Sex and Gender-based Analysis of this topic
Definition
Alcohol is the most common substance used by women. Over the past decade, women’s use of alcohol has increased. Studies suggest that women are less likely to drink and less likely to report heavy drinking than men but that drinking patterns are changing. In 2010, an estimated 10% of Canadian women reported being heavy drinkers, defined as 5 drinks or more on one occasion [1]. However, new Canadian low-risk drinking guidelines from 2011 have lowered the threshold for what is considered low-risk drinking and suggest that women should drink no more than 3 drinks on one occasion to reduce the risk of harm and injury. These new guidelines will likely result in a higher prevalence of what is considered female heavy drinking than previously estimated [2].
Sex Issues
Biological differences between men and women may result in a number of female-specific reactions to alcohol use. For example, compared to men, women reach higher peak alcohol levels from equal dose per pound body weight [3] which may be the result of slower alcohol absorption tissues and less water to dilute alcohol in the blood stream as well as lower levels of enzymes needed to metabolize alcohol [4]. Women can therefore be at increased risk for adverse effects of heavy drinking, such as hypertension, osteoporosis, brain shrinkage and impairment, breast cancer, and gastric ulcers [5].
Alcohol use may also negatively affect puberty and disrupt normal sexual reproductive functioning, which may result in a number of menstrual and reproductive problems, including irregular menstrual cycles, absence of ovulation, and infertility [6]. Research also suggests that compared to men, women may exhibit a more rapid progression to addiction to and/or dependence on alcohol [7] and may develop cirrhosis of the liver with less alcohol and over a shorter period of time [8].
A key sex difference is related to alcohol use in pregnancy. Alcohol is a teratogen and a range of birth defects and developmental disabilities described by Fetal Alcohol Spectrum Disorder can be a result of maternal alcohol use in pregnancy [9].
Gender Issues
Women differ significantly in the reasons for alcohol use, the pathways to problematic use, and the social consequences of alcohol use [10]. Although men exhibit a number of problematic drinking outcomes (e.g., absenteeism, family problems, violence), increased alcohol consumption patterns among young and middle-aged women are resulting in elevated concerns regarding future social and health consequences [11]. Many women identify their alcohol use as a way to cope with experiences of violence [12] and women often drink more after a violent incident [13]. Early experiences of violence are associated with initiating alcohol use at a younger age [12]. For example, women in treatment for alcohol problems are more likely then men to report being sexually abused as children [14]. The rate of alcohol problems has been found to be up to 15 times higher among women who are survivors of intimate partner violence [13]. Women and men also report drinking for different reasons. As noted earlier, women consume alcohol and other substances to cope with problems and stress and to increase confidence [12]. Some studies suggest that women can have more stressors due to their high workload associated with family responsibilities, care-giving and other unpaid, domestic labour as well as paid labour [15], which may affect their drinking behaviour. Gendered experiences can also prevent women from accessing treatment and related supports for problem drinking, including the heightened stigma associated with female substance use, in particular among pregnant women and mothers [16]. Other treatment barriers include difficulties related to family responsibilities, job loss, unsupportive spouses, and lack of local or accessible treatment centres [16]. Other gendered influences that could impact women’s alcohol consumption include alcohol marketing, which is often directed towards women [10], including free entrance and inexpensive drinks offered to women as incentive to visit various bars and clubs [17].
Diversity
Women who have unstable housing or who are homeless may be at particular risk of heavy alcohol use and other risks associated with their substance use [5]. Women with lower incomes may use alcohol as a coping mechanism to deal with the range of stressors they face [18]. As well, exposure to violence associated with substance use may be especially problematic for Aboriginal women [5]. Other populations of women that show unique patterns of problem substance abuse include young women (aged 18-34 years) who are more likely to report heavy drinking than other age groups [1] and lesbian and bisexual women who may be more likely to drink alcohol and use tobacco or other drugs, which may be uniquely linked to the specific personal, relational, and societal pressures these women face [19].
Alcohol use during pregnancy is another important women’s health issue. Although women may be aware of the risks associated with alcohol use during pregnancy, supportive prenatal care may not be available and women with alcohol problems may avoid asking for help for fear of losing custody of their children [3, 20].
Equity
Drinking among individuals in higher socioeconomic groups tends to be more frequent due to social drinking situations which are often light-to-moderate drinking occasions compared to individuals from lower socioeconomic group where binge drinking is more common [21]. These patterns of consumption among groups with lower socioeconomic status result in a higher burden of alcohol-attributed disease even though overall alcohol consumption may be lower than groups with a higher socioeconomic status. These health inequities may be further exacerbated among women if they are viewed more negatively for having alcohol problems and/or receive less attention from professionals regarding potential alcohol problems [11].
Critique
Until the revised drinking guidelines were created, measures of alcohol use and heavy drinking were identical for men and women, a practice which ignored a number of important biological and social differences between men’s and women’s alcohol use patterns. Identifying appropriate reference periods for alcohol use is also problematic. Longer reference periods, such as alcohol use over the past 12 months (which is the main reference period used by the Canadian Community Health Survey) may not capture varying consumption levels throughout the year. However, shorter reference periods, such as alcohol use over the past week, may not reflect typical drinking patterns, especially among infrequent drinkers. Because so much of research has focused on Aboriginal women’s risk for substance use while pregnant, levels of alcohol use and related risks for non-Aboriginal women are largely unknown. For example, middle class and/or Caucasian women are often not screened for substance use during pregnancy because they are not considered ‘at risk.’ Large population surveys need to attend to differing patterns and risks associated with women’s alcohol use. In addition, methods for creating a supportive context for women to describe their alcohol use in pregnancy, in both surveys and other types of research are important [22].