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Alcohol Labelling Bill [HL]

Volume 691: debated on Friday 20 April 2007

My Lords, I beg to move that this Bill be now read a second time. It has a very simple objective: it seeks to compel manufacturers, distributors and retailers of alcoholic products to display a warning label on all bottles or cans that contain alcohol. The label will state the following:

“GOVERNMENT WARNING: drinking alcoholic beverages during pregnancy, even in small quantities, can have serious consequences for the health of the baby”.

In drafting the Bill, several points have been uppermost in my mind. The first is that the Bill should be tightly focused. We could have widened it much further, but we judged that for a privately introduced Bill of this nature, the wider it is, the less likely will be our chances of success.

We also thought long and hard about the inevitable objections that will be raised. The words “nanny state” have already been raised in some quarters, so we have ensured that the Bill is only about giving a warning and is not about forcing any member of the public to do anything that he or she does not want to do.

Finally, we have thought about the cost of labelling. It is predictable that the alcohol industry will raise this matter, but its argument looks a little thin when it already meets identical costs in other countries where labelling is compulsory.

In a nutshell, the Bill is being introduced because drinking alcohol while pregnant is dangerous. Many women are unaware of the danger. We seek to make them, their partners and the world in general aware of the risks to the unborn baby.

It does not need me to stand here today to tell your Lordships about the alcohol pandemic that plagues our country; we see it in the media, and we see it in all its harsh and revolting reality on our streets. However, we are walking a tightrope; we do not want to come across as puritans preaching against fun. Drinking is a highly pleasurable experience, and most of us enjoy it. We are not against young people drinking, even occasionally to excess—after all, which of us never did that? However, what we do want to do is to increase the awareness of the dangers of drinking while pregnant.

Since time immemorial, drunken young people have engaged in sexual encounters that when sober they might have avoided, and there is nothing much we can do about that. However, put sex and alcohol together and there is indeed a cocktail, but of a very different kind. The physiology is simple. The developing foetus in its early stages in the womb has no liver. Its formative body is unable to deal with the same toxins as the fully fledged human being. Therefore, all the poisons its mother ingests will pass through the placenta into the baby’s bloodstream.

Alcohol is a lethal poison. It has the potential to cause great harm to a foetus. It can kill brain cells that can never be replaced; it can damage the nervous system and connections within the brain itself; and it can retard the growth of vital organs, particularly the heart and lungs.

Like tobacco and lung cancer, the correlation is not perfect. People who do not smoke still get lung cancer, just as people who smoke do not get lung cancer. Nevertheless, the relationship of one to the other is now beyond dispute. So it is with drinking when pregnant. Harm is not certain, but it is more likely. It is the risk of this harm that we are trying to address.

Through no fault of their own, future children are being sentenced to lifelong brain damage. Tragically, many of their mothers have not been educated or informed about the risks of alcohol in pregnancy. That is the objective of the Bill—to inform them of the harm that their unborn babies could be exposed to. That harm is called foetal alcohol spectrum disorder. As a spectrum it has many forms. In its most benign form it can cause many types of behavioural problems. It is claimed that, for example, some forms of attention deficit disorder are caused by FASD. It is also felt that many forms of juvenile unsocial behaviour can be similarly traced back to FASD.

The cost to our society resulting from such conduct is vast. Any action taken to ameliorate this condition would be of benefit to society as a whole. It is believed that one live birth in 100 produces a baby with some form of foetal alcohol spectrum disorder. Put another way, this equals 7,500 babies per year.

At the other end of the spectrum is foetal alcohol syndrome. This takes the problem into a different and more acute dimension. It is judged that in this country between one and three children in 1,000 are born with the condition. That represents somewhere between 750 and 2,250 per year. That is more than the combined number of babies born with muscular dystrophy, spina bifida, HIV and Down’s syndrome. Foetal alcohol syndrome manifests itself in many ways. In some cases the child appears physically normal; in others the child has a series of facial deformities. Widely spaced eyes, a small head due to a smaller brain, thin lips and a flattened philtrum between the base of the nose and the upper lip are all indicators of the presence of the syndrome.

However, it is the hidden brain damage that causes maximum problems. Children with FAS are emotionally and mentally delayed. Typically, they have difficulty in telling time, they get lost, they cannot remember instructions and they are largely innumerate. Eighty per cent are not able to live independently and will always need to rely on the state or other carers.

