Suboptimal uptake and placement of a mandatory alcohol pregnancy warning label in Australia

Background: Mandatory pregnancy warning labels are an important public health measure to signal the harms of drinking alcohol during pregnancy. Ensuring these labels are salient is critical to enhancing their effectiveness. On 31 July 2020, Australia mandated that alcoholic beverages labelled from 1 August 2023 display a pregnancy warning label. This study assessed uptake and placement of this warning on alcohol containers after the policy start date. Methods: Between August and November 2023, data collectors obtained images of 4026 unique alcoholic beverages available for sale across four major Australian alcohol retailers in Sydney (three physical stores and one online store). Product images were investigated to assess overall uptake of the mandatory pregnancy warning label and its placement on products (i.e., front, side, back, top, or bottom). Analyses were conducted overall and stratified across six alcohol product categories. Results: Two-thirds (63 %) of products displayed the mandatory pregnancy warning label. Uptake was lowest for spirits (50 %), followed by wine (65 %), cider (79 %), premix drinks (79 %), beer (83 %), and other alcoholic beverages (e.g., sake and soju) (91 %). The mandatory pregnancy warning label was most commonly located on the back (88 %) and less commonly on the side (8 %), bottom (3 %), top (1 %), or front (0.3 %). Conclusion: To increase uptake of the mandatory pregnancy warning label, policymakers should consider mandating that all alcoholic beverages available for sale, not just products labelled from 1 August 2023, display the warning. Existing requirements could be revised to ensure that the label is more prominently displayed.