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>On the Accuracy of Self-Reports about Alcohol Consumption

March 29, 2011

>If you are an adoptive parent or the prospective adoptive parent of Korean children and take time to read the full text of only one of the reports highlighted in this series, read Alcohol Use During Pregnancy and Related Risk Factors in Korea, introduced in this post. I have also added the study to my list of resources linked in my sidebar.

The authors’ conclusions about the limitations of their study raises some interesting food for thought about the potential limitations of the self-reports contained in a referral. (For those reading from outside of Korean adoption circles, in Korea children who are abandoned –in the ‘foundling’ sense of that word –are not legally available for adoption. Korean law requires a birth mother to formally surrender parental rights. At that time, an intake social worker interviews her and collects information reported in the child’s referral.)

The common wisdom up until now, which I heard directly from a Korean intake social worker myself eighteen months ago, has been that birth mothers feel fairly free to tell the truth about alcohol consumption because there is little stigma associated with social drinking in Korea. True.

However, shame (and preventing shame) are key motivators in Korean culture. If the majority of the women surveyed stopped drinking socially in anticipation of planned pregnancy, doesn’t that suggest that for those who have been educated about the risks of drinking while pregnant, there may be growing stigma in Korea associated with consuming alcohol while pregnant? (Some birth mothers do report a change in behavior after they realized they were pregnant. Why?)

Here are the last two limitations identified in this study. How might similar dynamics affect the self-reports that we read in recent referrals? (Emphasis below is mine.)

“Second, data were obtained by self-report, and some women may have under-reported their alcohol use. To prevent this, it would be helpful to combine the self-report information with other more objective measures. However, as with any other test, ethical considerations need to be taken into account. Because more than half of the participants were in their 3rd trimester, even though they were asked about their drinking during the entire pregnancy, their answers might have referred to the period after their recognition of their pregnancy. Therefore, alcohol use prior to their awareness of pregnancy recognition might have been missed.

Third, the rate of refusal to complete the questionnaire was 26.1%. Most women who refused said they were busy and did not clearly explain the reason for the refusal. In the process of obtaining written consent from these subjects, pregnant women who consumed relatively large amounts of alcohol did not want to reveal their names. Furthermore, pregnant women with any suspicion of fetal deformity in the basic prenatal tests tended to refuse the survey questionnaire.” (S H Lee et al., 91-92; PDF pages 6-7)

By the time a birth mother makes a self-report to an intake worker, she has already given birth. Therefore any visible special needs the child has may be a source of shame that influences what she reports.

I will repeat: professionals who work with with children who have FASD have told us that it is a blessing to have known alcohol use reported in a referral of a child who later presents with symptoms of FASD. Known exposure is part of the diagnosis. So the potential for under-reported prenatal exposure doesn’t matter much by the time the child is old enough that the family is seeking a diagnosis.

However the potential for under-reported exposure would be of concern if as a prospective adoptive parent I believed the amount reported was somewhat predictive of the child’s outcome. I’ll be tackling that myth in the next post.
3 Comments leave one →
  1. March 29, 2011 2:11 pm

    >Excellent points – and relevent to adoption scenarios all over the world.

  2. March 29, 2011 3:59 pm

    >This series is really wonderful Carrie. I am especially thankful for the information regarding the socialization of alcohol in Korea. From what I've read, this pattern differs significantly from known exposure found in other international adoption programs (like EE or Russia) where the prevalence of binge drinking, or drinking to self-medicate, is (at least anecdotedly) higher.

  3. March 29, 2011 6:27 pm

    >Thank you Carrie – this series has been very informative.

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