Alcohol use before pregnancy recognition among women in seven South African communities

South Africa has the highest prevalence of foetal alcohol spectrum disorder, caused by prenatal alcohol exposure, globally. In this retrospective, exploratory document study, we evaluated data from intake interviews for an antenatal support programme to investigate the participants’ drinking behaviour prior to pregnancy. Participants in the antenatal programme who reported alcohol use before pregnancy and were enrolled between March 2021 and April 2025 were drawn from seven communities in the Northern Cape Province, South Africa. Participants consumed on average 7.51 standard drinks on one occasion (SD = 5.23), most often commercial beer from large containers (≥750 mL) followed by wine from large containers (≥3 L) and home-brewed alcohol. An analysis of variance (ANOVA) comparing the effect of drink type on total consumption was significant (p < .001), with the highest consumption associated with wine followed by beer. An ANOVA comparing the effect of container size in total consumption was also significant (p < .001), with the larger containers associated with higher consumption. This pattern of alcohol use was reported among women during the 3 months prior to pregnancy recognition, even though there was a high level of awareness of foetal alcohol spectrum disorder. An informal survey of alcohol pricing by container size showed a significant decrease in cost per standard drink as container size increased. Container size and type of alcohol purchased play a role in total alcohol consumption, likely driven by availability and affordability. Supply reduction interventions may therefore have a positive impact on the prevalence of prenatal alcohol exposure.