Sadly, many children in this world are born with all sorts of physical or mental handicaps and sometimes with both. But the harsh reality of foetal alcohol syndrome is that these births are not inevitable. They are not a quirk of nature; they are the result of someone else's actions, and that someone is the child's mother. The fact is that foetal alcohol syndrome and the complete spectrum is preventable: it does not have to happen.

For many years I and others have been lobbying the Department of Health, the alcohol industry and anyone else we can get our hands on, to make them aware of this problem. In the beginning we received polite but cool brush-offs. They asked: where is the evidence? And when confronted with experiences elsewhere, particularly in the United States, we heard, “Just because other countries make it mandatory for alcoholic containers to have labels attached to them, doesn't mean that we have to follow suit”. That is an odd and somewhat parochial conclusion when you think about how rampant binge drinking and alcohol abuse is in this country.

Refusing to take no for an answer is now paying dividends. We hear that the Department of Health is close to reaching an agreement with the alcohol industry. It has been reported that the industry is willing to adopt a code that will encourage labelling. I gather that the label will warn the public in general to restrict alcohol consumption to a number of units per week. I have always had a problem with units as a measure; it is too imprecise and too easily fudged. What is a unit? Is it a glass of wine? How big is that glass of wine, and how strong is that wine? Is it 14 units per week spaced over the week, or is it 14 units consumed in one boozy evening? And, “If they say 14 units, they probably mean 20; and if they mean 20 then probably we can get away with 25”. Such is human nature.

Standing around a bar with a bunch of friends is no place to consult the alcohol unit calculator. Nevertheless it is a start. What would be even better is if the label had a warning specifically directed at the dangers of drinking while pregnant. That would be the bold decision.

When it comes to pregnancy we are dealing with an imprecise measure. We do not know how much alcohol is safe. Neither do we know when it is safe. It is a game of Russian roulette—drink at one moment and the chances are you will be safe, but pick the wrong time, without realising it is the wrong time, and the consequences can be lethal.

I therefore ask the Department of Health to reconsider its current position, which is that for pregnant women a few units per week are acceptable. The only reliable message that they should be giving is that no alcohol is safe during pregnancy, and it is to be totally avoided.

Then the question is whether a code imposed by self-regulation is sufficient. I do not think it is, and that is why I believe that this Bill, making it mandatory to include a warning label, is a better solution. I simply do not believe that all suppliers of alcoholic beverages will abide by the code all of the time. The bottle of Bacardi Breezer may have the label attached, but will the bottle of Château Lafite 1982? Perhaps the Minister will let us know the department's thinking on that point.

Other countries have taken the lead on this issue. In the United States compulsory labelling has been in place since 1989. In France a law was passed last year. Others are following; for example, Finland, Chile and Poland. Of course this causes the alcohol industry a great dilemma. How can it possibly object to compulsory labelling in our country when it is forced to include it elsewhere? Where is the logic that requires one consignment of Scotch whisky going to New York to have an American label stuck on at the distillery, whereas a similar consignment bound for London from the same distillery will not? Is it really saying that British women are not entitled to have the same health message as American women? I sincerely hope not.

I should like to take a few moments to make a further comparison with the tobacco and cancer issue, because it is relevant and a pointer as to how matters could develop if not addressed now. The tobacco companies were well aware of the links between smoking and cancer from the early 1950s, yet they sat on the evidence and denied it in public. Labelling was eventually introduced on tobacco products, despite intensive lobbying by the very well resourced tobacco industry. Finally, the anti-smoking lobby won through. Warning labels are now printed on every pack of cigarettes, and with great success. Today, smoking in public places has become socially unacceptable. In many countries it has been banned outright, including our own with effect from 1 July of this year.

At least that is true in the developed western world. Elsewhere the tobacco companies ply their wares with ever increasing resolve. All of this is a pretty strong indicator that multinational companies, whether tobacco or alcohol, will respond to imperatives only if legally compelled to do so. The alcohol companies would do well to study what happened to the tobacco industry and the potential for legal actions against them.

In a recent article in the Lancet, Dr Raja Mukherjee of St George's Hospital in London and Mr Nigel Eastman address some of the legal and ethical issues. Dr Mukherjee has been to the forefront in matters to do with foetal alcohol syndrome, and we should all thank him for his persistence and scholarship. He cites a case in the American state of Wisconsin where a mother was charged with attempted murder and reckless endangerment because she drank heavily during her pregnancy. It was held that she should be held accountable to her unborn child by her actions.

