Introduction
Numerous studies have shown that across countries and cultures, men drink more than women (Wilsnack et al., 2009, 2018; World Health Organization, 2018a, 2024b). Globally, men also experience more alcohol-related problems, including aggression, accidents, and injury, from their own drinking than do women (Obot & Room, 2005; Wilsnack et al., 2000; World Health Organization, 2024b, 2024a). Moreover, when drinking, men are more likely to engage in violent and problematic behaviors that negatively affect their social relationships (Graham et al., 2011; Rolfe et al., 2006). Thus, relative to women’s drinking, men’s drinking not only results in more harm to themselves (World Health Organization, 2018a, 2024b) but also results in more adverse effects on others, notably women and children with whom they are in close relationships (Laslett et al., 2024; Stanesby et al., 2018; World Health Organization, 2024a). Because a relatively small proportion of the population drink heavily, most harm to drinkers is attributable to light and moderate use rather than to dependent drinking or alcohol use disorder (Babor et al., 2010; Rossow et al., 2013). Likewise, the harm men’s drinking inflicts on others, including women and children, is not confined to men with alcohol use disorders. Such harm can arise from a range of drinking patterns, including occasional episodes of heavy drinking (Haugland et al., 2015).
Gender differences in alcohol consumption and associated harms often relate to societal norms (World Health Organization, 2024a). For example, traditional masculinity may encourage higher alcohol consumption and risk-taking after drinking, which can harm both the drinker and others (Patró-Hernández et al., 2020). Both general and domestic alcohol-related violence are mostly attributable to men (Australian Bureau of Statistics (ABS), 2023).
Intersectionality (Crenshaw, 1991) highlights how political and social identities result in privilege and discrimination. For example, factors such as race, gender, disability, sexuality, and class often intersect and overlap to create greater disadvantage for some groups and greater empowerment for others. In the case of intimate partner violence and alcohol use (both separately and together), we see how these identities and factors may result in higher alcohol use and heighten vulnerability to violence for populations in low- and middle-income countries or those subject to multiple systemic oppressions, such as colonization and poverty. Along with gender inequality, these vulnerabilities interact to create greater disadvantage. Women suffer the greatest harm from men’s alcohol use when they are poor or have fewer resources and when gender roles in the culture normalize harm to women, such as when violence toward a wife is considered a husband’s right.
Thus, men’s alcohol use can lead to a multitude of harms to women (Huhtanen & Tigerstedt, 2012; Radcliffe et al., 2021) and children globally (Giusto & Puffer, 2018; Hameed, 2019). Few studies have focused on the scope, extent, diversity, and long-term impact of the harm that men’s alcohol use causes women and children, and few policy options specifically address these harms (Karriker-Jaffe et al., 2023; I. M. Wilson et al., 2014). In response, the World Health Organization–funded International Health Policy Program Foundation, based in the Ministry of Health, Thailand, in keeping with the Sustainable Development Goals relating to health and gender equality (United Nations, 2015), funded reviews of literature on harm to women from men’s alcohol use (I. M. Wilson et al., 2024), harm to children from men’s alcohol use (Hopkins et al., 2024), and potential policy directions to reduce harm from men’s alcohol consumption (Karriker-Jaffe et al., 2023). This paper draws on the three published reviews and connects the key findings to inform policy, system responses, and service responses, forming an evidence base for advocacy and intervention.
The left side of Figure 1 shows the different ways that alcohol affects men’s behavior relevant to harms to women and children, and the right side shows adverse consequences experienced by women and children from men’s drinking. We discuss these actions and their consequences in more detail below. The circles in the center describe the factors and interventions at different levels that can moderate the relationship between men’s alcohol-affected behavior and the impacts on women and children. These include household, community, cultural, and broader societal factors.
