Objective

To promote abstention from alcohol during pregnancy and nursing.

To reduce the number of children born with alcohol-related disabilities (Foetal Alcohol Syndrome - FAS).

Description

Foetal alcohol syndrome (FAS) refers to a range of physical and mental impairments of varying severity that result from alcohol consumption during pregnancy. While FAS is not curable, it is completely preventable. Highlighting the need to abstain from alcohol during pregnancy is the goal of an initiative, ‘Verantwortung von Anfang an! – 9 Monate – 0 Promille’ (‘Responsible from the Start! – nine months, zero blood alcohol’). This is because abstention is a sure way of preventing foetal alcohol syndrome. 

The initiative provides expectant mothers and young women of childbearing age with numerous practical tips on how to keep up the resolution to abstain (hence ‘nine months, zero blood alcohol’). 

‘Responsible from the Start’ began as an initiative of the Working Group on Alcohol and Responsibility in 2009. The prevention initiative has several components:

1. Leaflet: ‘Verantwortung von Anfang an! – Leitfaden für den Verzicht auf alkoholhaltige Getränke in Schwangerschaft und Stillzeit’ (‘Responsible from the Start! –Guidance on abstention from alcohol during pregnancy and breastfeeding’)
2. Leaflet: ‘Verantwortung von Anfang an! – Was Mädchen über alkoholhaltige Getränke in der Schwangerschaft wissen sollten’ (‘Responsible from the Start!’ – What girls need to know about alcohol in pregnancy’)
3. Leaflet: ‘Verantwortung von Anfang an! –Die Fetale Alkohol-Spektrumstörung’ (‘Responsible from the Start! – Foetal Alcohol Spectrum Disorder’)
4. Website: www.verantwortung-von-anfang-an.de
5. Instagram channel: ‘9monate0promille’ (‘ninemonthszerobloodalcohol’).

The focus of the prevention initiative is the information leaflets for pregnant women, girls and nursing mothers. These are updated annually and are published in cooperation with Dr Reinhold Feldmann (University Hospital Münster (UKM) Paediatric Clinic and Polyclinic and FASD outpatient department, Walstedde outpatient clinic) and Dr med. Gisela Gille (practising physician in Lüneburg and Honorary Member of the German Society of Gynaecology and Obstetrics (DGGG).  Information posters and kits containing all three leaflets are distributed to midwifery associations, counselling centres and gynaecologists.

The leaflet on abstention from alcohol during pregnancy and breastfeeding has been published since 2009.  It provides clearly worded and presented information about FAS and guidance for pregnant and nursing women on how to abstain from alcohol.  Because of the important part played by family and acquaintances, the leaflet also targets fathers-to-be, friends and co-workers with the message that they must never encourage a pregnant woman to drink alcohol.

The leaflet has been successfully distributed for many years in ‘Happy Mom’ bags and ‘For You’ gift boxes handed out to pregnant women through gynaecological practices together with the maternity record book. In addition, since 2013, the leaflets have been distributed in doctors’ surgeries via IDS, a health information service provider.

The leaflet on what girls need to know about alcohol in pregnancy is handed out to girls at their first gynaecological consultation.  It provides information and advice and highlights why it is necessary to abstain from alcohol during pregnancy and breastfeeding. Written by Dr med. Gisela Gille, a practising physician in Lüneburg and Honorary Member of the German Society of Gynaecology and Obstetrics (DGGG), who also hands out the flyer in her training workshops.  It has been distributed continuously since 2012.  Also, since 2014 it has been handed out since 2014 for education purposes to girls from age 12 with the “Happy Me” bags they receive when they visit a gynaecological practice.  Since 2015, paediatricians also hand it out with the “Happy Youth” leaflet presented at the J1 adolescent health check-up from age 13.  Since 2016, it has also been distributed via IDS Service Company for Information in Healthcare.

The leaflet on foetal alcohol syndrome aims to help children, adolescents and adults better understand prenatal alcohol-related harm, providing tips for successfully helping those affected together with pointers to potential therapy, school and statutory assistance for them and their families. Compiled by Dr Reinhold Feldmann, the leaflet has been available in German and English since 2012.  It is distributed through the IDS, in the “Happy Youth Bag” and at the FAS outpatient clinic at the Walstedde day clinic.

The website features a message from Lisa Paus, MdB, Federal Minister for Family, Senior Citizens, Women and Youth.  It also contains more about the initiative; the effects of alcohol during pregnancy and breast feeding; information on Foetal Alcohol Syndrome (FAS); Tips for giving up alcohol; Frequently Asked Questions and Expert advice.

