Exploring women’s views towards No-Lo alcohol products during pregnancy: a photo elicitation guided qualitative study

Background: Pregnancy encompasses a period of socially expected and medically advised abstinence from alcohol. The UK has one of the highest rates of alcohol exposed pregnancies globally. ‘Non-alcoholic and low alcohol’ (NoLo) drinks may provide a viable means to support abstinence. We explore women’s views towards NoLo products including consumption barriers and enablers. Methods: We conducted 18 semi-structured photo-elicitation interviews with women who were pregnant within the UK. Findings were analysed using reflexive thematic analysis. Results: Two themes were identified: ‘navigating the sociocultural environment’ and ‘navigating the NoLo market’. Women used NoLo products to help adhere to societal norms of abstinence in pregnancy, while navigating the social expectation to consume alcohol – or an alcohol-adjacent product - in social environments. The NoLo market was viewed as hindering the adoption of NoLo products for pregnant women, with issues raised around inconsistent guidance and labelling, and barriers around pricing and availability. Conclusions: Findings suggest NoLo’s can aid social inclusion and satisfy social cravings for alcohol-adjacent products in typical drinking scenarios. Unclear guidance around ‘risk’ and perceptions of the possible ‘harms’ of low-alcohol drinks impacts consumption. Given pregnancy’s high-risk nature for alcohol-related harm, evidence-informed guidance on NoLo’s is crucial for potential harm reduction.