Alcohol and pregnancy on the agenda at the National Public Health Conference in France

WHO/François Bourdillon

Professionals working in the health, social and educational sectors of public health in France met in Paris for the National Public Health Conference on 30 May to 1 June 2017. The newly established Santé publique France, which now serves as the national public health agency, organized the event.

Despite relatively good public health, France faces challenges related to health inequalities between socioeconomic groups as well as geographic locations that start at a young age. The theme of this year’s Conference was individual and collective determinants, and how to address public health issues by targeting determinants at each of these levels.

Alcohol and pregnancy in focus

A specific public health issue on the Conference agenda was alcohol and pregnancy. Recent estimates show that the prevalence of alcohol use during pregnancy as well as fetal alcohol syndrome is higher in France than in the rest of the WHO European Region.

Dr David Germanaud, a paediatric neurologist at Hôpital Universitaire Robert Debré in Paris, emphasized the need to identify pregnant women who are consuming alcohol at an early stage in order to prevent potential harm to the fetus. Detecting women with alcohol dependence in order to provide care and support to both mother and child is particularly critical.

However, practitioners’ lack of knowledge and practices around advising pregnant women about alcohol presents a challenge in France. Ms Chloé Cogordan, an addiction prevention researcher at Santé publique France, presented findings from a survey of general practitioners. The results indicated that while 82% routinely screen for smoking during pregnancy, only 61% routinely screen for alcohol use. Furthermore, despite the fact that official guidelines in France recommend complete abstinence, 23% reported that they do not provide this recommendation.

Dr Lisa Schölin, Consultant at WHO/Europe, presented a European perspective on alcohol use during pregnancy, and policy and prevention activities in the Region and individual Member States from a 2016 WHO report. Other presenters offered examples of efforts to prevent harm caused by alcohol exposure during pregnancy in France.

The discussion during the session centred on three major themes. First, participants focused on the issue of alcohol use in early pregnancy, before a woman is aware that she is pregnant. Questions emerged regarding pre-pregnancy interventions and an approach to the harmful use of alcohol in the general population.

Second, they highlighted the need to improve identification and provision of support to women who are drinking alcohol. They emphasized the importance of ensuring that health-care providers know how to ask questions about alcohol consumption, and of providing them with referral information in case a woman needs further support.

Finally, participants focused on how to ensure that messages come across to women, without deterring women with alcohol dependence from reporting that they are drinking. Several presenters pointed out that addressing stigma is an important focus of future work.

The organizers of this themed session concluded that the issue for the coming years will be to tailor messages and provide support for different target groups, including women who consumed alcohol before they became aware of their pregnancy and women who are alcohol dependent. They also noted that promoting networks among social, medical and public health professionals to prevent alcohol-related prenatal harm is essential.