It has long been known that alcohol use during pregnancy has detrimental effects on women and infants; however, the practice remains common. Besides fetal alcohol syndrome, abortion-related maternal deaths and various fetal complications are also caused by alcohol consumption during pregnancy [21]. According to the study, in Ethiopia, almost a third of pregnant women have consumed alcohol during pregnancy, signaling a significant problem in the country. The study also demonstrated that there is no significant difference between rural and urban women, among different educational levels, and along the age spectrum. Other factors found to be associated with the alcohol use are lifetime number of partners, having tried to terminate the pregnancy, working status, and chat chewing.
In previous local studies, the prevalence of alcohol use during pregnancy varied from 4.3–45% [10, 18], which is consistent with the national survey. However, the prevalence is higher compared to a recent meta-analysis in sub-Saharan Africa [20.8% (95% CI: 18.2, 23.5)] [22], the World Health Organization Africa region (18.5%) [23], Korea (16.4%) [24], the United States (11.5%) [25], and global estimated prevalence (9.8%) [26]. On the other hand, this finding is lower than studies done in Australia (64%) [27] and Russia (60%) [28]. One possible explanation for this variation could be a variation in socio-demographic and economic status, cultural practices, and health policies. There could also be differences in measurement tools for alcohol drinkers s. Under reporting due to social desirability bias, recall bias, religious beliefs, and geographic variations were also mentioned as limitations in previous studies that could affect the accuracy of measurements of prevalence of alcohol drinking during pregnancy [29, 30] .
Findings of a systematic review showed that alcohol consumption during pregnancy was associated with socioeconomic factors, like source of income, employment status, and knowledge of harmful effects of alcohol; and behavioral factors, like prior alcohol consumption, partner’s alcohol use, peer pressure to use alcohol, and smoking [22]. Other studies show that women’s alcohol drinking has been increasing due to having their own income, socialization with friends, peer pressure, and lack of adequate information about the adverse health effect of alcohol [31–35]. Women who are working have their own money to spend on alcohol, while their counterparts who are not working do not. In the current study, women who were employed had increased odds of alcohol use during pregnancy, which is consistent with the previous research [35].
The literature has shown that alcohol consumption is significantly associated with abortion-related maternal deaths. Alcohol consumption may lead to increased risk of induced abortion and consequently, death due to unsafe abortion [21]. The current study revealed that prior attempt to terminate the pregnancy was significantly associated with alcohol use during pregnancy, which is consistent with previous studies [36, 37]. Unplanned pregnancies are at high risk for exposure for different teratogens; alcohol, radiation and drugs. Women who have attempted to terminate the pregnancy might have an unplanned pregnancy or unstable family situation. The social and psychological impacts of unplanned pregnancy may influence the initiation of alcohol or other substance use to relieve or mask stress [38]. Being a khat user also increased the odds of alcohol use during pregnancy in this study, likely following a similar mechanism.
In this study, having more than one lifetime sexual partner increased the odds of alcohol use during pregnancy. Multiple lifetime sexual partners expose women to different people with different behaviors. Having a partner who drinks may lead a pregnant woman to drink as well. Alternatively, being a drinker may have been a cause or outcome of prior unsuccessful relationships. The literature also reveals that the association between alcohol use and number of sexual partners is stronger for women than men [39].