How the Alcohol Industry Fought Against Pregnancy Warning Labels in France. A Press Coverage Analysis Spanning 20 Years
Abstract
Background
Using alcohol while pregnant is dangerous for health. To inform on this issue, various countries have adopted pregnancy warning labels on alcoholic beverages, including France since 2007, where wine holds deep cultural consonance. The aim of this research was to analyze the arguments put forward by the alcohol industry (producers, distributors, wholesalers, allied industries, trade associations, social aspects, and public relations organizations, councilors who publicly defend wine-sector interests) via the press in France:
- in 2007 when pregnancy warnings were first implemented, and
- in 2018 when larger pregnancy warnings to increase visibility were proposed but not adopted.
Methods
This study used the documentary method to analyze the arguments advanced by the alcohol industry in the mainstream (national, regional, and specialized) press in France from 2000 to 2020, using the Europresse documentary database. Quantitative analysis (number and trend curve of articles, mapping alcohol-industry actors who spoke in the press) and inductive thematic content analysis (analytical framework of the arguments identified) using NVivo software were carried out.
Results
This study found a total of 559 relevant press articles in the database, of which 85 were included in the analysis.
Peaks in the number of publications were found to coincide with the warning label implementation and with the expansion-project schedule.
A large majority of the arguments promoted by the alcohol industry contested the pregnancy warnings measure (very few were in favor).
The alcohol industry argued:
- pregnancy warnings were a questionable measure (e.g., ineffective, or the pictogram clearly links alcohol to mortality),
- pregnancy warnings would have counterproductive effects (on women and the wider economy),
- better alternatives exist (e.g., targeted prevention programs, prevention by health professionals).
A large majority of the actors who spoke in the press came from the winegrowing sector.
Conclusion
This study fills a gap in the Anglosphere research on lobbying against alcohol warnings by analyzing lobbyists’ arguments over a 20-year period covering both failed and successful industry lobbying. New findings have emerged that are likely related to the wine-oriented culture of France. In order to counter the alcohol lobbying practices, the authors conclude with a number of public health recommendations.
Identification and evolution of who spoke via press articles
A large majority of the alcohol industry actors who spoke in the press came from the vine and wine sector (93 times) followed by the broader “alcohol” sector (when no specific sector was cited; 14 times) and Social Aspects and Public Relations Organizations (SAPROs, 8 times). The spirits sector (3 times), the beer sector (3 times), and another agent (a printer: 1 time) also voiced opinions via the press.
Between period 1 and period 2, the number of wine-sector actors using press remained stable, at 48 vs. 45 occurrences, whereas other voices had a weaker and more isolated presence. This could be explained by the fact that the wine sector is well-perceived in France, and is increasingly becoming the front group for all the alcohol actors in the media (36). An identical phenomenon was observed during the lobbying against the Evin’s Law of marketing regulation in France: the winegrowers were a very visible front group to fight against the law compared to other alcohol actors (36).
Arguments advanced by the alcohol industry in French media
The majority of the arguments used by the alcohol industry from 2000 to 2020 were raised against the original introduction and subsequent evolution of the warning (268 occurrences). There was nevertheless a small minority of alcohol industry arguments in favor of the measure (30 occurrences). Different sub-categories of arguments emerged from the analysis.
Analysis suggested there were three categories of arguments against the measure:
- Pregnancy warning labels are a questionable measure,
- Pregnancy warning labels would have counterproductive effects, and
- Better alternatives exist.
Pregnancy warning labels are a questionable measure
The alcohol industry asserts: Exaggeration and overzealousness of actors in health (61 occurrences).
The alcohol industry claims: The pictogram clearly links alcohol to mortality was one of the main arguments advanced by the AI (28 occurrences), essentially in period 2 (26 occurrences vs. 2 occurrences on period 1):
The sector is opposed to what it publicly describes as a ‘deadly pictogram’”
“Comment le lobby de l’alcool sape toute prévention prônant l’abstinence,” Le Monde website, 2020
The AI claims that this measure is driven by hygiene-first logic, i.e., dictated by the medical perspective (12 occurrences). This was the argument most used during period 2 (10 occurrences vs. 2 during period 1):
The winegrowers fear that this enlarged pictogram will lead to a ‘hygiene-first’ logic […] where the ultimate form would be a bottle similar to the plain tobacco packaging”
“Des viticulteurs bordelais entrent en guerre contre le logo femme,” L’Express website, 2017
The alcohol industry also claims that this measure only serves to reassure the health authorities (7 occurrences, of which 5 during period 2):
Does the reminder on wine bottles serve any other purpose than to reassure and hypocritically relieve the health authorities of all liability?”
“Attention, vivre est nuisible à votre santé,” Le Bien Public, 2018
To prove this point, the AI signals that France is one of the only countries to implement the pictogram, which they see as further evidence that the measure is exaggerated (5 occurrences, only during period 1):
This constraint is a feature specific to France and is not used in other European countries.”
