Alcohol Use and Harm in Women

Alcohol use among women is on the rise

But alcohol consumption among women has been on the rise globally. 

For example, a landmark study revealed in 2023 that alcohol use and related mortality increased much faster among women than in men, in the United States.

• Alcohol use among men in the US increased at an annual rate of 12.5% between 2018 to 2020.
• Alcohol use among women in the US increased at an annual rate of 14.7% between 2018 to 2020.

This is a serious public health and human rights concern. The worrying trend is influenced by several social, cultural, and economic factors.

The alcohol industry has increasingly targeted women through marketing strategies that link alcohol consumption with female empowerment, sophistication, and social success. These marketing efforts often depict alcohol consumption as a symbol of modern, independent womanhood. Whereas alcohol use among women was previously stigmatised, alcohol use amongst women is now normalised, glamorised, and heavily promoted by alcohol companies.

This change reflects the financial and social freedoms that women have won in recent decades, for example through increased participation in the workforce and changing gender roles. The normalisation and promotion of alcohol among women has resulted in less stigma around female alcohol consumption as well as and increasingly pervasive social norms and environments that push women to consume alcohol (WHO, 2024b).

Alcohol use among girls is rising and reaching worrying levels

In 2024, the Health Behaviour in School-aged Children (HBSC) study highlighted a narrowing gender gap in alcohol use with girls equaling or surpassing boys in rates of alcohol consumption by the age of 15. Of particular concern is evidence that alcohol use may be increasing again among girls in some countries and regions.

• For instance: the United Kingdom reported the highest prevalence  of life-time alcohol consumption for 11-year-olds (35% for boys and 34% for girls) and 13-year-olds (50% boys and 57% girls). 
• The highest prevalence of life-time alcohol consumption for 15-year-olds (83% for boys and 84% for girls) was observed in Denmark. 
• Overall lifetime alcohol use in boys decreased between 2018 and 2022, particularly among 15-year-olds. Conversely, an increase was observed among girls (except for 15-year-olds).
• In 12 of the 15 countries and regions in which there was a gender difference, more 15-year old girls were consuming alcohol in the past 30 days compared to 15-year old boys.

As with alcohol consumption (lifetime and current), a reversed gender pattern was seen at age 15: in six of the 11 countries and regions that showed gender differences, more girls than boys had been alcohol inebriated at least twice in their lifetime. 

• Between 2018 and 2022, the overall prevalence of lifetime alcohol inebriation did not change for 11- and 13-year-old boys and decreased for 15-year-old boys. 
• In contrast, there was a significant increase among 13- and 15-year-old girls. A similar pattern was seen for alcohol inebriation in the past 30 days among girls. 

The HSBC study includes data from countries across Europe, central Asia and Canada.

The findings reveal a shift in gender norms and how alcohol industry marketing has made alcohol more available and normalized among girls.

The long-term consequences of these trends are significant, and policy-makers cannot afford to ignore these alarming findings.

This emphasizes the need for prevention strategies, such as alcohol excise taxes and alcohol age limits. 

An Editorial in The Medical Journal of Australia addressed the need to oay much greater attention to the link between rising alcohol consumption in women – over decades – and the harm these generations of women are experiencing, including older women.

Ann M Roche and Jacqueline Bowden wrote: 

In 2024, an Irish study showed the harms that older women in Western societies face, due to the decades-long trends of rising alcohol consumption. For example, in Ireland:

• Women who are over 50 years are consuming alcohol in higher quantities and more frequently than in previous decades. 
• Good engagement with primary care is crucial for women’s physical and psychological health, particularly if they use alcohol.
• However, women who consume alcohol heavily are less likely than men to attend General Practitioners (GPs).
• At the same time, GPs are less likely to ask questions or discuss alcohol with women than with men.
• And: GPs offered less advice on alcohol to women than to men, and less women than men received alcohol screening from their GP.

While women above the age of 50 are consuming more alcohol, their alcohol use is underreported and insufficiently provided for in primary health. 

The rising alcohol use among girls and women has significant health implications. Women are at higher risk for certain alcohol-related health issues, including liver disease, cardiovascular problems, and breast cancer. Additionally, alcohol use during pregnancy can lead to adverse outcomes such as foetal alcohol spectrum disorders (Reynold JP, 2019).

Differences in alcohol use and related harm between men and women

Gender differences in alcohol consumption fluctuate over time and across cultures. These differences are more pronounced in countries with greater gender inequality and in lower-income nations.

