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Increasing tax is never popular. In October last year, the Health Secretary asked the Chancellor to raise the tax on alcopops and other drinks favoured by teenagers, recognising the clear link between the price and availability of alcohol and its consumption. This is not just a problem for government; retailers have their part to play in supplying alcohol in a responsible way. We have to remember that many groups of young girls go to the supermarket to buy cheap alcohol, often spirits, to get tanked up before going out clubbing. When girls are sober they are more likely to read the label or get pressure from their peers. If a young girl knows that her friend is pregnant, there is a chance she might warn her not to drink that night.

In most EU countries wines and spirits are sold in separate areas in supermarkets, but in the UK they are presented as end-of-aisle offers. Let me be clear: as someone who buys wine in a local supermarket, I do not suggest that retailers should try to sell less alcohol in a way that would damage profits. However, many retailers sell alcohol as loss leaders, particularly at Christmas, with end-of aisle promotions most

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visible. An end to that practice would not only demonstrate corporate responsibility, it would certainly not harm retailers’ profits and it might allow reductions on food, vegetables, toys and other products.

I hope that a broad-ranging approach would also include guidelines on the advertising of alcohol. Adverts for alcohol play a large part in fostering our culture of excessive drinking, as adverts increase positive beliefs about alcohol and reduce perceptions of risk. Advertising bans are controversial, but it is interesting to note that there is no watershed for alcohol adverts, and many of them are focused strongly towards young people. We take a remarkably liberal approach in this country. France, which is not famed for a puritanical approach to alcohol, allows no broadcast advertising for alcohol.

One further area I would like to see covered is that of drink driving. Lowering the UK maximum blood-alcohol level from 80 milligrams of alcohol in 100 millilitres of blood to 50 milligrams, as is more generally the case across the EU, would be a significant move. In Australia, lowering the drink-driving limit from 80 to 50 milligrams resulted in a lower accident rate and a fall in health-related harm.

The Bill takes an important step towards tackling the increasing problem of the effect of alcohol on the foetus, and I hope that it might have a secondary effect on drink driving and other areas of life. It is when babies’ brains are developing that they are damaged by booze abuse. Let us not forget the cost to society and the cost to the child, and I hope the Minister will remember the cost to health and social services in the care these children require, as well as the cost to education departments in meeting their specific learning needs. Such a Bill could well prove to be remarkably cost-effective in terms of its impact on our health services. I hope that the success of this Bill will come to represent the first in a series of measures to bring about a healthier, safer and happier drinking culture. I wish it well and I end by saying, “Cheers, my Lords”.

2.41 pm

Lord Monson: My Lords, I apologise for not putting my name down on the speakers’ list, but I had a long-standing hospital appointment this morning which I feared might overrun. Luckily, I have been able to make it just in time. Courtesy dictates that this Bill should receive an unopposed Second Reading, but I hope it will not go much further, certainly not in its present form. As my noble friend Lord Walton of Detchant said only a couple of days ago when speaking in a health debate:

There is no empirical evidence that for the great majority, taking alcohol in moderation—one must stress the word—during pregnancy harms the unborn child. If it did, neither I nor my siblings would be here today to tell the tale, and nor would most of my contemporaries. The same goes, I think, for my sons’ generation. The noble Lord, Lord Mitchell, said that

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a survey had revealed that 61 per cent of pregnant women admitted to drinking. I would have thought that 40, 50, 60 or 70 years ago it was probably more like 90 per cent, the difference being that pregnant women would restrict their drinking to a glass of sherry or half a pint of mild at one end of the social scale up to a dry martini or a glass of scotch at the other. Binge drinking simply did not happen, except perhaps at university after finals or something like that. It is a modern phenomenon which was then unknown, and I agree that it is a serious one. I shall come back to that issue in a moment.

Not so long ago, doctors and district nurses would urge nursing mothers to drink a pint of Guinness a day for the sake of their health and that of their baby. Medical fashions change from year to year, and indeed from month to month. We were told not long ago that butter was a deadly poison and we must all switch to margarine. The position has totally reversed and now margarine with its hydrogenated fats is the villain of the piece while butter in moderation is perfectly all right. A decade before that, antibiotics were prescribed for everything under the sun—for anything from a scratched finger to a boil on the bum. That has resulted in people becoming desensitised to antibiotics so they no longer work. A decade earlier, anyone feeling slightly down in the dumps was prescribed tranquillisers, and hundreds of thousands were prescribed to ill effect. A couple of decades before then, asbestos was considered God’s gift to mankind. You were doing a public service by lining your house or place of business with as much asbestos as possible. Now we know better. Medical and health fashions do change.

