Food Insecurity and Alcohol Use Among Pregnant Women
at Alcohol-Serving Establishments in South Africa
Lisa A. Eaton
Eileen V. Pitpitan
Seth C. Kalichman
Kathleen J. Sikkema
Melissa H. Watt
Demetria N. Cain
Published online: 23 March 2013
Society for Prevention Research 2013
Abstract South Africa has the highest rate of fetal alcohol
syndrome (FAS) in the world. While efforts have been made
to curb the high rate of FAS, little is known about situational
factors that may contribute to alcohol use during pregnancy.
In the current paper, we focus on the role of food insecurity
and its relationship to alcohol use among pregnant women.
Women completed computer-assisted interviews. Generalized
linear modeling was used in all analyses. Women attending
alcohol-serving establishments in a township in Cape Town,
South Africa were recruited for the study. Five hundred sixty
women were sampled and 95 women reported being pregnant.
High levels of alcohol use were reported among pregnant
women: 65 % of women consumed alcohol at least every
month and 29 % consumed alcohol as often as two to three
times per week. Thirty-four percent of the women reported
having six or more drinks per occasion on at least a weekly
basis. The majority (87 %) of pregnant women reported
experiencing some form of food insecurity (e.g., food
unavailable, eating less) in the past month. Alcohol use was
significantly associated with food insecurity, even when con-
trolling for relevant demographic variables. Intervention with
pregnant women who consume alcohol is urgently needed.
Future research should focus on understanding the intersec-
tion of food insecurity and alcohol, and how the experience of
food insecurity may contribute to greater rates of alcohol use
and abuse among pregnant women.
Keywords Food insecurity
Alcohol use among pregnant women residing within South
African townships is prevalent and alarming (Eaton et al.
2012; May et al. 2007; Morojele et al. 2010; Rosenthal et al.
2005). Rates of fetal alcohol syndrome (FAS) in South
Africa are the highest in the world (Viljoen et al. 2003).
The Western Cape Province of South Africa in particular has
the highest rates of FAS ranging from 43.8–89.2 per 1,000
children; by comparison, the United States and Canada
have rates generally observed at 1 per 1,000 children
(May et al. 2000; 2007; 2009; Viljoen et al. 2005). FAS
is directly linked to a multitude of negative health out-
comes including deficiencies in the growth and development
of cognitive and physical capabilities, particularly damage to
the central nervous system. The effects of FAS are life-long
with only limited treatment available (Adnams et al. 2001;
Kodituwakku et al. 2006; Peltzer et al. 2006). Furthermore,
economy and health care system (Crede et al. 2010).
Heavy alcohol use occurs in informal drinking establish-
ments or shebeens and taverns within many townships in
South Africa (Kalichman et al. 2007a; b; 2008a, b; c;
Schneider et al. 2007; Suliman et al. 2010). As such,
South Africa has high rates of hazardous drinking.
Although the proportion of South Africans who drink alco-
hol is fairly low (in a national household survey just 39 % of
men and 16 % of women reported alcohol use in the past
year), South Africa has one of the highest per-capita rates of
alcohol consumption in the world among those who do
This project was supported by National Institute of Alcohol Abuse and
Alcoholism grant R01 AA018074.
L. A. Eaton (*)
E. V. Pitpitan
S. C. Kalichman
D. N. Cain
Center for Health, Intervention and Prevention,
University of Connecticut, 2006 Hillside Rd,
Storrs, CT 06269-1020, USA
K. J. Sikkema
M. H. Watt
Duke University, Durham, NC, USA
Stellenbosch University, Cape Town, South Africa
Prev Sci (2014) 15:309–317