No abstract

The paper provides a nuanced and contextualised insight into "how" the ideals of consumerism and user involvement are translated into everyday encounters between service providers and users.

In this article we explore the construction of risk in government guidelines on alcohol intake during and before pregnancy in four Nordic countries given that there is no sound evidence linking a low level of alcohol intake during pregnancy to foetal harm. In the article we draw on two sources of data to examine the rationale behind the advice given to pregnant women: health education materials and other government documents, such as guidelines for professionals. We found that in all the four countries the government guidelines advised pregnant women to completely abstain from alcohol consumption, but there was some variation between the countries in the advice for non-pregnant women. The guidance in the four countries also differed in the extent to which they discussed the lack of evidence behind the abstinence advice and the precautionary approach on which the advice was based. In all the four countries the printed and widely circulated health education materials did not explain that the abstinence advice was not based on actual evidence of harm but on a precautionary approach. The other government documents adopted varying strategies for justifying the abstinence advice including not offering information about the uncertainty of the knowledge base, implying that there was evidence that low alcohol consumption was harmful to the foetus, acknowledging that a safe level of alcohol intake during pregnancy could not be specified and explaining the precautionary approach to risk. In this article we argue that the shift from 'estimation of risk' to the 'precautionary principle' is a part of a wider socio-cultural push towards broader employment of the precautionary principle as a strategy to manage uncertainty, and in the context of pregnancy, it is a part of the symbolic struggle to protect the purity of the foetus and construct the 'perfect mother'.

AImS-Adverse effects of alcohol on the fetus are currently defined as a serious public health problem in all western countries. Exposure of the fetus to alcohol may result in a spectrum of adverse effects, referred to collectively as fetal alcohol spectrum disorders (FASD). Different countries vary in terms of policy regarding alcohol consumption during pregnancy. This paper sets out to examine and compare official recommendations on alcohol intake during pregnancy in Finland and Denmark since the 1970s. In addition, the paper analyses the rationale behind these recommendations. mETHODS AND DATA-The method used is qualitative content analysis. The data consists of 1) health education material for pregnant women and 2) reports and guidelines produced by government health authorities. The data comes from Finland and Denmark and covers the period between the 1970's and today. RESULTS-The article demonstrates how the official Finnish and Danish recommendations regarding alcohol intake during pregnancy have in the last decades fluctuated between a more permissive and a total abstinence approach. both countries have recently adopted a total abstinence message. This policy line is not, however, based on research evidence pertaining to the harmfulness of a small-to-moderate alcohol intake during pregnancy but rather on the principle of precaution. The Finnish data contains very little information about the background of the changing recommendations whereas the Danish trajectories are explained in policy documents and expert debates. The paper suggests that the recent adoption of a total abstinence message in Finland and Denmark is closely linked to a change in the social and cultural climate regarding FASD. moreover, it is argued that the adoption of the total abstinence model in Finland and Denmark is part of a wider international trend. CONCLUSIONS-The knowledge gap with regards to the fetal effect of low-to-moderate levels of alcohol consumption combined with an urge to protect the fetus makes the formulation of health education messages complicated. The paper discusses problematic features in the current Finnish and Danish policy arguing that the recommendations to pregnant women contain contradictory elements. Future research should focus on women's and health professionals' risk perceptions and international trends with regards to the total abstinence model. KEy wORDS-Fetal alcohol syndrome disorders (FASD), pregnancy, health education, total abstinence, risk, Denmark, Finland.

This article examines how the amplified role of pharmaceutical substances in addiction treatment affects the everyday realisation of care, particularly the relationship between workers and patients, in so called austere environments. Theoretically the article draws firstly on the literature that links pharmaceuticalisation to the neoliberal undoing of central public structures and institutions of care, and secondly on Anne-Marie Mol's concept of the logic of care. Based on an ethnographic analysis of the everyday life at a Finnish opioid substitution treatment clinic we show the mechanisms through which the realisation of pharmacotherapy can, in the current political climate, result in a very narrow understanding of drug problems and minimal human contact between patients and professionals. Our analysis manifests an important shift in the logic of addiction treatment and health-care policy more broadly; namely, a growing tendency to emphasise the need for patients to care for themselves and make good choices with limited help from formal care institutions and professionals. We call this new ethos the logic of austerity.