However, in some countries, particularly among younger populations, the alcohol use behaviors of men and women have become more similar (Wilsnack, 2005).

Physiological differences

Women have lower levels of alcohol dehydrogenase, an enzyme that breaks down alcohol, leading to higher blood alcohol concentrations and more significant effects at lower doses. Hormonal differences and variations in body fat distribution also contribute to the accelerated progression of alcohol-related harm in women. 

Men generally have higher water content in their bodies, which helps dilute alcohol and results in lower blood alcohol concentrations.

The differences in metabolism, body composition and size creates the so called telescoping effect – the phenomenon where women progress more rapidly than men from initial alcohol use to the onset of alcohol-related problems and dependence (Keyes KM, 2010).

Psychological differences

Women are more likely to use alcohol to cope with stress, anxiety, and depression.

Societal stigma related to women’s alcohol use is seen as both risk and protective factor. While it can lead to lower (or none) alcohol use among women, it can also lead to women’s fear to talk about and treat their alcohol use related problems (Nolen-Hoeksema, 2004). 

Sociological differences

The sociological differences in alcohol use between men and women are shaped by a range of factors, including cultural and social norms, social expectations, economic conditions, and social determinants of health, such as ethnicity, sexuality, socio-economic class, life stage, and other identity markers. These differences manifest in various ways, affecting patterns of alcohol use, motivations, and the resulting consequences (Hunt, 2019).

Masculinity

Traditionally, alcohol use has been more socially accepted and even encouraged among men in many cultures. Alcohol use is often linked with masculinity, social bonding, and risk-taking behaviours. Male alcohol use is often linked with social activities and peer pressure. The alcohol industry functions as a powerful determinants of the norms, frames, and expectations around men’s alcohol use, especially through decades of alcohol marketing that has depicted male dominance over females, female objectification, dehumanization, and sexualization.

Men are more likely to use alcohol in groups and in social settings such as bars, clubs, or sports events. The social settings also have an impact on the type of alcohol consumed by men. It is mainly beer and hard liquor. 

The consequence is that men are more likely to experience acute alcohol-related harms, such as injuries, accidents, and violence. They are also at higher risk for developing chronic conditions such as liver disease and alcohol use disorder and addiction. Men tend to seek help for their alcohol-related problems too late (Rolando, 2020).

Femineity

Women have historically faced more social stigma and much less permissive norms around alcohol use. However, these norms are changing, and in some societies, alcohol use is increasingly seen as a marker of social independence and equality for women.

Women use alcohol in more private or intimate settings, such as at home or in small gatherings. The alcohol type women consume related to these environments, such as wine and cocktails. 

The alcohol industry functions as a stark determinant of women’s alcohol use. It is increasingly connected to empowerment of women, which is a deliberate marketing strategy of the alcohol industry. 

The combination of biological and sociological factors results in women being more vulnerable and susceptible to health issues caused by alcohol – already at low levels of consumption. These include liver damage, cardiovascular diseases such as hypertension, fertility complications, and increased risk of breast cancer. 

Women are also more exposed than men to harm caused by others and are victims of accidents and violence (psychological, physical, economical and sexual) (Rolando, 2020).

Alcohol harm in women is on the rise

In 2019, alcohol was responsible for 2.0 million deaths and 92.8 million DALYs lost among males globally, accounting for 6.7% and 6.9% of all deaths and DALYs lost, respectively.

Among females, the numbers were 0.6 million deaths and 23.2 million DALYs lost, representing 2.4% and 2.0% of all deaths and DALYs lost globally (WHO, 2024a). 

Physical health harm

Among females, the primary causes of alcohol-attributable deaths were 

• cardiovascular diseases (231,000 deaths), 
• digestive diseases (139,000 deaths), and 
• unintentional injuries (93,000 deaths). (WHO, 2024a).

In 2023, a landmark study revealed that alcohol-related mortality is increasing in the US. Researchers showed that the increase is faster among women. 

• Age-adjusted mortality rates increased by 12.5% per year among male individuals from 2018 to 2020.
• Age-adjusted mortality rates increased by 14.7% per year among female individuals during the same period.

The steepest increase in alcohol-related mortality in women was seen in just the last three years. The mortality trend in women over the period analysed can be summarised as follows. 

• 1999 – 2007: Death rates due to alcohol in women rose steadily by about 1% per year.
• 2007 – 2018: The death rate due to alcohol increased to about 4.3% per year.
• 2018 – 2020: The death rate due to alcohol increased to about 14.7% per year in women, compared to 12.5% in men.