For example, personal affluence (household level) may protect women and children from some harms from men’s drinking, while economic disadvantage could intensify some impacts. Community supports for women may help to lessen harms, while cultural factors such as local tolerance of alcohol-related intimate partner violence can increase the risk of more-severe harms. Similarly, societal level factors such as gender equality and economic development can moderate the extent to which men’s alcohol-affected actions cause harm to women and children. Intersecting contextual determinants also may enhance men’s power or create additional disadvantages for women and children. Thus, these proximal and structural factors and policies can, by their presence or absence, protect or disempower women and children. Finally, the figure shows the potential impact of policies and interventions directed toward decreasing men’s drinking as well as toward reducing the harms from men’s drinking. The following sections discuss this interplay of moderating factors, as well as some specific policies and interventions that may mitigate men’s negative alcohol-related actions and protect women and children from harm.
Figure 1.
303976A model for understanding harms affecting women and children from men’s alcohol use
How to read the diagram: In addition to alcohol policies and gender-informed interventions (top), the factors presented in the center can change the relationships between the actions on the left (in purple) and the impacts on the right (in blue).
Source: Adapted from (Hopkins et al., 2024).
Harms to Women
There is a long history of women’s movements calling for equality, safety, and security and acknowledging that women’s lives and homes should be free from men’s violence and heavy drinking. Yet there has been limited focus recently on how men’s drinking can affect women’s lives. Recent evidence from nine countries shows that many women, ranging from 4 percent of women in Nigeria to 33 percent of women in Vietnam, reported living with a harmful, heavy-drinking partner (Callinan et al., 2019). The United Nations Multi-Country Study on Men and Violence revealed that the odds of men reporting intimate partner violence perpetration were 3.4 times greater if they reported heavy episodic drinking, with the odds increasing further when men also reported less-equitable attitudes about women (Laslett et al., 2022).
Women experience the harmful actions of alcohol-affected men in different ways. Qualitative accounts from women provide nuanced perspectives on the alcohol-related harms that men inflict, with participants framing the role of alcohol critically and insightfully. The harms and the short- and long-term impacts on women from men’s alcohol use are described in the following sections.
Alcohol-Related Actions and Harms by the Alcohol-Affected Man
The qualitative literature identifies multiple types of harmful actions by men related to their alcohol use and the effect of these actions on women. These actions range in severity. Women’s descriptions reinforce quantitative evidence linking alcohol use to more-severe intimate partner violence (Cafferky et al., 2018; Graham et al., 2011). Women’s reports in many studies substantiate the issues of sexual coercion and violence from an alcohol-affected partner, but alcohol-related intimate partner sexual violence has yet to receive much research attention. The role of and the response to men’s alcohol use in economic abuse, such as withholding funds for household expenses or controlling a woman’s earnings, are not yet well-studied either (Postmus et al., 2020).
“He was drunk and so he hit me because he was suspicious, just in case. … It was because he was drunk, and I had come home from work really tired. … It was always when he came home drunk.”
Women’s reports of men’s acts of violence and aggression under the influence of alcohol include physical aggression, such as punching, kicking, burning, and use of weapons; verbal aggression, such as bullying and shouting; emotional abuse, such as humiliating or insulting; and intimidating actions, such as threatening death or injury and causing fear (Annan & Brier, 2010; Backe et al., 2022; Clark et al., 2019; Deuba et al., 2016; Keenan et al., 1998; Mazibuko & Umejesi, 2015; Satyanarayana et al., 2015; Sedziafa et al., 2016; Tamutienė & Laslett, 2017; I. M. Wilson et al., 2017).
Sexual aggression is consistently related to times when partners were alcohol-affected. Women describe being subjected to forced sex, sexual violence, and sexual coercion (Backe et al., 2022; Chowdhury et al., 2006; Guggisberg, 2019; Keenan et al., 1998; Mazibuko & Umejesi, 2015; Sedziafa et al., 2016; Tamutienė & Laslett, 2017; I. M. Wilson et al., 2017). Alcohol use also is reported to reduce the likelihood of men agreeing to safe sex, thereby increasing women’s vulnerability to unwanted pregnancy and sexually transmitted infections (Cash, 2011; Fox et al., 2007; Kyriakakis et al., 2012).
