Introduction

Alcohol is a legal and socially accepted substance in the Nordic countries, consumed in all parts of society. However, a safe level of alcohol consumption during pregnancy has not been established, and the safest option is therefore total abstinence for the duration of pregnancy. The health authorities in the Nordic countries have adopted a precautionary principle and recommend that women forgo drinking entirely during pregnancy and preferably from the time they plan to become pregnant. Any amount and type of alcohol may harm the foetus throughout the pregnancy and have lifelong consequences for the child. This message is important for all women regardless of their background and societal position (Mamluk et al., 2017; Nissinen & Frederiksen, 2020; Behnke et al., 2013).

Similarly to the Nordic health authorities, who do not recommend using alcohol during pregnancy, the World Health Organization (WHO) highlights the issue in the new version of the global alcohol action plan 2022–2030 to strengthen the implementation of the global strategy – now being drafted – to reduce the harmful use of alcohol. According to the action plan, one of the most dramatic manifestations of harm to persons other than the drinkers themselves are consequences of prenatal alcohol exposure that may result in the development of foetal alcohol spectrum disorder (FASD). The WHO also makes a point of there being no safe limit for alcohol consumption at any stage of pregnancy (WHO, 2021).

The Nordic health authorities may recommend abstinence from alcohol during pregnancy, but public attitudes on pregnant women’s alcohol consumption are nevertheless an interesting phenomenon to look at. Since 2010, the so-called IQ-initiativet in Sweden has conducted an annual survey to track the attitudes to alcohol in Sweden. In 2021 the same attitudinal survey was also conducted in Denmark, Finland, and Norway. The 2021 results are based on 4,020 interviews in Sweden and on roughly 1,000 interviews in Denmark, Finland, and Norway, including participants aged 16 years and up. Among the survey questions is one regarding drinking a glass of wine or beer when pregnant. Table 1 summarises the responses to this specific question.

(IQ-initiativet, 2022)

The table shows that over 80 percent of Swedes, Finns, and Norwegians think it is wrong to drink alcohol when you are pregnant, while 64 percent of the Danes think so. Also, 9 percent of the Danes consider it is fine to drink some wine or beer when pregnant, whereas the percentage is at 5 percent or below for the other Nordic countries.

The survey is not designed as research and the results should be interpreted with caution, but they may indicate how people think about (and possibly act in relation to) alcohol consumption during pregnancy in Sweden, Norway, Finland and Denmark. In all these countries, the percentage of people who think it is neither right nor wrong/do not know if it is okay to drink a glass of wine or beer while pregnant is higher than the percentage of those who think it is wrong. This is worrying, and the results underline that there may be a need to increase awareness among the Nordic population of the risks of pregnant women’s alcohol consumption. This might help to achieve a positive change in the attitudes towards abstinence from alcohol use during pregnancy (IQ-initiativet, 2022).

The Nordic region envisions to be the most sustainable and integrated region in the world by 2030. An action plan has been drawn up, based on 12 objectives linked to the strategic priority areas: a green Nordic region, a competitive Nordic region, and a socially sustainable Nordic region. Objective 9 states that by 2024, the Nordic Council of Ministers will contribute to good, equal, and secure health and welfare for all, which is fundamental for people’s ability to reach their full potential and contribute to the development of society (Nordic Council of Ministers, 2020). The vision is inspired, among other things, by the United Nations Agenda 2030 and the Sustainable Development Goals (SDGs), which the Nordic region is also very focused on achieving. Alcohol has an adverse effect on reaching 12 of the 17 overarching SDGs on Agenda 2030. In terms of child health, the key target of 3.2 seeks to end preventable deaths of newborns and children under 5 years of age. Alcohol use during pregnancy is the direct cause of foetal alcohol syndrome (FAS), but it also increases the risk of miscarriage, premature birth, and FASD. It is estimated that 25.2 percent of women in the WHO European Region consume alcohol during pregnancy. The prevalence of FAS in the WHO European Region is estimated at 3.74 per 100,000 population, which is more than twice as high as for all other WHO regions (WHO Regional Office for Europe, 2020).

There is a need to focus more on the issue of alcohol consumption during pregnancy and on its consequences, not least because an innocent population has to live with the effects of this risky behaviour. This population should have the opportunity to be identified and receive the appropriate support and services they need to live a good and healthy life.

In this report, the Nordic Welfare Centre provides recommendations to the Nordic countries on how to prioritise and strengthen the focus on children and their families affected by prenatal alcohol exposure to ensure them the best framework for a good life. More knowledge is needed about prenatal alcohol dependence and its consequences (FASD) in health care and among health professionals. With the right knowledge and skills, health professionals are better able to identify women who use alcohol during pregnancy, and they can better identify a child who may be at risk of FASD. As prenatal exposure to alcohol has lifelong consequences, we also highlight the need for and importance of individual support and follow-up for affected children, and their families. In addition to having a health-promoting effect on the target group, the recommendations can also benefit society and the economy at large.