The Instagram page was launched in October 2020.  The page’s title is ‘Verantwortung von Anfang an!’ (Responsible from the Start) and carries the message ‘9 Monate 0 Promille’ (9 months 0% blood alcohol). The initiative successfully launched its first social media campaign on Instagram in April 2021, using the hashtag ‘9monate0promille’ (‘nine months, zero blood alcohol’). This platform was chosen to target young women and girls and raise awareness about the importance of abstaining from alcohol during pregnancy. As influencers have a significant impact on health-related issues, collaborations were established with two pregnant influencers, Jennifer Turbanska and Lisa Weckwerth, who shared information about the consequences of alcohol consumption during pregnancy and breastfeeding with their followers. The ‘9monate0promille’ Instagram feed gained almost a million users within a few months, demonstrating the success of the mix of expert contributions, informative posts, and influencer collaborations.

In addition, every year since 2012, the German Professional Association of Gynaecologists (BVF) has published articles on the initiative in its professional journal, FRAUENARZT.  Two advertisements were published in the “familie&co” family’s magazine in 2020 and the Responsible from the Start! website is linked from happy-mom.de.  The initiative is linked to by the Federal Centre for Nutrition (BZfE) website and the pregnancy advice website links it via the Child Health Foundation website. The website is also linked from the internet portal wireltern.

In connection with the Präventionspakt Bayern (Bavaria Prevention Pact) round table, the BSI Working Group on Alcohol and Responsibility makes a substantial contribution through this project to the Bavarian campaign for zero alcohol in pregnancy (website here).  

Also, in recent years, the initiative has attracted supporters from the medical field, including the President of the German Society for Gynaecology and Obstetrics, Prof. Dr Anton J. Scharl, many supporters from politics, and the Federal Drug Commissioner (2009 to 2021).

Partners

Cooperation partners

• University Children’s Hospital Münster at the University Hospital Münster (UKM)
• FASD outpatient department at the outpatient clinic Walstedde
• German Society of Gynaecology and Obstetrics (DGGG),
• Practising physician in Lüneburg and Honorary Member of the German Society of Gynecology and Obstetrics (DGGG)
• German Professional Association of Gynaecologists (BVF)

Results

Printed materials (until December 2023):

• Women’s leaflets: A total of 5,700,000 women’s leaflets were distributed until December 2023.  In 2023 alone 270,000 copies were printed. 110,000 were distributed via "Happy Mom" bags and another 150,000 were distributed by IDS. 
• Girls’ leaflets: A total of 808,000 girls’ leaflets were distributed until December 2023.  In 2023 alone 83,000 copies were printed, 20,000 were distributed via "Happy Me" bags, 40,000 at the J1 examination and 25,000 via IDS.
• FAS leaflets: A total of 380,500 FAS leaflets in German and 12,000 FAS leaflets in English have been distributed.  In 2023 alone, 36,500 copies of the German version were distributed.
• Practice packs: A total of 69,500 practice packs (posters and leaflets) have been sent to gynaecological practices.  In 2013 alone 5,000 packages were distributed.
• Posters: A total of 70,000 copies of the “The healthy child” posters have been distributed.
• Articles/ads: In cooperation with the Professional Association of Gynecologists (BVF), the magazine “FRAUENARZT” distributed the leaflet “Responsibility from the start! – What girls should know about alcoholic beverages during pregnancy” in 2023. Every year the magazine publishes articles on Responsibility from the start!  Also, the influencer collaborations with Jennifer Turbanska (Instagram: reisezumglueck) and Lisa Weckwerth (Instagram: by.lisamaria) generated a reach of around 61,131 with feed posts and stories. 
• Website: The website has had over 107,000 users and over 244,000 page views until December 2023.  

Measurement & evaluation

Girls' leaflet: The evaluation analysis from June 2023 to January 2024 returned positive findings.  207 replies from girls aged 14 to 17 found that: 87% had read it; 74% said they learned something new; 96% felt well informed.  (Source: Working Group on Alcohol and Responsibility press release 2/2023 of 13 March 2024).

Women's leaflet: An evaluation from June 2023 to January 2024 (n = 1,367) showed that 86% of pregnant women who received the leaflet also went on to read it.  85% felt informed, 53% gained new information and knowledge, 79% learned how alcohol affects the unborn child, 72% learned to completely abstain from alcohol whilst pregnant.  In addition, around 83% learned more about Foetal Alcohol Syndrome (FAS).  Another evaluation between June to December 2023 (by IDS - n=175) showed that 82% learned that they should completely abstain from alcohol, 92% learned how alcohol affects the unborn child, 68% learned something and 82% would now avoid alcoholic beverages during pregnancy in the future.  In addition, 58% learned more about FAS (Source: Working Group on Alcohol and Responsibility press release 3/2024 of 19 March 2024).

Website

https://www.verantwortung-von-anfang-an.de/

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