Women report that their partner’s alcohol use is linked to economic abuse in several ways (Backe et al., 2022; Cash, 2011; Keenan et al., 1998; Kyriakakis et al., 2012; Nascimento et al., 2019; Wechsberg et al., 2013; I. M. Wilson et al., 2017). Men’s spending on alcohol may leave insufficient funds for necessities such as food and clothing. Men’s alcohol use also can lead to unemployment or missed work, thereby lowering family income and increasing women’s work burden and risk of other harmful situations, such as forced prostitution. Further, financial problems for the family related to men’s alcohol use may trigger conflicts that can escalate into violence toward women.
Some women describe men’s alcohol use within a broader context of abusive and controlling behaviors (Cash, 2011; Chowdhury et al., 2006; Deuba et al., 2016; Gilchrist et al., 2019; Keenan et al., 1998; Lennon et al., 2021; Nascimento et al., 2019; Rao, 1997; Wechsberg et al., 2013; I. M. Wilson et al., 2017, 2020), including restrictions on a woman’s movement, social ties, work, and access to resources. Alcohol-related abuse and the fear a woman feels because of a man’s drinking can facilitate the man’s control and increase the woman’s compliance. Sexual jealousy and resulting controlling behavior also are more likely when a man is intoxicated.
Impacts of Men’s Alcohol Use on Women’s Health and Well-Being
The harms resulting from men’s alcohol use are often hidden or not recognized as harms, although they affect not only women’s health and well-being but also their whole lives (I. M. Wilson et al., 2024). Physical injuries from violence are not the only harm; men’s alcohol use affects intimate relationships and family functioning, as well as women’s mental health and social well-being. Men’s alcohol use also decreases household stability and exacerbates women’s economic disempowerment. These harms further intersect and cascade to reinforce women’s disadvantages, particularly in contexts where women are subject to other forms of discrimination.
Harms to physical health. The link between alcohol use and increased volatility and severity of intimate partner violence is well-established (Graham et al., 2011). Men affected by alcohol can inflict fatal harm and significant acute and long-term physical injury and disability on women through physical beatings (Backe et al., 2022; Fox et al., 2007; Kaur & Garg, 2010; Keenan et al., 1998; Mazibuko & Umejesi, 2015; Rao, 1997; Satyanarayana et al., 2015; Tamutienė & Laslett, 2017; Wechsberg et al., 2013; S. R. Wilson et al., 2019). Women also report other harms from men’s alcohol use affecting their physical health, such as body aches and chronic pain, weight loss, and sleep difficulties (Nascimento et al., 2019; Satyanarayana et al., 2015).
Reproductive harms, including injuries, inability to conceive, child deaths, and unwanted pregnancies, can result from alcohol-involved violence during pregnancy and alcohol-related sexual aggression in general. In addition, some women describe men’s alcohol use as increasing the likelihood of their partner’s infidelity and risky sexual behaviors, thereby increasing women’s risk of sexually transmitted infections, including HIV (Backe et al., 2022; Cash, 2011; Deuba et al., 2016; Fox et al., 2007; Kyriakakis et al., 2012).
“My partner, when he drinks, he doesn’t have a cut-off point. He gets quite abusive when drinking. It’s like two different people when alcohol is involved. I feel intimidated and scared when my partner is angry, and I feel the same when he is drunk. You know, things get a bit out of hand … the sexual abuse…. When he has been drinking, then he is not a very nice person … and I fight back and get upset.”
Mental health harms that women experience include psychological distress, reduced self-esteem and loss of identity, anxiety and depression, and suicidality (Bloom et al., 2022; Ezard, 2014; Guggisberg, 2019; Hellum et al., 2022; Kohli et al., 2015; Nascimento et al., 2019; Sørensen et al., 2017; I. M. Wilson et al., 2017, 2020; S. R. Wilson et al., 2018, 2019). Women express fear and anxiety from the constant vigilance required from living with a partner who is aggressive when affected by alcohol. Women also may experience sadness, despair, and a feeling of helplessness because of their inability to change their partner’s alcohol use.
“My husband, there was this thing that after he drank, when he comes into the house, we have to fight, the children cry and we have to fight, he would make a noise and he would hit me, and I must leave the house running.”
