Drinking alcohol is known to be harmful to people’s health. It’s also known to be harmful in other ways.
For example, men experience more harm such as aggression, accidents, and injury, from their own drinking than do women. But when a man drinks, the women and children closest to him often pay a price too.
I’m part of a global collaborative group of health researchers who set out to explore how – and how much – men’s drinking harms women and children.
Our recent research drew on three global reviews of findings from rich, poor and middle income countries. These covered harm to women, harm to children, and policy options for reducing harmful drinking by men. The reviews covered 49 studies and 11 reviews between the period 1990-2023.
We synthesised the evidence to inform policy and practical responses, as well as directions for research. Our findings suggest possible system changes to continue advancement towards health and well-being for women and children around the world.
What we found
The studies that were included in the three reviews show that men tend to drink more than women, and when they are alcohol-affected they sometimes engage in harmful behaviours such as aggression and violence, disrupting family life, control and sexual coercion. They are also frequently away from home, often in drinking spaces, or not prioritising the needs of women and children. When men spend household money on alcohol, there may not be enough left for food, school fees, or medicine. That, in turn, harms women and children.
Women reported that men’s alcohol-related acts of violence and aggression included punching, kicking, burning and beating them.
But the effects of men’s drinking are not always visible; many women told stories about the hidden harms they experienced as a result of having a drinking partner. They described their embarrassment and shame; self-isolation to avoid expected public humiliation; and a sense of loneliness from being associated with having a drinking partner. These stresses can lead to depression, insomnia, or even thoughts of suicide.
One woman said:
I really hate what alcohol does to him. We would fight at home; the next thing he shows up at my workplace drunk and demands that we talk about our fight right there. He embarrasses me at my workplace.
Another said:
I get sort of a trauma reaction if people were drinking too much around me, so I don’t tend to socialise much in that area.
Children are affected too
When men drink alcohol, it can cause both direct and indirect harm to children. On the one hand, men can jeopardise the safety and well-being of their children by making them targets of, or witnesses to their own violence.
Research has found that when children grow up in homes where there is violence, this places them at risk for a range of negative outcomes. Those can include poor school performance, low self-esteem and children themselves becoming perpetrators or victims of violence. When there is fighting in the home, children become active or silent victims.
Studies in the reviews show that men’s drinking can also lead to neglect and abuse of children. Children whose fathers drink heavily may not feel as emotionally close to them, because they fear their fathers when they drink. And drinking might lead to more conflict at home, neglect of family duties, or growing apart.
Drinking is often considered to be a private issue, but alcohol use is influenced by many factors at the level of society, the community and the household.
For example, alcohol laws and policies affect the availability of alcohol, the number of alcohol outlets in neighbourhoods, and what age is appropriate for people to purchase alcohol. Drinking has an impact on well-being and safety in homes, communities and society.
We found that women and children in poorer countries suffer the worst from the effects of men’s drinking because they have fewer resources. Also, both men’s drinking and abuse of women are considered normal in poorer than richer societies.
What can be done
Governments and health authorities focus mainly on reducing harm to drinkers themselves. As a result, the policies, programmes and services in place are individualised.
While research has shown that drinkers can be helped through peer support programmes like Alcoholics Anonymous, or by seeking individual psychological support, including brief interventions, these programmes must occur within a social and policy environment that supports positive change, and one that takes a gendered lens.
Our study found that policies and programmes must consider the harms to others, especially women and children.
One way to do this is to pair alcohol interventions with community-based interventions that focus on harms that specifically affect women and children. A useful first step is to design interventions that raise awareness of alcohol misuse as a public health issue that affects women and children disproportionately, and combine these with treatment programmes, screening in primary care settings.
Declaring “dry zones” where alcohol use is prohibited is an additional tactic. Although some zones designate specific areas such as certain neighbourhoods, or entire states, or municipalities as dry, where alcohol sales are prohibited or where specific sales practices are restricted, these zones are typically concentrated on public areas like parks and roads.
Governments across the world must prioritise alcohol policies that have proven to be effective, and cost-effective:
- reduce the availability and affordability of alcohol
- ensure no sale to persons under the legal drinking age
- limit marketing and advertising of alcohol, especially to children.
However, they must go beyond this and look at alcohol and its related harms through the eyes of women and children. Policies and programmes cannot be separated from issues of gender and power that are prevalent in many societies and that result in harm.
