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When I was pregnant with my daughter in 2016, I started getting at least one inquiry a week from friends and acquaintances who were also expecting. Most asked some version of the same question: Is it OK if I have a glass of wine every now and then while I’m pregnant? No one had asked me this a few years earlier, when many of us were pregnant for the first time. I’m a public health policy and communications strategist and a former molecular biologist, so I’m often asked for help making health decisions. But the shift was dramatic. And it wasn’t just my circle that was curious about drinking during pregnancy.
Last month, the Journal of the American Medical Association published the results of a study that should concern all of us. Researchers at Columbia University and the University of California, San Diego, analyzed more than a decade of data from the Centers for Disease Control and Prevention’s annual survey of health behaviors and found that the proportion of pregnant women who had reported drinking in the previous month rose from 9 percent in 2011 to nearly 15 percent in 2024—a 59 percent increase. Binge drinking rose by three-quarters, and heavy drinking nearly tripled.
What’s more, drinking among women who weren’t pregnant remained stable and actually declined in recent years. Yes, drinking rose nationwide during the COVID-19 pandemic, especially among women, whose days of heavy drinking rose 41 percent from spring 2019 to spring 2020. But Americans’ drinking has since fallen to a 90-year low, and women’s alcohol use dropped 11 percentage points from 2023 to 2025. Meanwhile, pregnant women’s alcohol use moved in the opposite direction. The JAMA study cannot tell us what drove this change. But this trend must force public health leaders to confront what a communication failure looks like when well-meaning but blunt advice stops being heard and heeded and more sympathetic, appealing messages take hold.
The health information landscape has transformed since my first pregnancy in 2012. Back then, only 9 percent of American adults used Instagram; today 50 percent do, and 37 percent use TikTok. Advice from physicians and public health agencies now competes with influencers and content creators, nearly two-thirds of whom have no listed health credentials. A majority are women, many of whom draw on their experience as parents; this matters because people often seek health information from others whose experiences resemble their own. And although 85 percent of Americans still get health information from healthcare providers, 4 in 10 adults—and more than half of women age 18 to 49—also get it from influencers or podcasters.
At the same time, a justified pushback has grown against the one-size-fits-all and sometimes paternalistic advice public health hands out, especially to pregnant women. Emily Oster’s 2013 book Expecting Better is perhaps its best-known expression. She argued that the case against drinking during pregnancy was paper-thin and patronizing and there was no good evidence that light drinking harms a baby. According to her, one or two drinks a week in the first trimester and then one drink a day thereafter was fine: “Drink like a European adult, not like a fraternity brother.” This advice, as anticipated, received backlash (which Oster defended herself against in Slate), but that didn’t stop it from also receiving a deluge of coverage and being amplified across the internet to thisday. I have since wondered and worried about the impact of this and other messages contrary to public health advice, especially against the backdrop of growing skepticism of public health recommendations and the proliferation of questionable health information across social media and from influencers.
The new study found that drinking during pregnancy was more common among women who were older, college educated, and employed; this group was also least likely to binge drink. That demographic profile mirrors the woman to whom Oster’s argument speaks most directly. It resonates in part because pregnant women are routinely handed absolutes with little explanation and expected to comply, so permission to have a little leeway is a welcome relief. There aren’t any studies that assess exposure to that advice and drinking during pregnancy, so we can’t conclude that it is among the reasons drinking during pregnancy has increased. But the overlap is hard to ignore.
Medicine and public health have long communicated like a scold, especially about women’s bodies. But a lenient countermessage framed as female autonomy is no better. It, too, considers only fetal outcomes, reducing the woman to the same thing existing guidance does: a baby incubator. An empowering message isn’t one that recommends the opposite of long-standing guidance. It considers a woman’s own health, not just the baby’s, and communicates risk without shame or a heavy hand
What would nuanced messaging look like? It would center the woman, not just her baby, and recognize the perceived benefit she is weighing against the risks. A pregnant woman very understandably might view a drink as an occasional treat with which to unwind, but alcohol actually undermines that goal. The message would be candid about alcohol’s harms to a woman’s own body—among them sleep disruption, increased blood pressure, and cancer risk—pregnant or not. And it would not catastrophize fetal harm, which lands as shaming rather than a warning. It might sound something like: There is no amount of alcohol known to be safe for your baby during pregnancy. Drinking alcohol also stresses your body and increases your risk of high blood pressure and cancer. Avoiding drinking during pregnancy is the healthiest choice for both you and your baby. In short, drinking during pregnancy does a woman—not just her baby—a disservice. But this is rarely, if ever, the argument against it.
The recent crescendo of critiques of health messaging is not unfounded. Statements like “There is no amount of alcohol during pregnancy that is risk-free” are so absolute and fear-inducing that they invite resistance, especially from well-educated, well-resourced women like Oster, me, and my peers. Heavy-handed messages obscure uncertainty and patronize people, which has contributed to the collapse in trust in physicians and in the CDC. Health and wellness influencers have swung the pendulum in the other direction, but that is not the answer either.
I know from my decades of work in public health—including at the nation’s largest health department and public hospital system—how often communication is treated as a final, trivial step. Experts review the evidence, choose a key message, then ask someone else to package it for the public. I’ve heard “The data speak for themselves” countless times. They most certainly do not: Effective messages are made of far more than data. Years ago, when I suggested using tactics drawn from my education in health communication and experience as a communication consultant for the CDC and for-profit health companies, I was usually scoffed at or dismissed. Medicine and science were serious; communication was fluff. That arrogance is in part how we got here.
Nuanced, engaging public health communication takes training, skill, and savvy. Without it, messages lean toward absolutes, because getting nuance wrong can be a liability—and also because health and medical leaders have long relied on the public listening to them simply because they know more than the rest of us. The people leading health campaigns and creating and sharing messages should be trained in and have experience with health communication, which draws on behavioral science, sociology, and marketing. Those disciplines are integral to public health, not beneath or beside it.
Public health does not need a firmer hand, especially now. A medical degree and an air of authority no longer work in getting people to follow recommendations that are, at their core, meant to help them be healthy. Our field needs to recognize the importance of and invest in more health communicators, behavioral scientists, and adept practitioners who understand that being right is only part of the task. Until public health puts the right people in charge of messaging, people asking questions will keep getting their answers somewhere else, and the trust we need and our hard-won public health gains will keep slipping away.