Men’s alcohol use also plays a role in marital conflict and decreased family functioning (Cash, 2011; Clark et al., 2019; Nascimento et al., 2019; Rao, 1997; Satyanarayana et al., 2015; Sedziafa et al., 2016; Sørensen et al., 2017; Stöckl & Gardner, 2013; Tamutienė & Laslett, 2017; I. M. Wilson et al., 2020; S. R. Wilson et al., 2019). Women describe their male partners’ intoxication as contributing to verbal aggression, jealous accusations, and fights triggering violence. Men’s alcohol use also causes relational conflict; in particular, when women question or challenge men about their alcohol use and its impact on the family, men often counter with threats and violence.
In addition, women describe social harms linked to a partner’s alcohol use, including loneliness, shame, social isolation, and even self-isolation, as a way to avoid anticipated humiliation or situations that would trigger memories of abuse (Cash, 2011; Ezard, 2014; Hellum et al., 2022; Kohli et al., 2015; Kyriakakis et al., 2012; Mazibuko & Umejesi, 2015; Nascimento et al., 2019; Satyanarayana et al., 2015; Sørensen et al., 2017; Stöckl & Gardner, 2013; Tamutienė & Laslett, 2017; I. M. Wilson et al., 2020).
Framing the Role of Alcohol
The qualitative literature reveals that women who consistently experience harm from a partner who is alcohol-affected often frame alcohol as a main cause of intimate partner violence and other harms, or as a trigger for conflict or escalation to violence (Annan & Brier, 2010; Bloom et al., 2022; Clark et al., 2019; Deuba et al., 2016; Galvani, 2006; Gilchrist et al., 2019; Kaur & Garg, 2010; Keenan et al., 1998; Kohli et al., 2015; Mazibuko & Umejesi, 2015; Radcliffe et al., 2021; Rao, 1997; I. M. Wilson et al., 2017).
Studies also show that women commonly describe different sides of their partner, distinguishing the sober “good man” from the intoxicated or drunk “bad man” (Bloom et al., 2022; Hellum et al., 2022; Mazibuko & Umejesi, 2015; I. M. Wilson et al., 2017). This framing is not always present, however; some women question a causal link between alcohol and violence and note that violence also occurs when their husbands are not drinking (Kaur & Garg, 2010). Women’s qualitative descriptions of alcohol’s role in the harm they experience reflect an ongoing debate about alcohol’s causal role in violence toward women, as well as alcohol being an excuse for violence (Gilchrist et al., 2019; Leonard & Quigley, 2017). Although the role of alcohol use in men’s perpetration of violence is complex, it is important that any research on this topic take women’s lived experiences into account.
Harms to Children
The prevalence of children living with individuals who have problematic drinking patterns varies widely. A European study spanning 19 countries found rates of exposure ranging from 6.2 percent of children in Italy to 35.2 percent of children in Lithuania (Tamutienė & Stumbrys, 2023). Although both paternal and maternal alcohol use can negatively affect children, men are more likely than women to drink and to drink heavily (World Health Organization, 2024b). As a result, more children may be exposed to men’s drinking and potential harm than to women’s. In fact, in 17 of the 19 countries included in the European study, children were significantly more likely to reside with men who self-reported problematic alcohol consumption than with women who self-reported this behavior (Tamutienė & Stumbrys, 2023).
Men’s alcohol consumption within the family is linked to direct and indirect harm to children (Karriker-Jaffe et al., 2023). The harms can be categorized into four areas: (1) relationships and family; (2) violence and maltreatment; (3) health, development, psychological, and well-being impacts; and (4) social and educational outcomes.
Relationships and Family
Heavy drinking by men in the family is associated with negative outcomes, including marital discord, conflict, and reduced family cohesion (Allen et al., 2022; Giusto & Puffer, 2018; Hameed, 2019; Heimdahl & Karlsson, 2016; Orford, 1990; Park & Schepp, 2015b). Parental alcohol use also can negatively affect parent–child relations (Hameed, 2019; McGovern et al., 2020; Orford, 1990; Park & Schepp, 2015b; Solis et al., 2012). Children of fathers who drink heavily may feel less emotionally close to their fathers, possibly because of the impact of the father’s drinking on conflict within the home, neglect of family responsibilities, or estrangement.