The Wisconsin appeals court concluded that because a foetus is not a human being the mother could not be held criminally liable. In our country, if a mother were to feed her newly born baby with neat alcohol, she could be prosecuted for doing so, but if she feeds her unborn child alcohol through her bloodstream, she has no responsibility. I find this somewhat bizarre.

Dr Mukherjee also shows in the same article that many healthcare professionals have shown difficulties in diagnosing FAS. In Canada, in a survey, 98 per cent of paediatricians and GPs had heard of FAS but fewer than half felt able to diagnose it. Dr Mukherjee states that diagnosis is key because after the birth of a single child with FAS, the risk of another child, similarly affected, being born to the same mother increases by 800 times. The ethical issues are enormous.

In getting to this point, I have been helped by many people whom I must thank. In particular, I have been ably assisted by Susan Fleisher, who heads NOFAS-UK, and Mr Ross Cranston, a former MP who helped me to draft this Bill. I owe both of them a huge debt. There are also many people who confront the consequences of foetal alcohol spectrum disorder every day of the year; that is, doctors, social workers and other carers, but most of all parents, particularly mothers. Imagine, if you can, the guilt and grief that thousands of mothers endure, realising only too well what the momentary pleasure of drinking went on to cause. It does not bear thinking about. Finally, the children themselves only want normality. There is somehow a haunting plea from all of them—“Mummy, why can’t I be normal?”.

In market research that we commissioned, 61 per cent of women admit to drinking when they are pregnant and 75 per cent are aware that it might have some effect on their unborn child. Sadly, it is still the young and less-educated women who are unaware of the dangers and it is particularly them we seek to inform. Ask a mother-to-be what she wants for her baby and, whoever she is and whatever her background, the answer will be the same: “I want my baby to be healthy”. It is not given to us to make all babies healthy. That is beyond our power. But this Bill, by making the dangers of alcohol more widely known, will undoubtedly result in some babies being born healthy who otherwise would not be. If we can do that, we will spread joy where otherwise there would be sadness. That is why I have introduced this Bill and why I hope your Lordships will support me in taking it further.

Moved, That the Bill be now read a second time.—(Lord Mitchell.)

My Lords, I support the Bill introduced by the noble Lord, Lord Mitchell. Drinking alcohol to excess in pregnancy is known to harm the unborn child. As the noble Lord has said, we do not know whether there is a safe level of alcohol intake during pregnancy. Although there is overwhelming evidence of harm, there is no evidence of harm from abstinence. The Government’s policy, which is based on a precautionary principle, is eminently sensible but it could go further. Therefore, the Bill misses a potential opportunity, but I understand why it does not target the many others who are at risk from alcohol abuse. Let me be clear that it is not alcohol but excessive binge drinking which leads to some of the problems that we see in society today. It seems that in pregnancy the drip-drip of alcohol is also harmful. Therefore, the problem of foetal alcohol spectrum disorder is being addressed in this Bill.

The Bill also raises a question, and an opportunity, as to whether other health benefits could come from labelling. In the sub-committee on allergy, which I have the privilege to chair, we have heard about the allergenic potential of the sulphites found in wines and the benefit that a statement of the sulphite content would have for those allergy sufferers who can tolerate low but not high levels of sulphites. In this Bill, labelling is confined to pregnancy, although there would be benefits in extending the warnings about the dangers of excessive drinking to everyone, not just to pregnant mothers. My support is built on the evidence that we need a commitment to a broad-reaching approach. I fear that this Bill, by itself, may not prevent mothers drinking while pregnant, but it is a very important move towards prevention.

We have seen from warning labels on tobacco products about harmful effects that labels are not enough to bring about culture change. Warning labels on alcohol may act as a deterrent where alcohol is sold in sealed containers to people who are sober, but they will not deter those buying excessive alcohol in licensed premises, such as pubs and clubs, where it is dispensed in glasses, which cannot, of course, be labelled. I would like to see an amendment to require such premises to display a warning similar to that proposed for labels.

Drinking in moderation produces health benefits in those who are not pregnant and is an enjoyable social interaction, but excessive drinking harms individuals and society. The social role of drinking together is deeply embedded in our society and has been for thousands of years. We now have beautifully designed labels on some wine bottles, some of which are glass works of art in themselves. I am sure that some objections will come from those who find the proposed labels aesthetically unpleasant. But I do not think our intention to protect the unborn child should be inhibited by such objections and I am confident that we have such good graphic designers that the challenge posed could be easily surmounted.

