1. Direction générale de la Santé Sanitary warnings on alcoholic beverages French experience Pierre-Yves Bello, MD, MPH Protecting the unborn baby from alcohol Eurocare’s policy debate, the European Parliament 17th of September 2013

2. Direction générale de la Santé Plan Context Implementation of the “No alcohol during pregnancy logo” on alcoholic beverages Elements on the evolution of beliefs and behaviours Conclusion Alcohol & sanitary warnings in France

3. Direction générale de la Santé The French context The French regulatory framework on alcohol ads is included in the Public Health code since the “Loi Evin “(1991) publication Total ban on television Partial ban on radio broadcasting Total ban on newspapers, magazines and websites specifically for young people Sponsoring is forbidden if it produces propaganda or advertisements Content of ads is regulated (only the products and its description) Alcohol & sanitary warnings in France

4. Direction générale de la Santé The French context -2- A sanitary warning on ads is mandatory (Art L3323-4 PHC) : “all advertisement […] must display a sanitary message explaining that alcohol abuse is dangerous for health.” Alcohol & sanitary warning in France

5. Direction générale de la Santé Logo on alcoholic beverages Impossible to define a non problematic threshold of consumption of alcohol during pregnancy : No alcohol during pregnancy February 2005 : law on disabled people’s rights Senator’s Payet amendment : “All units of alcoholic beverages display a sanitary message advocating avoiding alcohol consumption by pregnant women.” Decree (02/10/2006) : “the sanitary message must be either a text or a logo” A warning message has been mandatory in France since October 2007 Alcohol & sanitary warnings in France

6. Direction générale de la Santé Alcohol & sanitary warnings in France Logo on alcoholic beverages -2- “La consommation de boissons alcoolisées pendant la grossesse, même en faible quantité, peut avoir des conséquences graves sur la santé de l'enfant.” or

7. Direction générale de la Santé Alcohol & sanitary warnings in France logo on alcoholic beverages -3- Some concrete examples

8. Direction générale de la Santé Alcohol & sanitary warnings in France logo on alcoholic beverages -4- The implementation of the mandatory warning was accompanied by :  Information at schools  Communication campaign  Information within pregnancy follow-up document  Professionals training  Experimental surveillance system

9. Direction générale de la Santé Beliefs and behaviour GP-2005GP-2007GP-2008PW-2012 Not definitive PW must not drink82%87% Some wine is good33%31%4% Beer & breast- feeding 29%25%9% Drunk = risk for baby 81%82%90% Alcohol & pregnancy = danger 22%27%70% Alcohol & sanitary warning in France

10. Direction générale de la Santé Beliefs and behaviour -2- Among pregnant women or those who recently gave birth Non definitive results Knowledge of the sanitary warning : 66% Among alcohol consumers before pregnancy : 77% Among alcohol consumers during pregnancy : 75% Logo is remembered by 93% of women knowing the warning Logo is understood by 99% of women Alcohol & sanitary warning in France

11. Direction générale de la Santé Beliefs and behaviours -3- Alcohol consumption of pregnant women 1995199820102012 Not definitive O after knowing3.2% 0 drink 3 trimester75%77%77% all pregnancy 89% all pregnancy 1-620%19%17% 1 or less/month 8% 1 or less/month 7-133,5%3% more1,40,9% 2-4/month or more2,5% Alcohol & sanitary warning in France

12. Direction générale de la Santé Conclusion Pregnancy and alcohol :  An increase in positive knowledge and attitude during the last 10 years  Dangers linked to alcohol are still underestimated in France  8% PW had 4 drinks or more during the first three months Warning logo  A relatively high knowledge of the warning message and its meaning, despite industrials’ reluctance, but  25% of drinking pregnant women not aware of it  Necessity of making it more readable for consumers  A useful tool which must be included within a global strategy Alcohol & sanitary warning in France

13. Direction générale de la Santé Alcohol & warning message in France Conclusion Thank you for your attention