Joan Smith: Medical advice is fine. But moral judgement is not

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The Independent Online

For some time now, pregnant women have risked hostile stares if they drink the occasional glass of wine in public. Mothers-to-be are supposed to consider the health of their babies at all times, and the days when a pregnant woman could have a carefree night out with a few women friends and a bottle of wine are long gone; most lay people are aware of government advice to limit alcohol consumption during pregnancy, even if they don't know the guidelines in detail.

Until now, women have been advised they can drink 1.5 units of alcohol a day after the first three months of pregnancy when the risk of miscarriage is highest. The Royal College of Obstetricians and Gynaecologists says there is no medical evidence that drinking small amounts of alcohol harms the foetus, and most women are happy to limit (though not halt) their alcohol consumption for nine months. But there is a widespread feeling that pregnant women should not drink at all, and now the Government's health watchdog has ventured in to new territory by telling pregnant women exactly that.

The latest advice from the National Institute for Health and Clinical Excellence (NICE) is part of a comprehensive review of advice to pregnant women which covers such subjects as breast-feeding, maternal and infant nutrition, and antenatal care. Obviously it's sensible for the Government to tell pregnant women the latest and best medical thinking on a whole range of issues, and no-one would quarrel with advice based on peer-reviewed studies. Amazingly, though, NICE has admitted that its change of heart on pregnant women and alcohol consumption is partly the result of a recognition of the harm done by excessive drinking in society generally. In that sense, it is as much a moral judgement as a medical one and sets a dangerous precedent for a body which has to make controversial decisions about treatment for a whole range of diseases and conditions.

NICE's decisions on new drugs are frequently attacked by patients' groups, which argue that Alzheimer's or breast cancer sufferers should not be denied the latest medication on grounds of cost. But recommending abstinence for social rather than medical reasons is a departure which will worry many observers, who are bound to hear echoes of 19th-century temperance campaigns. Is it really the role of a government watchdog to recommend abstinence from alcohol, sex or anything else without overwhelming medical evidence that it is necessary? It is hard not to interpret NICE's advice as a reflection of growing popular disapproval of women who enjoy drinking. Articles about problem consumption are appearing more and more often, usually illustrated by photographs of young women being supported by friends as they leave a bar or vomiting in the street.

Mass-market newspapers have started running alarming features on liver damage, accompanied by photographs of normal-looking women whose drinking habits hardly suggest a state of constant inebriation. The subliminal suggestion is that binge-drinking is a largely female problem, even though it's overwhelmingly young men who get drunk, brawl and fill police cells in the early hours of the morning.

This misogynist critique has mass appeal, popping up everywhere from the Daily Mail to Islamist rants against Western culture. It is the latest manifestation of an age-old prejudice, traceable all the way back to Greek and Roman times; the myth is that women who drink are dangerous and out of control, even if the truth is that they are actually in danger from strangers and acquaintances rather than a threat to anyone else. There has been a series of cases in recent years in which men have denied raping women who were too drunk to fight them off; when their trials result in acquittals, there is much hand-wringing over the ordeal the man has been through, reflecting the pernicious assumption that an inebriated woman is "asking for" whatever happens to her. Pregnant women, in other words, are just the latest group to feel the weight of misogynist social attitudes about drinking.

No-one would deny that women who drink very heavily should be told about the risk to themselves and their babies, or that they should be offered help to deal with their addiction. But most of the women NICE's advice is addressed to are not consuming dangerous quantities of alcohol, and the new guidelines are likely to make them unnecessarily confused and anxious. Indeed, it could be argued that the watchdog has just added a completely artificial risk to the natural ones associated with pregnancy, which have actually been decreasing in Western countries. Pregnant women now have to be virtuous, it seems, as well as healthy.

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