PI: Melissa Watt
Co-PI: Soraya Seedat (Stellenbosch University)
Investigator: Kathleen Sikkema
Funder: DGHI Pilot Grant, 2015-2016
Site: Cape Town, South Africa

Alcohol use during pregnancy is recognized for its deleterious impacts on fetal development and neonatal outcomes, including fetal alcohol spectrum disorders (FASD). The Western Cape Province of South Africa, historically a wine-growing region, has among the highest rates of FASD globally. Reducing the incidence of FASD in the Western Cape requires novel prevention interventions that target individuals at high risk for alcohol-exposed pregnancies. Our research in Cape Town suggests that targeting women who drink in alcohol-serving venues can be a feasible and effective strategy for FASD prevention. One strategy for primary prevention of FASD is the prevention of unintended pregnancies among women who drink at hazardous levels. Among a cohort of 560 women whom we recruited from alcohol-serving venues and followed over 12 months, 20% became pregnant; almost all pregnancies were unintended, and in almost all cases women continued to drink heavily during pregnancy. Developing interventions to reduce unintended pregnancy among women who drink requires a nuanced understanding of their attitudes, social norms, and beliefs that influence contraceptive use, as well as an understanding of the structural and contextual barriers and facilitators that impact their ability to access and use contraceptives effectively. The objective of this DGHI small grant is to understand pregnancy intentions and contraceptive use patterns among women who drink in alcohol-serving venues.

This mixed-methods study builds on our history of community-engaged research in South Africa to address the following aims:

• Aim #1: To quantitatively document factors influencing pregnancy intentions and contraceptive use among women who attend alcohol-serving venues, by conducting cross-sectional surveys of 120 women recruited from four alcohol-serving venues.
• Aim #2: To qualitatively explore the social norms, barriers, and facilitators that influence consistent and effective use of contraceptives among women who engage in hazardous drinking, by conducting in-depth interviews with 24 women purposively recruited from the survey respondents.
• Aim #3: To assess available contraceptive options and to identify structural factors that support or obstruct access to contraception, by conducting a structured situational analysis of reproductive health services available in the community.

The study is complete, and findings are reported in the Journal of Studies on Alcohol and Drugs. Among 200 women surveyed, almost all met criteria for hazardous drinking. In total, 20.3% of sexually active women were identified as at-risk for an alcohol-exposed pregnancy, and two women were currently pregnant and drinking. Given the high rates of alcohol consumption during pregnancy, alcohol-serving venues should be targeted for FASD prevention interventions. Efforts should be made to increase uptake of long-acting contraceptives among women who do not wish to get pregnant, and to promote alcohol cessation among women with pregnancy intentions.