The excellent report by the Academy of Medical Sciences, Calling Time: The Nation’s Drinking as a Major Health Issue, suggests that price and availability make a difference to alcohol consumption and, therefore, to alcohol-related health damage. In order to decrease excessive drinking, we need to consider measures affecting both those factors. Such measures will often be unpopular.

Alcohol has never been cheaper in real terms in living memory. The price is determined in large part by the duty on alcohol, but that is no longer linked to the strength of the drink. White cider, at up to 7.5 per cent alcohol by volume, is taxed at only half the excise duty on weaker beers. Sadly, there is a cohort of poor, stressed single mothers who find escape in alcohol. I am informed by Professor Gilmore, president of the Royal College of Physicians, that some mums with liver damage are drinking up to two litres of white cider a day because of the combination of high strength and low price, which allows them to escape from their problems. We also know that when these mums are under the influence of alcohol they are at a higher risk of unplanned pregnancy. Therefore, the unborn child is at high risk again and there is a cycle which perpetuates itself. The low price of alcohol also makes it more available to young people and puts it within the financial, if not always legal, reach of teenagers. Most pregnancies occur in young women, so it is important to ensure that they heed the warnings in order that the next generation is not damaged.

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 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”.

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:

“My Lords, we are in serious danger of living in a grossly over-regulated society”.—[Official Report, 18/4/07; col. 289.]

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 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.

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

“The uncertain level of individual risk to the developing fetus, together with the possibility of misinterpreting a health promotion message, mean the only safe message in pregnancy is abstinence”.

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.

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 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.

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?

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 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 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.

My Lords, I congratulate my noble friend Lord Mitchell on introducing and securing the Second Reading of his Bill. I also congratulate him on the fine quality of his speech, as I do other noble Lords who have spoken. It has been a short but highly informed and high quality debate.

This issue, I know, is close to my noble friend’s heart, reflecting his close involvement with the National Organisation on Fetal Alcohol Syndrome, to which I pay warm tribute today. The organisation is at the forefront of efforts to alert women to the potential dangers of alcohol consumption during pregnancy, and its work is well known to the Government, particularly through its regular contact with my ministerial colleagues in the Department of Health. I commend the organisation and wish it well in the future.

There is no doubt whatever that foetal alcohol syndrome is a devastating condition and the effects of foetal alcohol spectrum disorder on a child’s future life can be grave. The Prime Minister’s Strategy Unit interim analytical report on alcohol estimated that there are between 240 and 1,190 cases of foetal alcohol syndrome per year in England and Wales. Moreover, NOFAS estimates that in the UK as a whole, more than 6,000 children are born each year with the more prevalent condition of foetal alcohol spectrum disorder.

When my noble friend last spoke to the House about this subject, he painted a worrying picture of the health symptoms of the syndrome and the spectrum disorder. He did so again today and was very persuasive on that point. His remarks and those of the noble Baroness, Lady Neuberger, about the problems of misdiagnosis and non-diagnosis were also persuasive. It is clear that much more needs to be done to educate health professionals in this area.

Understandably, our debate took in a number of issues around alcohol consumption. There is no question that, particularly among young women, there has been an increase in alcohol consumption. The evidence that I have is that the proportion of 16 to 24 year-old women who had drunk more than six units on at least one day in the previous week increased from 24 per cent to 28 per cent between 1998 and 2002 but had fallen to 22 per cent in 2005.

Thirty-nine per cent of women aged 16 to 24 reported drinking more than three units on at least one day compared with 5 per cent of those aged 65 and over. Average weekly alcohol consumption in the past 12 months in England for women increased from 5.5 units in 1992 to 7.6 units in 2002. Among women, the proportion drinking more than the recommended weekly benchmark of 14 units increased from 12 per cent in 1992 to 17 per cent in 2002. Nine per cent of women are drinking more than twice the recommended daily amount and 15 per cent of women drink at hazardous or harmful alcohol levels.

The latest figures that I have are that in the UK in 2000, 30 per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy. Those mothers who continued to drink during pregnancy reported drinking very little, and 71 per cent of those who continued to drink consumed less than one unit of alcohol a week on average. Only 3 per cent drank on average more than seven units a week.