“Des viticultrices à l’Assemblée,” Sud Ouest, 2010
Finally, the alcohol industry also claimed that the measure was disproportionate (3 occurrences) and would open the floodgates to more virulent messages (3 occurrences, only during period 1), such as those for tobacco (“alcohol kills”), arguing that alcohol should not be treated in the same way as tobacco (3 occurrences):
And the media coverage of it is odious. Soon, we will see ‘alcohol kills’ on labels of good Burgundy wine. Just like on cigarette packets.”
“La filière viticole se sent attaquée, le milieu médical se dit sceptique,” Le Journal de Saône-et- Loire, 2004
It is even a ‘total idiocy’ that will ‘further fuel the idea that wine is a dangerous product like tobacco’”
“Déconseillé aux femmes enceintes: un vigneron affiche la couleur,” AFP Infos Economiques, 2004
Ineffectiveness of the measure (55 occurrences)
The AI also put forward the claim of ineffectiveness of the warning, arguing that the measure is ineffective in changing behaviors among pregnant women (26 occurrences, 14 occurrences in period 1 vs. 12 occurrences in period 2):
Women who are addicted to alcohol will continue to drink, just as smokers continue to smoke despite the warnings displayed on tobacco packages. The rest [of the women] already know not to drink during pregnancy.”
“Le message pour les femmes enceintes n’inquiète pas la filière,” Le Journal de Saône-et-Loire, 2007
To date, no comprehensive study has been produced to demonstrate the effectiveness of this measure.”
“Désaccords autour d’un logo,” Emballages magazine.com, 2018
This ineffectiveness is explained by the poor design and content of the label. The AI claims that the warning is not precise enough and could thus create confusion (such as the belief that wine in the presence of the pictogram would be a contraceptive) (2 occurrences, in period 1), and is poorly crafted (1 occurrence, in period 1):
When our Chinese customers saw it, they thought our wine was a contraceptive…”
“Pression sur l’étiquette,” Sud Ouest, 2009
The AI also claims that it is unreadable because container labels are already overloaded with information (11 occurrences, 7 occurrences in period 2):
For the Vignerons Indépendants [professional association of independent winegrowers], it is yet another feature to fit on already overcrowded label”
“Naissance difficile de l’étiquetage préventif des boissons alcoolisées,” Les Echos, 2006
Pregnancy warning labels are touted as ineffective because they are perceived as a “cosmetic” measure (8 occurrences, all during period 2): according to the AI, pregnancy warning labels are considered as superficial and therefore useless. AI actors also claim the warning label was inappropriate (7 occurrences) to fight against alcoholism among pregnant women:
The measure is an ‘inadequate response to a real public health issue’”
“Non au logo agrandi pour femmes enceintes,” L’Union, 2017
Minimization of the severity of the alcohol problem (14 occurrences)
The AI minimizes the severity of the issues tied to alcohol use by arguing that women are already informed and responsible (7 occurrences, mostly in period 1):
Question: Do pregnant women know that alcohol is dangerous for their unborn child? Answer: To not know, either they’d have to ignore it on purpose or spend their pregnancy lost in a cave in the woods.”
“Attention, vivre est nuisible à votre santé,” Le Bien Public, 2018
The AI also claims that wine is not alcohol (or at least not an alcohol like any other) (5 occurrences, of which 4 during period 1):
Is wine an alcohol like any other? ‘Wine, consumed in moderation, is part of the traditional French foodways. It has to be kept apart from other alcoholic drinks’”
“Alcool et femmes enceintes le nouveau logo sur les bouteilles de vin fait polémique chez les vignerons,” AFP, 2018
They also added that alcoholics do not tend use wine (1 occurrence, during period 1) and that FAS remains rare (1 occurrence, during period 1):
It is even more ridiculous for wine: I have never considered myself as trading in alcoholism, and in any case, alcoholics are not loyal customers of the winegrowers!”
“La filière viticole se sent attaquée, le milieu médical se dit sceptique,” Le Journal de Saône-et-Loire, 2004
Fetal alcohol syndrome (FAS) is exceptionally rare (0.1 to 0.3% of births)”
“Une efficacité douteuse,” Sud Ouest, 2006
Skirting the alcohol problem (5 occurrences)
The AI claims there are other more important problems than alcoholism during pregnancy and therefore regrets that the pictogram draws all attention onto this one specific issue. It thus proposes setting up pictograms for other (health) problems (3 occurrences, only in period 1):
If I have to add this pictogram, I think I will also add ‘forbidden for diabetics’, ‘forbidden for people under 16’ and ‘forbidden for idiots’.”