In two or three years’ time it may well be decided that on balance it is beneficial once again for pregnant women to have a single glass of red wine a day, but that would be a bit too late if this Bill goes through. Moreover, the Bill would target the wrong people. Young, university-educated women are having babies later and later, mainly for economic reasons, and are finding it harder to conceive. Once pregnant they are more prone than younger women to complications. So they will usually religiously avoid drink, and often tea and coffee as well. The Bill is not necessary for them. Women from a more feckless background—the binge drinkers to whom the noble Lord, Lord Mitchell, referred—are likely to do most of their drinking in pubs and clubs. When they buy bottles, they are unlikely to peruse the labels carefully.

That brings me, lastly, to an aesthetic objection. The noble Lord, Lord Mitchell, talked about Château Lafite 1982. Imagine how terrible it would have been if those marvellous Château Mouton Rothschilds—I have only tasted it once—with their magnificent labels designed by Dufy, Matisse, Picasso and so on, had been ruined by ugly warnings plastered all over them, especially when such warnings are not really necessary, and certainly not on the front of the bottle.

12.46 pm

Baroness Neuberger: My Lords, first I pay tribute to the noble Lord, Lord Mitchell, for his persistence in highlighting foetal alcohol spectrum disorder and

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for keeping his campaign going over the years, and for introducing his excellent Bill. Let me say now that had it been possible to add a second name to a Private Member’s Bill, I would have done that, so convinced am I that this is the right way forward. I am sure that the Minister will tell us more about the voluntary labelling of alcohol that is already taking place. Scottish & Newcastle is the leader, and all credit should go to the company for doing it.

However, a voluntary labelling system, however admirable, is not enough. The Minister for Public Health in another place is on record as saying that warning labels for alcohol will be voluntary initially, but if the drinks industry ignores them, the Government will consider legislating. That is absurd. We are asking for labelling that is not punitive but informative. The industry should not be allowed to resist precisely because so many women are ignorant of the possible effects of alcohol on the unborn child, and the duty to inform on the bottle or the can should be comparable with what is done on cigarette and tobacco packets.

This is even more important because the level of ignorance in the general population is quite high. My children are what might be described as quite aged now, at 27 and 25. When I was pregnant—which sometimes I think was not all that long ago—no one thought that drinking moderate amounts of alcohol was dangerous for the foetus or the very young baby. Indeed, in my day experienced maternity nurses and health visitors advised drinking a glass of wine before the last feed at night to help the new baby sleep. I do not think they would be saying that now, and that was not so very long ago. Our knowledge of foetal alcohol spectrum disorder has increased hugely, but public awareness has not kept pace. Most young women, especially the less well educated and the very young, do not know about the risks at all. They have not heard forensic psychiatrists talking about the prevalence of foetal alcohol spectrum disorders among young people in prison, and those with the condition are not by any means all identified because of a continuing lack of clinical awareness of these conditions in many cases.

Only last night I was with Professor Sue Bailey, the registrar of the Royal College of Psychiatrists, who is a child and adolescent forensic psychiatrist at the University of Central Lancashire. She said that signs of foetal alcohol spectrum disorder are frequently missed within prisons, even by those who know about it. Young women who do not know about it have not heard prison governors talk about how prisons are becoming the last closed institutions in this country, and it is suspected that in among the sheer misery of the huge incidence of mental illness among prisoners, there is also a fair prevalence of undiagnosed learning disability within which foetal alcohol syndrome may well figure to a considerable extent. Unlike the case with cigarettes, the public do not know about the risks of alcohol in pregnancy.

I am not of the view that we should forbid drinking alcohol in pregnancy or that we should regard the pregnant woman who drinks alcohol as a criminal because I do not want even more of a nanny

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state than we already have. However, I would like women to know about the risks so that they can decide whether to accept them. Few pregnant women are really willing to add consciously to the risk of having a child with a problem such as foetal alcohol spectrum disorder. All women fear the possibility of having a child with some kind of disability, much as those disabled children are usually dearly loved after their birth. But we all want the best for our children and if not drinking during pregnancy means lowering the risk of some kinds of birth and developmental defects, that is something most women would accept if they knew. So information is critical, and making it widely available—which is why I think it has to be compulsory—is also critical.