A study from Canada, published in early 2025 revealed that gastrointestinal complications from alcohol are increasing in adolescents and young adults (age, 13-39 years) at rates much higher than in other organ systems. 

• Males were most affected by both pancreatitis and alcohol-associated liver disease.
• But young females had changes in the rates of alcohol-associated pancreatitis and alcohol-associated liver disease that were higher than males. 

A similar study published in December 2024  found that over the past two decades, the rates of alcohol-associated hepatitis among adolescents and young adults increased significantly, with the greatest increase observed among females.

Non-communicable diseases

Alcohol consumption is a significant risk factor for several types of cancer. This risk is particularly pronounced in women. 

The relationship between alcohol and cancer in women is well-documented, with even low dose alcohol use increasing the risk of certain cancers, particularly breast cancer (White, 2020, WHO 2024b).

For example, breast cancer cases in Europe are higher than ever, according to WHO Europe.

Breast cancer represents a major health concern for women across the WHO European Region, with more than 600,000 cases in 2022. For women in Europe, breast cancer is the primary cancer caused by alcohol, making up 66% of all cases of alcohol-attributable cancers. 

Research indicates that even low levels of alcohol consumption contribute to the risk of developing breast cancer. More than half of all breast cancer cases caused by alcohol in Europe are not due to heavy alcohol use, and about one third of new cases every year are due to the consumption of ca.  up to 2 small glasses of wine per day.

The problem is very similar for women in Australia. In an editorial for the Medical Journal of Australia in 2023, Roche and Bowden wrote:

With the rise in alcohol consumption among older women, in contrast to declining consumption in other population groups, the importance of the role of alcohol in breast cancer and preventive interventions is increasing.

As alcohol consumptions patterns have changed dramatically in Australian women, awareness of the harms due to alcohol that are specific to women, including breast cancer risk, should be promoted.

Finding ways to effectively inform women about the breast cancer risk linked with alcohol consumption and to effectively support behaviour change mechanisms is increasingly important.

Heavy alcohol use by older women is a relatively new concern; preventive strategies have largely been centred on alcohol use by young people and middle-aged men.

However, research provides increasing evidence for the elevated risks incurred by women who consume alcohol, even at relatively low levels. 

It is time to turn our attention to those who have not been the traditional focus of attention of alcohol-related harm mitigation discussions — women over 40 — certainly not in relation to the increased risks associated with cancers, most notably breast cancer.”

Roche, A.M. and Bowden, J. (2023), Women, alcohol, and breast cancer: opportunities for promoting better health and reducing risk. Med J Aust, 218: 509-510. https://doi.org/10.5694/mja2.51984 

Communicable diseases

Alcohol use is linked with increased risky sexual behaviours, including unprotected sex and multiple sexual partners. This elevates the risk of acquiring sexually transmitted infections (STIs) such as HIV, human papillomavirus (HPV) and others. 

Alcohol consumption can impair the immune system, reducing the body’s ability to fight off infections. This makes women more susceptible to communicable diseases (Morojele, 2021).

Foetal alcohol spectrum disorders (FASD) 

• Alcohol use has detrimental effects on the health of women and children. Alcohol consumption increases the risk of unintended pregnancies, through its contribution to unprotected sex (WHO, 2018).
• Alcohol use during pregnancy is also a risk factor for multipleadverse pregnancy outcomes. Some of the adverse pregnancy outcomes due to alcohol are:
  • Stillbirth, 
  • spontaneous abortion, 
  • premature birth, and 
  • sudden infant death syndrome. (Henriksen, 2004),
• Alcohol use during pregnancy is linked with a dose‐responsive increase in miscarriage risk (Sundermann, 2019).
• Evidence from Ghana shows that alcohol use is significantly associated with abortion-related maternal deaths: Women who had ever consumed alcohol, frequent alcohol users, and even occasional alcohol users were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol (Asamoah, 2012). 
• Even though the brain is the organ most severely impacted by prenatal alcohol exposure, abnormalities within the heart, kidney, liver, gastrointestinal tract, and the endocrine system can also occur (Alcohol and Society 2020).
• The effects of prenatal alcohol exposure on foetal development are stronger than those from tobacco use, use of other psychoactive substances and exposure to other hazards such as lead and radiation.
• Alcohol does not increase human milk supply and is associated with early cessation of breastfeeding (Alcohol and Society 2020).
• Even low levels of ethanol exposure can disrupt infant sleep patterns and reduce maternal milk production. Applying the precautionary principle here would suggest it safest to avoid alcohol exposure while breastfeeding (Alcohol and Society 2020).
• The effects of alcohol on pregnant women and their offspring are related to the alcohol use of both men and women in the general population (Alcohol and Society 2020).
• Male alcohol use in the pre-conception period may adversely affect the foetus and possibly subsequent generations through genetic modification of sperm (Alcohol and Society 2020).

