We’ve Come a Long Way, Baby? Alcohol Trends and Women’s Health in the US

In recognition of Dry January, VBCF is looking at the history of alcohol and women. We mentioned in a November 2021 blog post that women and alcohol have a complicated relationship, so we’re going to take some time to try and review that relationship in the U.S. 

Why are we writing this? The direct reason is the growing, but still very much incomplete, understanding of alcohol’s effect on breast cancer. However, the 30,000-foot view on the topic relates to our mission in a much broader way. 

By examining the systems that have impacted and controlled the consumption of alcohol by women, and how women have impacted the alcohol industry, we can gain a broader understanding of the history of women’s advocacy work, and how cultural attitudes affect our health and access to information. This blog is not a complete analysis of nor does it cover the intricacies of different subcultures within the broader U.S. cultural attitude towards alcohol. In this examination, we are attempting to illustrate the famous quote “those who cannot remember the past are condemned to repeat it.”

Of course, we must start with a (very) brief history of alcohol. The consumption of alcohol is so integral to human civilization that there is actually a debate about whether farming first originated in order to grow grain for bread or beer. In early Europe, women were traditionally the family beer makers, though they were not allowed to consume the beer and could in fact, be put to death for drinking alcohol. As alcohol production became more centralized, its production required a license, which women were not allowed to acquire. Women drinking alcohol were also depicted as dirty, immoral, and otherwise undesirable. 

There are also a lot of class divides when it comes to the type of alcohol consumed. We can’t go into that too much here. Still, wine has historically been viewed as refined and “cultured”, beer is a “working class” drink, and liquor or spirits are the choice of the “problem drinker” and viewed as the most problematic alcoholic beverage. Spoiler alert: the same alcohol, ethanol, is in all three types of drinks, so the alcohol’s effect on the body is the same. Could this class divide on the perception of alcohol be a confounding variable in “red wine is good for you” studies? Maybe. Let us know if you want us to look more closely at that. But, we digress.

Fast forward to the Temperance and Prohibition movements, beginning in the 1800s and ending with the repeal of the 18th Amendment in 1933. The Temperance movement advocated for moderate alcohol consumption, which eventually turned into a campaign for total alcohol prohibition. Women were at the core of these movements, both in leading the advocacy work and as propaganda to promote Prohibition. A central argument for Prohibition was that men were getting their paychecks on Fridays and “drinking it away” over the weekend, leaving little money for their wives to care for the household and feed the children. During this movement, women marched in the streets protesting alcohol sales, and some even burned or otherwise destroyed bars. An example, “[i]n Illinois, ‘about fifteen women…approached [a] saloon and asked its keeper to close down.’ When he refused, the women ‘brandished their hatchets.’” 

Full disclosure, one of my great-grandmothers was a member of the Women’s Christian Temperance Union in Kansas around this time. Unfortunately, I don’t know if she approved of Carrie Nation’s hatchet-wielding tactics or not. The Temperance movement also was the training ground for some prominent future Suffragists, like Susan B. Anthony and Elizabeth Cady Stanton. They helped pave the way for the future of women’s activism, including gaining the right to vote in 1920 and the breast cancer awareness movement in the 1990s. 

The Temperance movement also led to Prohibition, where the production and sale of alcohol in the U.S. was prohibited. The law only lasted nationwide for 13 years. It resulted in more women getting involved in the now unregulated alcohol industry and more women drinking in speak-easies than they ever did in bars. 

Regardless of the end result, the Temperance and Suffrage movements showed women that they could exert political power and effect nationwide change, an example that feminist movements in the 1970s tried to emulate. Unfortunately, these were the same movements that ended up being exploited by the cigarette and alcohol industry. 

When it comes to successfully marketing harmful products, the tobacco industry wrote the playbook, and the alcohol industry followed it. In 1968, Virginia’s own Phillip Morris introduced Virginia Slims, a cigarette designed specifically for women, and they needed a marketing strategy to go along with it. 