However, let us not be puritanical about this, as the noble Lord, Lord Mitchell, said. I am certainly no puritan about this: I come, on my mother’s side, from a family of small-time wine growers and wine merchants in southern Germany. My grandfather’s drinking companions—and he could certainly drink—in the prisoner-of-war camp in France during the First World War were also the people who went into my grandparents’ apartment three days before the Second World War broke out, just after my grandparents had left for this country, and packed up all their possessions which they then sent them after them.

Drinking can provide strong social bonds. This House has its bars, and most of us drink socially. The difference is this: if we knew that by drinking we were risking the development of our unborn children, most of us would stop, just as many of our own young are so much better in many cases about not drinking at all if they are going to drive. We are talking not about abstinence but about abstinence for nine months. Similarly, no one asks for total abstinence from those who are drivers, only that they do not drink when they are going to drive. Some women are fortunate enough to have their tastes change so much during pregnancy that they cannot face even a single glass of wine. But the evidence shows that just under 50 per cent of mothers visiting the teenage antenatal clinic at St George’s Hospital drank more than four units in one go, and 27 per cent occasionally got seriously drunk when pregnant.

With an increasing culture of binge drinking among young women, to which the noble Baroness, Lady Finlay, drew our attention, we should be all too aware that this will rise. The noble Baroness is right to suggest that warning notices about alcohol when pregnant should also be displayed in bars and pubs.

We do not really know the extent of harm. The estimate is that one in 100 of live births is affected with foetal alcohol spectrum disorder, making it the most common cause of learning disabilities worldwide. The acute form of foetal alcohol syndrome occurs in between one and three live births per 1,000. So Dr Raja Mukherjee, one of the UK’s foremost experts, along with Professor Nigel Eastman and Professor Sheila Hollins, the president of the Royal College of Psychiatrists, summarised the position when she said:

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Unlike the noble Lord, Lord Monson, I think the case is irresistible. I hope that the Minister will agree that this is not about voluntary labelling. We need it made compulsory, because the level of knowledge is low, and, from what we can now see, the incidence of binge drinking and drinking in pregnancy is high and the conditions are preventable. We on these Benches strongly support the Bill.

12.53 pm

Earl Howe: My Lords, I join other noble Lords in congratulating the noble Lord, Lord Mitchell, on bringing forward this Bill. It is two and a half years since he introduced his memorable debate on foetal alcohol syndrome. None of us who researched the subject at that time was left in any doubt that we were dealing with something of major importance. I felt then, and I feel now, that doing nothing is simply not an option. The noble Lord reminded us today about the devastating and lifelong consequences which can ensue for children born to mothers who have indulged in binge drinking during pregnancy or who, in some cases, have consumed a relatively modest amount of alcohol at the wrong time.

The wider issues to do with FAS present challenges in relation to prevention, as well as to the issues further down the track such as the diagnosis, education and appropriate care of children and adults afflicted with the syndrome. The Bill deals with the preventive aspect, so I shall not talk about the other ones today.

I think that the noble Lord has successfully made the case for putting warning labels on alcohol containers. Awareness of this issue is generally low—61 per cent of British women drink while pregnant. In the background, as noble Lords have emphasised, we need to be mindful of the increasing culture of heavy drinking among the young in all socio-economic groups.

It is true that the Government have spent not inconsiderable sums on public information initiatives over the past few months, such as the Know Your Limits campaign, and these are to be welcomed. But campaigns of this sort are inevitably transitory and we cannot know that the message has reached everyone who needs to hear it. As a means of raising awareness, appropriate labelling has much to recommend it.

The questions we need to settle are twofold: first, do we need a piece of legislation to do this, as opposed to a voluntary agreement with the drinks industry; and secondly, what exactly should the label say? When we debated FAS in 2004, the Minister replying, the noble Baroness, Lady Andrews, told us that the Government were taking the problem very seriously and were working with the drinks industry on developing a voluntary labelling scheme. I was more than prepared to accept those assurances at face value, but here we are, two and a half years later, and there has been no visible result from those discussions. I would much prefer a voluntary scheme as long as it could be made to work, but after this interval of time one has to wonder whether there is

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actually any mileage in the idea; and I frankly am not surprised that the noble Lord has lost patience. It may be that the Minister will deliver some words of genuine comfort on the matter today, but if we carry on without agreeing on a voluntary scheme, then yes, I think the Government need to take at least back-up powers to introduce a scheme of statutory regulation.

The noble Lord has made a very good fist indeed of drawing up his Bill. One could criticise it for being too detailed: quite a lot is perhaps more suited to secondary than to primary legislation. But notwithstanding that, full marks to the noble Lord for showing us exactly what he intends Parliament to consider.

