A new study published in the journal Health Promotion International looks back at the alcohol policy advocacy success to achieve the mandatory pregnancy warning labeling on alcohol products in Australia and New Zealand.
Big Alcohol wants to keep people in the dark
While scientists knew that alcohol use can cause harm to a fetus for decades, it took almost 25 years to get this message on alcohol product labeling. The delay was caused by heavy Big Alcohol opposition. The alcohol industry was relentless in attempting to avoid mandatory pregnancy warning labeling on their products. Their efforts included lobbying against the labels, promoting voluntary self-regulation, and muddying the science about alcohol’s harm to unborn babies. However, after almost 25 years, the alcohol industry failed and public health won – at least in Australia and New Zealand.
On July 17, 2020, the ministers of the Australian and New Zealand Ministerial Forum on Food Regulation adopted mandatory pregnancy warning labeling of alcohol, recommended by the Food Standards Australia New Zealand (FSANZ).
The forum adopted the recommended red, white, and black label with the wording “PREGNANCY WARNING: alcohol can cause lifelong harm to your baby.” The alcohol industry was given three years to phase in the new labels. This period ends next year in July.
Pregnancy warning labeling in Australia and New Zealand: How it started
This alcohol policy advocacy success story was three decades in the making. The story begins in 1996, when the first application for pregnancy warning labels was lodged with Food Standards Australia New Zealand (FSANZ).
FSANZ is the agency that develops legal standards for food and alcohol in both countries. FSANZ is an independent agency, directed by the Forum on Food Regulation. The Forum consists of health and agriculture ministers from the central governments of Australia and New Zealand and the eight Australian states and territories.
Later, the 1996 application was withdrawn due to alcohol industry interference. Then another application was lodged with FSANZ in 2006. This led to new studies commissioned to explore the issue of alcohol and pregnancy.
Studies found that alcohol use during pregnancy can lead to fetal alcohol spectrum disorder (FASD) and miscarriage and stillbirth. Health guidelines were updated to state that “to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not consume alcohol”. There is no known safe limit.
Despite the update to health guidelines, women were only told that “it is safest not to use alcohol while pregnant”. This message was not clear enough. A 2018 study found that 32% of New Zealand women continued to use alcohol during the first trimester and 19% continued throughout pregnancy.
Big Alcohol opposition to evidence-based labeling
As public health advocacy and community calls for mandatory health warning labeling on alcohol products were increasing, the alcohol industry took a strategic decision to thwart it. In 2011, the alcohol industry adopted a voluntary labeling standard. This allowed alcohol companies to control the label, the wording, its size, and its colors. Basically, Big Alcohol could make the label have the least impact on lowering profits by making it as insignificant as possible.
The FSANZ and the ministerial forum gave the alcohol industry several years to implement their voluntary standard. However, alcohol companies failed to keep their own promise. By 2017, implementation of the voluntary standard was less than 50%.
In 2018, FSANZ developed a policy options paper on pregnancy warning labeling. This paper included an evidence review and cost benefit analysis. The ministerial forum approved the paper and a proposed label standard was published in October 2019.
The alcohol industry started its relentless attack against the proposed labeling. It mobilized companies and industry bodies to lobby ministers complaining about the proposed language and colors and claiming the costs were unjustified.
As Movendi International reported, first, the alcohol industry was claiming that the label would be “too confusing” for consumers and then moved on to say that it would be “too costly” for the industry to implement.
Later on, they tried another claim from their list of bizarre and baseless excuses to avoid implementing the health warning label. Alcohol industry lobbyists stated the label “does not contrast well on a red label/bottle”.
Policy change is slow and difficult in most contexts, but alcohol policy is particularly challenging,” wrote researchers Maddie Heenan, Janani Shanthosh, Katherine Cullerton and Stephen Jan in their paper on the pregnancy warning labeling, as per Stuff.
The alcohol industry spent many years using tactics to delay or prevent comprehensive regulation – including building relationships with political decision-makers, lobbying against increased regulation for labeling, developing their own self-regulatory scheme, and discrediting scientific evidence,” wrote the researchersResearchers Maddie Heenan, Janani Shanthosh, Katherine Cullerton and Stephen Jan
In February 2020, after consultations, the FSANZ submitted its 2019 proposal to ministers unchanged, including a literature review, cost-benefit analysis, and consumer survey report.
The Ministers again requested FSANZ to review the proposed health warning label standard in March, 2020.
Big Alcohol’s lobby interference in public health policy making was very apparent as the ministers cited industry concerns about the wording, colors, and the costs of the label.
This led to some changes in the originally proposed FSANZ label. FSANZ had previously recommended a red, black, and white label that said “HEALTH WARNING: Alcohol can cause lifelong harm to your baby”.
But the new label recommended by the FSANZ changed “HEALTH WARNING” to “PREGNANCY WARNING” while retaining the red, black and white colours.
Pregnancy warning labeling: A win for public health
In July 2020, this final label was adopted by the Ministerial Forum on Food Regulation. It was a close call of six to four.
The Yes voters were:
- New Zealand,
- Northern Territory,
- Western Australia,
- Tasmania, and
- the Australian Capital Territory.
The No voters were:
- the Australian Commonwealth,
- New South Wales,
- South Australia, and
In her opinion piece for Movendi International, Dr. Nicki Jackson described eight lessons learned in the journey toward implementation of a best practice pregnancy health warning label on alcohol products.
She further outlines the next steps, highlighting three crucial aspects for the way forward.
- Expect to be in it for the long haul – because the alcohol industry is,
- Actively build and constantly share your evidence base,
- Never underestimate the power of stories, especially by those with lived experience of FASD,
- Build a coalition of the willing, able to reach multiple sectors of society and achieve solidarity including with the media,
- Use multiple strategies and tools,
- Be nimble – expect the unexpected and respond swiftly,
- Be consistent in your goal – demand best practice, and
- This is, and can be far more, than just a label on a bottle.
Meanwhile, Michael Thorn in his opinion piece for Movendi International analyzed the pregnancy warning label decision itself, including its shortcomings, sharply. His revelations about alcohol industry interference and the inability of political leaders to protect public health are provocative. And the bigger picture view he espoused of the meaning of the pregnancy warning label decision brings into focus some inspiring aspects for public health advocates.
Movendi International takes a deep dive into the pregnancy warning label success in Australia and New Zealand in season 1 episode 4 with Caterina Giorgi of the Alcohol Issues Podcast. Listen to the podcast to explore this story more.