In 2000, 87 per cent of mothers who had recently given birth reported drinking alcohol before their pregnancy and 61 per cent continued to drink while they were pregnant—a fall from 66 per cent in 1995. I understand that older mothers are more likely to drink during pregnancy—71 per cent of mothers aged 35 or over did so compared with 53 per cent of those under 20. Thirty per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy, which compares to 24 per cent in 1995. In addition to the 30 per cent of mothers who gave up drinking during their pregnancy, 65 per cent said that they reduced their alcohol intake.

Clearly, there are a lot of statistics there. They suggest that there is a general issue about an increase in alcohol consumption, but they also suggest that pregnant women have taken to heart some of the messages that have come through.

Noble Lords made a number of interesting remarks on the question of units of alcohol. Noble Lords will know that the Chief Medical Officer recommends that men should not regularly drink more than three to four units a day and that women should not regularly drink more than two to three units a day. The definition that I have of a unit is 8 grams of alcohol—typically, one small glass of wine, one half pint of beer, though not a strong variety of beer, and one measure of spirits. However, I fully accept the arguments made by noble Lords that the size of glasses can vary considerably and the use of very large glasses has become more frequent, both in pubs and restaurants but also at home. Equally, more generally, I take to heart the point that the noble Earl, Lord Howe, and my noble friend raised about the lack of awareness in that regard.

The noble Baroness, Lady Finlay, made some very telling points about the more general issues in relation to alcohol, and gave some recommendations for the Government to take on board. I listened very carefully to that. We launched the alcohol harm reduction strategy for England in 2004, with the specific aim of minimising the harm caused by alcohol through better education, prevention efforts and the improved identification and treatment of alcohol problems. We are committed this year to reviewing that strategy and to identifying what further actions we wish to take. Of course, today’s debate will be very helpful in informing officials as they advise the Government on taking the new strategy forward. We have launched the Know Your Limits campaign—the first national campaign on alcohol, focusing on young people who binge drink, to which a number of noble Lords have referred. We are taking action to tackle underage drinking, which has led to targeted enforcement including the wider use of issuing fixed penalty notices.

Drinkaware Trust has been established as a new organisation, independent of government and the alcohol industry, and it is developing work to change behaviour and the UK national drinking culture. We have developed Models of Care for Alcohol Misuse Services, published in June 2006, and we have launched alcohol misuse interventions, which is guidance on developing local programmes of improvement. We are not complacent; we understand very clearly the importance of action in this area. As I have said, the review of this strategy in 2007 will be a very good way in which to take on board the comments that noble Lords have made today.

The noble Lord, Lord Monson, and the noble Earl, Lord Howe, referred to the evidence specifically in relation to alcohol drinking by pregnant women. In 2005, my department commissioned the National Perinatal Epidemiology Unit to undertake a review of existing evidence. The main aims were to update what we knew from existing evidence about the effects of prenatal alcohol exposure. The principal findings were that there is no consistent evidence that low to moderate consumption of alcohol during pregnancy has any adverse effects, although there is some evidence that binge drinking can affect neuro-development of the foetus. The department has commissioned a recent review from the National Perinatal Epidemiology Unit on the effects of low to moderate alcohol consumption in pregnancy. The review has broadly concluded in support of the scientific conclusions of the 1995 Sensible Drinking working group.

I have to say that this evidence base is not strong. While the current advice remains scientifically correct, there is a perception that it might be construed as too permissive. It is interpreted by some as meaning that it is safe to drink a little when pregnant, when a little can differ from person to person. Most women, as we know, stop drinking or drink very little in pregnancy, so a slightly stronger message could be aimed at those who do not reduce their consumption to appropriate levels. I echo the words of the noble Earl, Lord Howe, that action must be based on scientific evidence. His speech was a tour de force of some of the available evidence that we now have. It is clear that we do not have enough evidence—but clearly we need to do more to obtain it.

It is clearly important that labelling is used as a strong component in a preventive approach. We are committed to action on labelling, as was laid out in the Government’s alcohol harm reduction strategy, which was published in 2004. We know that the public support labelling. I refer noble Lords to the recently published Eurobarometer survey on attitudes to alcohol, which showed that almost eight out of 10 people agree with putting warning labels on alcohol products and in adverts, in particular, to warn pregnant women of the dangers of misusing alcohol. In the UK, 75 per cent of people supported labelling.