Mental health harm

Alcohol use has a profound impact on mental health in women, exacerbating existing conditions and contributing to the development of new mental health issues. 

Women are more likely than men to use alcohol as a coping mechanism for stress, anxiety, and depression, which can lead to a vicious cycle of increased consumption and worsening mental health. 

Studies have shown that women who use alcohol heavily are at a higher risk for developing mood disorders, including major depression and anxiety disorders. For example, women who consume alcohol are nearly twice as likely to suffer from depression compared to those who abstain. Additionally, alcohol use in women is linked with a higher incidence of suicidal thoughts and behaviours (McHugh, 2019). 

Alcohol use disorder (AUD) and dependencies are on the rise among women. Several studies and reports indicate a significant increase in alcohol consumption and related disorders among women in recent years. 

• For instance, in the United States, a study found that overall alcohol use among women increased by 16% from 2001-2002 to 2012-2013. During the same period, the prevalence of high-risk alcohol use (defined as consuming four or more alcoholic drinks on any day) among women increased by 58% (Movendi International, 2021a).

Case study: COVID-19 Pandemic and rising alcohol harm in women

Worldwide data indicate that alcohol use increased during the pandemic, adversely affecting women’s physical, psychological, and social conditions. 

• A study conducted in the United Kingdom and Australia found that COVID-19 was linked with increased high-risk alcohol consumption among women who felt anxious, depressed, or fearful.
• A German study reported that 23% of women increased their alcohol consumption during the second wave of the COVID-19 pandemic, with fluctuations in anxiety contributing to this increase.
• In Australia, various changes in alcohol use patterns were identified in certain groups, including increased daily and heavy alcohol use by women in midlife. For many, alcohol was a mechanism to cope with stress and pressure. 

Women were reported to carry additional burdens associated with working from home, providing home schooling for their children, and caring for isolated and homebound relatives, in addition to broader pandemic-induced stress. Concomitantly, opportunities for socialising were very restricted, further encouraging alcohol use at home, whether alone or in company. 

This is true for Latin American countries, as a recent study published in February 2025 shows:

• Studies from the early stages of the COVID-19 pandemic in the Americas show an increase in mental health events such as anxiety, depression, and insomnia and its correlation with high levels of alcohol consumption at the population level. 
• Evidence indicates that these patterns were more prevalent in women.
• Women were more prone to consuming alcohol to cope with COVID-19 stressors than men.
• Women who reported heavy episodic alcohol use before the pandemic tended to increase their use during the pandemic.

Miller et al.’s research in Uganda showed that almost half of the women investigated were experiencing domestic violence, with reports of increased aggression during the COVID-19 restriction phase. They were more likely to consume heavy amounts of alcohol than women who did not report experiencing violence.

The alcohol industry has exploited these vulnerabilities of women during COVID-19 to push more alcohol on them via social media advertising. During the pandemic, alcohol companies targeted women deliberately with messages promoting alcohol products as tools to cope with pandemic stress and anxiety.

• According to a RAND Corporation study, the days of heavy alcohol use in women in the US rose by 41% compared to pre-pandemic times.

Similar to the developments in the United States, alcohol companies have also been exposed in Australia for their deliberate marketing strategy to target women during COVID-19. This led to more women consuming alcohol during the pandemic.

• University of Queensland researchers revealed how alcohol advertisers in Australia are using social media to prey on parents and encourage alcohol use as a way to cope with the added stress during the COVID-19 pandemic. 
• Survey findings from September 2020 revealed that this alcohol industry marketing strategy – to establish, normalize and promote alcohol as coping tool – during the public health crisis was seriously harmful.

Also in India alcohol consumption by women rose during the pandemic. The alcohol industry exploited the public health crisis to convert Indian women to alcohol consumers. 

• Multinational alcohol giants and their front groups pushed Indian state governments to allow alcohol e-commerce during the COVID-19 pandemic. 
• This strategy converted more Indian women to alcohol consumers. 
• While women consume less alcohol than men, a 2022 survey showed that more women reported increasing alcohol use since the pandemic. 

