGE (the ‘Cut-Annoyed-Guilty-Eye-opener’ four question screening test for alcohol dependence; use of CAGE was higher among GPs).
Seven out of ten health professionals also said that they discuss whether alcohol is safe to drink when pregnant, with every patient (70%). Fewer health professionals discuss the quantity of alcohol that is safe to drink when pregnant, or the risks to the fetus of alcohol when planning a pregnancy, with every patient (64% and 57%, respectively).
Forty four percent (44%) of health professionals did not identify any difficulties discussing pregnancy and alcohol with patients/clients, but over half (56%) did identify difficulties. A significant proportion (28%) said that concern about the patient/client’s discomfort made it difficult to have these conversations. This was higher among Aboriginal health workers (50%) Most health professionals, indicated that they felt comfortable initiating conversations with patients/clients about alcohol and pregnancy, with mean comfort scores of over 8.5 out of 10 (with 10 being the most comfortable) for each patient type (mean scores were lower among Aboriginal health workers).
A lack of referral options was identified as a difficulty by a quarter of health professionals (25%). Further to this, over two fifths said that they were unfamiliar with referral pathways available to them to assist pregnant patients/clients modify their alcohol consumption (42%).
The vast majority of health professionals viewed brief intervention as effective in assisting pregnant and breastfeeding patients/clients in modifying their alcohol consumption (93% for each).
Advice given about alcohol and pregnancy/breastfeeding
The advice that most health professionals said they were giving patients/clients about alcohol and pregnancy aligns with the Alcohol Guidelines. Over three quarters (76%) of health professionals said they advise abstinence from alcohol during pregnancy. This was higher among GPs (87%) and lower among Aboriginal health workers (54%). More than one in ten advised that there is no safe level of alcohol during pregnancy (14%). This was higher among midwives (27%).
The proportion of health professionals advising abstinence from alcohol while breastfeeding was lower than the proportion advising it during pregnancy (59%). This was highest among GPs (70%) and lower among Aboriginal health workers (44%).
Awareness of Alcohol Guidelines
While over three quarters of health professionals were aware of the Alcohol Guidelines (78%), only a third indicated that they were familiar with the content (33%). Over two fifths said that they used the Alcohol Guidelines for information about alcohol consumption during pregnancy and breastfeeding (44%). Aboriginal health workers were more likely to use the guidelines for information, and obstetricians/gynaecologists less likely to.
Nearly two thirds of health professionals thought that evidence strongly supports guideline 4a (relating to alcohol and pregnancy) for all levels of consumption (64%), however opinion was more divided about the strength of the evidence for guideline 4b (relating to alcohol and breastfeeding) with under half believing that evidence strongly supports the guideline for all levels of consumption (45%) (i.e. not just higher levels of consumption).