Girls and women at disproportionate risk of alcohol harms

Dr. Abi Rose is a Reader in psychology at Liverpool John Moores University, specialising in girls’ and women’s alcohol use. Her research interest developed from laboratory-based alcohol research to applied health research after the birth of her first child. “I’d go to mum and baby groups, and invariably, the conversation would turn to alcohol,” she says.

“Then, I became aware of the UK Birth Trauma Association because I had my own diagnosis of postnatal PTSD and depression after my second child was born. Because my previous work had often looked at things like how stress and low mood can be a trigger for drinking, I was interested to see whether traumatic birth experience and its related mental health issues might be a risk factor for higher alcohol use in mothers. And I basically found that there was no research on it.

“There can be an expectation that when women become pregnant, the vast majority stop drinking and then they never really return to drinking once they’re mums, and we know that’s not true.”

She began researching “why women may choose to drink or not drink during [pregnancy and early motherhood]. What are the sorts of barriers to them receiving support? What are the specific roles that alcohol plays during those stages of our lives? Does alcohol act as a way to bond socially, to reconnect with your partner? Does it help you to deal with stress, to reward yourself, and all those sorts of things? And then, because for various reasons some women are having children later in life, I found that quite a lot of women mentioned perimenopause and talked as if these two quite significant life stages were colliding – looking after young children and suddenly finding that their hormones were all over the place – and they were experiencing high levels of stress and anxiety,” which impacted alcohol use.

Her research has since expanded to examine “how girls and women drink over the life course, the different roles alcohol takes on at different stages, and then how that should help us to identify the different types of support and kind of help that women need that will be most effective without ever causing any more blame to the woman or making them feel judged for their drinking choices.”

She notes a paradox whereby, despite drinking less than men, women are more vulnerable to alcohol harms, partly due to “biological factors like sex hormones – oestrogen and progesterone,” which can play a role in the desire to consume alcohol. Alcohol can also remain in women’s bodies for longer due to greater fat ratios, and women, especially older women, have less acetaldehyde dehydrogenase – the enzyme that breaks down alcohol. Gendered discrimination also plays a role, and women are “more likely to say that they use alcohol to manage [negative] internal states like stress”.

Moreover, despite more men still drinking than women, and at higher levels, the well-known gender gap is decreasing because women’s alcohol use is increasing. Rates of alcohol use disorder are increasing more in women than men, and there’s been a substantial rise in alcohol-specific deaths in women.-

Girls can also be more likely to engage in underage drinking than boys, and be admitted to hospital due to alcohol consumption, though Rose notes that this may be partly due to “greater concern about girls drinking compared to boys”, such as increased risk of sexual violence after consuming alcohol.

Due to gendered assumptions about alcohol use, “alcohol research and treatments have often focused on men, and historically been developed for men by men, and then applied to women,” Rose says. This means that women may be more reluctant to access support – for instance, if a service is located in an area that they do not feel safe visiting alone, or if they have been a victim of abuse from a male perpetrator and feel reluctant to access spaces shared by men experiencing alcohol use disorder. Women also may not feel that the support offered is relevant to them or fits with their lives.

There are “lots of biological and cultural factors that are gendered that affect the way we drink and our risk of harm,” she emphasises, “so we need to be able to understand that much better if we’re to develop appropriate policies and support.”

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We are calling on the government to commit to developing – and properly funding – a national alcohol strategy that will focus on education and support, and that acknowledges the increased vulnerability of marginalised people. Please join us in our efforts by signing our petition, writing to your MP and sharing our #DyingForADrink campaign on social media.