The women who were most at risk of increased alcohol use in India were women with young kids, those who were employed, those from higher-income groups, and those who suffered from depression and anxiety. 

The survey revealed how effective alcohol industry efforts are to turn women, especially already vulnerable women, into alcohol consumers:

Intentional and unintentional injuries

While women are more likely than men to abstain from consuming alcohol, they experience disproportionate harm from alcohol-consuming spouses, partners, ex-partners, or family members – second-hand harm. 

In all societies, alcohol’s second-hand harm is a substantial public health concern. And when the second-hand harms are added to the health harms to alcohol users, the total harm from alcohol is about double that from tobacco. (Laslett, 2019; Andreasson, 2015).

Research indicates a link between alcohol consumption and violence, affecting various relationships including family, intimate partners, friends, and strangers. Alcohol fuels a significant proportion of cases of violence against intimate partners both in and outside the household. 

The WHO Global Plan of Action on Interpersonal Violence identifies the availability of alcohol in communities as a major risk factor for the occurrence of gender-based violence. Alcohol is seldom the sole explanation for the use of violence, but it is often the triggering factor, and alcohol use creates a context for violent acts. It is often used as excuse for otherwise socially unacceptable behaviour (WHO, 2024b).

• In the U.S., up to 50% of domestic violence incidents involve alcohol (Laslett, 2015).
• In Australia, alcohol contributes to 50% of all partner violence, and to 73% of physical assaults by a partner (Laslett, 2015).
• In Argentina, 68% of all cases of domestic violence are alcohol related (Fonseca, 2009).
• In six LMICs in Asia and the Pacific, men with high-risk alcohol use reported higher rates of intimate partner sexual violence.
• For instance, Brazilian women who experience alcohol violence have a risk of death that is 8 times higher than the general population (Fulu, 2013).
• 65% of women experiencing intimate partner violence in India, Vietnam, Uganda, Zimbabwe, South Africa reported the perpetrator had used alcohol. Also, in Uganda and Malawi did alcohol use by the perpetrator play a pivotal role in gendered domestic violence. Focus groups in rural Rwanda show that women who are victims of domestic violence rank alcohol as number one factor (WHO, 2006).

Many violent incidents, especially domestic and sexual violence, are under-reported. Women and children are particularly vulnerable to under-reporting.

A landmark study in 2024 provided a global analysis of the impact of men’s alcohol use on women and girls. The study uncovered that men’s alcohol use causes harms like violence, coercion, mental health issues, economic strain, and social isolation for women, often unnoticed.
It also found that alcohol worsens violence in intimate relationships, linking to partner violence.
Moreover, the study highlighted that women in low and middle-income countries bear a heavier burden than in the rest of the world.

Women experience a multitude of direct, indirect and hidden harms from a male intimate partner’s alcohol consumption, particularly in LMIC settings.

Analysis across 10 countries found that 14% to 44% of women reported experiencing harm from a known alcohol user during the previous 12 months.

The study identified alcohol-related actions by the alcohol-affected man:

• General aggression and violence
• Physical violence
• Verbal aggression
• Intimidation/threats
• Alcohol-related sexual aggression and coercion
• Alcohol-related economic abuse and related behaviours

Alcohol contributes to sexual coercion 

• In a study of Ugandan men and women’s perspectives on sexual violence and HIV/AIDS, around 65% of men indicated that alcohol was a contributing factor in forced sex with their wives.

The impacts on women and girls are severe:

• Physical, reproductive and mental health harms
• Harms to the intimate relationship and family functioning
• Social harm – shame, loneliness and isolation

This review consolidated global qualitative evidence from diverse women’s lived experience and added a broader understanding of harm from men’s alcohol use, beyond physical and verbal abuse shown in quantitative evidence.

Shining a light on men’s alcohol-related economic abuse of women

Implications of household alcohol use on child health and women’s welfare in six low and middle-income countries: An analysis from a gender perspective

In 2021, a study examined the implications of household alcohol use on child health and women’s welfare using a gender lens in Ethiopia, India, Indonesia, Jordan, Kenya, and Nigeria with varied geographical and cultural characteristics in the pattern of alcohol use.

• In most countries, women are significantly more likely to experience IPV when their husband/partner uses alcohol.
• Across a diverse set of countries with varied cultural characteristics which affect the uptake and use of alcohol, alcohol use is linked with crowding-out of acute and preventative health-related behaviours and crowding-in of harmful behaviours. 

This has significant implications for alcohol policy programmes, and positions alcohol policy as central to human capital initiatives and in achieving health for all.