“Vins: la femme enceinte a bon dos. . . ,” Le Progrès – Lyon, 2006
The pictogram is also argued as questionable on the grounds that all human activities are dangerous (1 occurrence, in period 2) and so other more serious issues should be addressed first (1 occurrence, in period 1),:
Just as I’d let you have fun coming up with all the pictograms that could be put everywhere in our environment to remind us that the most banal human activities—breathing, eating, driving, sports—all carry risks and that, ultimately, living is bad for your health.”
“Attention, vivre est nuisible à votre santé,” Le Bien Public, 2018
Wine kills fewer people than pharmaceutical drugs, but it is not politically correct to say so”
“Pas d’eau dans le vin de vignerons sancerrois,” La Nouvelle République du Centre-Ouest, 2006
The warning would have counterproductive effects on the economy (66 occurrences)
The AI argues that this measure attacks the wine sector (43 occurrences, of which 26 in period 2) and weakens producers (12 occurrences, distributed over the two periods):
these 64 wine-growing estates denounce ‘the transformation of a product that vectors excellence and is sold across the globe into some kind of contraband […]’”
“Le logo qui irrite des viticulteurs,” Midi Libre, 2018
The labeling of bottles [with the pictogram] also appears to be the last straw for a wine industry already in crisis.”
“Grossesse sans alcool: les femmes seront prévenues,” Le Progrès – Lyon, 2004
To a lesser extent, the AI claims that the producers need time to implement a warning label (3 occurrences, only in period 1), that the cost will be high (3 occurrences, of which 2 in period 2) and that containers carrying the pictogram will be harder to export (2 occurrences, distributed over both periods):
For the president of Brasseurs de France, ‘implementing the measure will necessarily take some time, given the time needed to print new labels for our 400 different product references’.”
“Femmes enceintes: les fabricants d’alcool résignés à apposer un pictogramme,” AFP Infos Françaises, 2006
Adding labels or creating back-labels increases our costs”
“Discrétion assure,” Sud Ouest, 2008
How can we grow exports if wine is considered a dangerous product in France?”
“Alcool et femmes enceintes: le nouveau logo sur les bouteilles de vin fait polémique chez les vignerons,” AFP, 2018
The measure is claimed to be unfair (1 occurrence, in period 1) for producers. The alcohol industry fears that the measure will cause a drop in sales due to lower consumption (1 occurrence, in period 1).
Five public health recommendations to tackle the issue of AI lobbying against health warnings (and against public health measures in general)
First, given the strength (and effectiveness) of lobbying at national level, international treaties are needed to counter national-level influence on individual governments. A European Union Directive on alcohol warnings would be a relevant option, as already done for tobacco in 2014 requiring a combined health warning consisting of a picture, a text warning, and information on stopping smoking, covering 65% of the front and back of cigarette packs. Beyond the European Union level, a “Framework Convention on Alcohol Control” would also be relevant, as already done for tobacco in 2005 (the FCTC: Framework Convention on Tobacco Control) wherein article 11 stipulates that each Party signing and ratifying the treaty is to adopt and implement effective labeling measures within a period of three years. For countries similar to France very close to the alcohol industry, the article 5.3 of the FCTC that stipulates that each Party has to protect its “policies from commercial and other vested interests of the tobacco industry in accordance with national law” should be replicated to the alcohol industry in order to protect alcohol policies.
Second, the French example appears to highlight strong links between the alcohol industry and government that could explain why certain public health measures do not get adopted. To counter this problem, citizens and health actors need to be better informed on these links via transparency instruments that could limit interference in public decisions. National legislation could be proposed on alcohol, following the example of the French law on transparency of the tobacco industry’s influence relations, in particular on expenses related to influencing or representing the interests of tobacco product manufacturers, importers and distributors and their representatives. This could go further by compelling the AI to disclose any and all expenses tied to indirect lobbying channels (research funding, presence and participation of the AI in public commissions).
Third, more research is needed on the arguments used by the alcohol industry against alcohol warnings. To counter the AI’s argument challenging the effectiveness of pregnancy warning labels, more studies should be conducted on the content and design of effective warnings. There is limited research on alcohol warnings compared to tobacco warnings at international level and especially in France where only three studies have been published on these issues. Concerning the argument around the economic costs for the AI, more research is needed on the economic burden of alcohol for society. In France, the first (and only) research that estimated this social cost dates from 2010 and arrived at a figure of €120 billion per year. No research has been carried out since to update this figure.
Fourth, it is vital to provide actors in health (NGOs, public institutes, health professionals) with more training and skills in order to make them more effective in lobbying tactics and press relations and adopt similar strategies of the AI to better counter them.
Fifth, given that denouncing the industry’s marketing and lobbying tactics seems to be effective, counter-marketing campaigns should be implemented, as was done in tobacco with the “Truth” campaign in the USA. It could be useful to develop a campaign via social media to denounce AI lobbying. The effectiveness of counter-marketing campaigns is explained by inoculation theory, which posits that people can be protected from attempts at commercial manipulation if they are warned against them with counter-arguments.