Labelling is not a panacea and is no substitute for other actions, such as education and wider information. The evidence for the effectiveness of health warnings alone is not particularly strong, but it can be an essential component of a broader strategy to help consumers to estimate their own unit consumption and to help people to become more conscious of drinking in relation to their health.

I agree with the noble Earl, Lord Howe, and my noble friend that doing nothing is not an option. We are working in close partnership with the alcohol industry and wider stakeholders to implement the many initiatives that were set out in the 2004 alcohol harm reduction strategy. Industry has shown its willingness to help us to achieve that aim and we know that more than 75 per cent of spirit labels and 85 per cent of beer for sale in the UK market already carries information on unit content. It is much less for wine and it is clear that more needs to be done. It is also pleasing to remark that many supermarkets’ own brand beers, wines and spirits include that information on their labels—but we need to move beyond this.

Providing only unit information, important though it is, is not sufficient. We have asked the industry to go further to ensure that there is more consistency and visibility in the information that is provided and to add a short health message on drinking for adults and on pregnancy to ensure a link to the Government’s wider campaigns, and that there is an agreed timetable for intervention. We want government intervention to regulate the industry to be proportionate. We do not want to impact unfairly on responsible consumers, manufacturers and retailers, and we need to work with industry on this, but we are not opposed in principle to legislating in this area should a voluntary approach fail or prove ineffective. I can say to the noble Baroness, Lady Neuberger, that I think that that is an entirely sensible approach. If in a very short time we can pull off an agreement with industry that produces the kind of advice that we want, that is a very desirable way forward.

My Lords, what does the Minister make of the observation of the noble Earl, Lord Howe, that we started having this debate in this Chamber in 2004 and nothing has happened? I regard it as absurd that nothing has happened since 2004—and that is why maybe the voluntary method is not enough.

My Lords, my understanding is that we hope that we can report progress on our discussions with the industry very soon. I entirely accept that if talks became protracted and it looked as if there would not be a successful outcome, noble Lords would be absolutely right to come back and say to the Government, “The time for talking is over; let’s see some action”. But I have discussed this with officials and we are confident that we shall be able to report progress very soon. However, I reiterate that we shall not shrink from tougher measures if we do not reach a satisfactory agreement with the industry. I say to my noble friend that there is no question that there is a need for women to be alerted to the potential dangers of alcohol for the unborn child and his or her future well-being. The points made by noble Lords today were entirely persuasive. We have a responsibility to future generations to ensure that parents, and mothers in particular, are fully aware of the dangers for unborn children of drinking. This is a very serious matter.

We consider that there is great hope of partnership with the industry. It is worth spending a little more time ensuring that we reach agreement. I thank my noble friend for raising this matter so effectively and powerfully. I again reassure the House that if a voluntary approach does not work, the legislative option remains.

My Lords, it was almost predictable that we would have a good Second Reading debate today given the list of speakers. I thank all noble Lords for their contributions.

I say to the noble Baroness, Lady Finlay, that I thought very seriously about notices in pubs and off-licences. She made a very strong point. As I said in my opening remarks, I wanted to keep my speech very focused. I take the point that she made about the cost to society and the nation of children who are affected by this syndrome.

I say to the noble Lord, Lord Monson, that we are not saying that all pregnant women who binge drink will have foetuses with some form of foetal alcohol syndrome. Nor are we saying that the foetuses of all pregnant woman who drink will have foetal alcohol syndrome. We are talking about the minority who drink a lot or perhaps even a little, whose foetuses may be affected if the alcohol is consumed at the wrong time. We are not preventing them from drinking, we are just issuing a warning.

On the subject of labels, to the best of my knowledge the relevant labels that I have seen are on the back of bottles of wine. That is certainly the case with bottles that I have seen in the United States. In Australia, I believe that they are on the side. I have no desire for such labels to be inspired by the designs of Matisse or any other great artist.

I should have loved the noble Baroness, Lady Neuberger, to be a co-sponsor. I agreed with everything that she said. I thank the noble Earl, Lord Howe, for the support that he gave on the previous occasion the Bill was introduced and again today.

I thank the Minister for his remarks. It was good that he said there was government understanding of the issue and no complacency about the fact that something needed to be done. He gave a very strong hint about a voluntary code. If such a code were 100 per cent effective, it would be a good thing. However, he hinted strongly that if there were any wavering on this issue, the Government would support legislative action. That is as much as we can hope for. I ask the House to give the Bill a Second Reading.

On Question, Bill read a second time, and committed to a Committee of the Whole House.