It is not only America that is pointing the way on this. If we look at what is happening in France, Finland, Canada, Australia and New Zealand, we see that public health messages on bottles and cans about not drinking alcohol during pregnancy are gaining widespread acceptance. Indeed, in 2004, a YouGov poll of more than 2,000 people found that 67 per cent of those asked would welcome labels warning of the dangers to the unborn child. I do not think we need be too fearful that warning labels may be seen as an unnecessary piece of nannying. It is, after all, only a label.

Lord Monson: My Lords, can the noble Earl tell us whether the labels which have to be displayed on the containers in the countries he mentioned are displayed on the front or the back of the cans or bottles?

Earl Howe: I am afraid I cannot, my Lords. Perhaps the noble Lord, Lord Mitchell, can enlighten us when he winds up.

The problem, in my view, is how to achieve a message that reflects the current state of scientific knowledge and does not run the risk of alarming women without due cause. The fact is that many women when pregnant can have a couple of units of alcohol once or twice a week without any apparent detriment to the health of their baby. Indeed, the current official advice from the Royal College of Obstetricians and Gynaecologists says that drinking alcohol at that level has not been shown to be harmful, even though it makes it clear that the safest approach for a pregnant woman is to choose not to drink at all. The guidelines also warn that episodic binge drinking around conception and early pregnancy is especially harmful to a woman and her baby, and this line is echoed by the Royal College of Midwives.

I do not think that anybody disputes the advice about binge drinking. The real question is whether we can justify a message as drastic and uncompromising as the one contained in Clause 1. We must be guided, surely, by the science. There is no consensus at the moment about the threshold below which consumption of alcohol causes negligible damage in the expectant mother. Nor is there consensus about the causal mechanisms which lead to foetal alcohol syndrome. We know that some populations are more prone to alcohol-related disorders; for example, those

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in lower socio-economic groups and ethnic minorities. The prevalence of these disorders also seems to be a function of maternal age, poor nutrition, drug use and use of tobacco, so the picture on causation is not wholly cut and dried. There is scope for further research into these issues to enable us to explain why some babies are more affected than others.

The research that we do have suggests increasingly that if we err at all it should be on the side of caution. In the 1990s, Ann Streissguth, at the University of Washington, established that children of mothers who had drunk seven to 14 standard drinks per week in pregnancy tended to have specific problems with arithmetic and attention, as well as behavioural difficulties when older. These results have been confirmed by the work of Sandra and Joseph Jacobson at Wayne State University, Detroit. At the same time, what is important is not just the number of drinks you consume: it is when you are drinking them, whether you have eaten beforehand and how fast your body metabolises alcohol. Drinking all seven units at one session during a week would amount to a binge which potentially puts the baby at risk.

What do we know about very low levels of alcohol consumption? The Jacobsons found that children of mothers who drank fewer than seven drinks a week had no detectable mental deficits. But a study by Hepper at Queen's University, Belfast, indicated that fewer than seven drinks a week can have a measurable effect on the developing nervous system of an unborn baby. John Olney, a neuroscientist at Washington State University, has performed studies on rats. These show that cell death in the brain can occur when developing rats are exposed to only mildly raised blood alcohol levels equivalent in humans to 50 milligrams per 100 millilitres of blood for a period of only 45 minutes. This level would be sufficient to delete 20 million neurons in the brain of a foetus—not enough to translate into a detectable effect on a child's cognitive abilities, but nevertheless a measure of damage.

What does all that say to us? It says, rather messily, that we cannot as yet convert our current scientific knowledge into categoric blanket advice for all women about how many drinks they can have when pregnant. But we appear to know that the less alcohol she consumes, the better it is likely to be. Meanwhile, the noble Lord's approach in this Bill is to adopt the precautionary principle. In the circumstances, it is hard to disagree with that approach. It is right that we should think carefully about the precise wording of the warning message and whether it could be improved on, but I would not wish to suggest to the noble Lord that the general tenor of the message he has proposed is misplaced.

If I have a worry at all, it is on an associated issue—the vagueness of alcoholic measures, to which the noble Lord, Lord Mitchell, referred. If we are to talk in terms of units of alcohol, people need to be aware of the true number of units they are consuming. A 125 millilitre glass of wine contains roughly one unit. But a glass of wine that you pour at home is likely to be larger. It may also have a stronger alcohol content, so a glass of wine at home may be far

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more than one unit. The lack of awareness of these basic things needs to be addressed every bit as much as the matters covered by the Bill.

Naturally, I hope that the Minister will look at the Bill in a positive light. I wish the noble Lord, Lord Mitchell, well with its future progress.

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