They went with the now ubiquitous “you’ve come a long way, baby” and it was very successful by business measures. By health measures, it was devastating. Just four years earlier, in 1964, the first Surgeon General’s report on the connection between lung cancer and smoking did not include information on women, because not enough women smoked to know if smoking caused lung cancer in women like it did in men. By 1980, the effect of smoking on women was extreme enough that it warranted it’s own Surgeon General’s report.

By the 1980 report, smoking in men had declined by about 14 percentage points, but had only fallen 4 points in women. A similar report in 2000 specifically calls out marketing focused on women as the cause of the devastating impact of cigarette smoking on women’s health and mentioned that the effects of cigarette smoking might actually be worse in women. I’ve included some examples of that advertising as a reminder. (Specific advertising also had a devastating effect on the LGBTQ+ community, running ads targeting the community as recent as the 2000s).

The slogan “you’ve come a long way, baby” exploited the feminist movement occurring at the time, equating smoking cigarettes to increasing women’s autonomy and becoming more “equal” to men. This slogan held a double meaning for women of color during the same time as they were also engaged in civil rights advocacy. Keep this in mind as you look at the following images:

It’s hard not to draw the parallels between previous cigarette marketing and current alcohol marketing aimed at women. A new addition in recent years however is “mommy wine culture”, as represented by the second two images. Granted, as a mother of a four-year-old, I definitely find some of these products/comics/memes to be funny because being a mom is hard, and sometimes we need to have a laugh at some of our unproductive coping mechanisms. However, this cultural phenomenon is also a bit scary because of the behavior being normalized. 

Labeling a plastic wine cup as “Mommy’s Sippy Cup” and memes of women guzzling down wine to prep for stressful parenting moments, these kinds of images and jokes could demonstrate to a struggling mom that it’s ok to drink a bottle of wine in a day and that drinking copious amounts of alcohol is the only way to survive motherhood. 

Remember earlier in this blog when I mentioned that different alcoholic beverages have different reputations? Is this why it’s “mommy wine culture” instead of “mommy beer culture”? Is it more acceptable for a woman to drink a bottle of wine than a six-pack of beer in one night? 

These memes and products are all in good fun, but what kind of real impact can we glean from this messaging? From 1999 to 2017, the alcohol-related death rate in women increased by 85%. Read that again: 85%! In addition, the total number of women who died from alcohol-related causes more than doubled in that timeframe. And shockingly, that might actually be an undercount. 

“The researchers said that the new figures, for men and women, may be vastly below alcohol-related death rates because death certificates often do not mention alcohol, even when it is a significant or partial cause. Alcohol can be left off death certificates when coroners or others identify a more immediate and obvious cause, such as a fall that broke a hip, not the alcohol that caused the person to fall in the first place.” New York Times, 2020 

This also means that a woman may die from breast cancer that was exacerbated by alcohol overconsumption, but we wouldn’t know because it’s not on the death certificate. And these numbers are pre-pandemic. I am very concerned as to how the burden of the pandemic on women has and will continue to impact breast cancer diagnoses and fatalities for years to come.

VBCF feels the need to tell this story and ask these questions because of the growing knowledge around the effect of alcohol and breast cancer. We can conclude from history that we cannot tell women, or any adult, what to do when it comes to how much and what one should drink. It doesn’t work, and VBCF is not in the business of shaming women for their choices. 

We can conclude from the current research and data that alcohol overuse can negatively impact women’s health, whether it applies to breast cancer or broader health. So what is a breast cancer organization to do? What is the best way we can serve Virginians given this context? VBCF continues to have this conversation as the research and culture evolve around us, but for now, we recommend that you try and drink mindfully if you choose to drink alcohol. 

Take note of when you drink and how much, and ask yourself questions about why. If you are not comfortable with your answers to those questions, talk to your loved ones and/or your healthcare provider about ways you can change your habits. If you are interested in finding ways to drink less, check out Drink Less for Your Breasts or this article from Healthline on mindful drinking.

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