Violence and Maltreatment
Men’s heavy drinking can create a toxic family environment, compromising the safety of children, who may become targets of violence and witness violence against others (Allen et al., 2022; Chan et al., 2021; Choenni et al., 2017; Hameed, 2019; Isobe et al., 2020; Orford, 1990). Both direct and indirect exposure to increased violence and conflict within the household adversely impact children’s development and their mental and physical well-being (Hameed, 2019). Violence between adults in a household also has been linked to increased risk of child abuse and neglect (Chan et al., 2021; McTavish et al., 2016). Although several reviews have identified a link between parental heavy drinking and child maltreatment (Choenni et al., 2017; Karriker-Jaffe et al., 2023; McGovern et al., 2021; Orford, 1990; Solis et al., 2012), most studies do not differentiate between the father’s and mother’s drinking.
Health, Development, Psychological, and Well-Being Impacts
Men’s heavy drinking can contribute to a range of negative physical and psychological outcomes for children, both at a specific time and lasting into adulthood (Park & Schepp, 2015a). Evidence suggests a father’s heavy alcohol consumption may be associated with aggressive behavior among children, hyperactivity disorders (mixed results), and adolescent drinking (McGovern et al., 2020).
The effects of men’s heavy drinking on children can be moderated by risk and protective factors that affect children’s vulnerability or resilience. Protective factors such as a secure relationship or better parenting by a non-alcohol-affected parent (often the mother) can buffer some of the negative effects of another parent’s (often the father’s) alcohol use disorder on children (Park & Schepp, 2015a). In addition, resilience and positive coping strategies such as engagement with community or religious organizations and obtaining social support may help mitigate negative alcohol-related outcomes (Wlodarczyk et al., 2017). Children whose parents have an alcohol use disorder also may take on caregiving roles, though assuming these roles can lead to poor self-concept, a sense of isolation, and other emotional problems, such as difficulties with trust later in life (Jokinen et al., 2021).
Social and Educational Outcomes
Generally, disruptions to the family environment from the father’s and other male relatives’ drinking can negatively impact children’s schooling outcomes. Fathers’ heavy drinking has been linked to educational challenges for their children, including school-related behavioral problems and lower educational attainment (McGovern et al., 2020). School behavioral problems associated with paternal alcohol misuse may include truancy, absenteeism, suspensions, attention difficulties, and conduct problems. Evidence suggests that the number of male relatives with an alcohol use disorder affects children’s risk of deficits in verbal and abstract reasoning, verbal learning, performance IQ, and memory (Solis et al., 2012). Effects on children’s learning differ across developmental stages, suggesting that the interplay of resilience and risk factors can vary over the life course (Solis et al., 2012).
An Expanded Model for Understanding Harms to Women and Children from Men’s Alcohol Use
Figure 2 highlights community, cultural, and household factors that may modify the associations between men’s alcohol use and harm to women and children. These moderators include contextual determinants and household factors that can intensify the impacts of men’s alcohol use (e.g., poverty, gender inequality) or lessen them (e.g., women’s access to emotional support and financial assets), as described below.
Figure 2.
303977A model providing possibilities for integrating cost-effective policy interventions for reducing the harms from men’s alcohol use on women and children
How to read the diagram: Follow the solid arrows to view the effects of determinants, policies, and interventions on specific outcomes. Follow the dashed arrows to understand the influence of household and contextual moderators.
Source: Adapted from Karriker-Jaffe et al., 2023.
Community- and Societal-Level Contexts
Community- and societal-level contexts contribute to harms that women and children experience because of men’s alcohol use (Allan et al., 2012; Laslett et al., 2019). Community-based factors may include socioeconomic disadvantage, social disorganization, available supports and treatment services, and the number of retail alcohol outlets and licensed (or unlicensed) premises in an area. Cultural factors may include social norms around alcohol use and women’s roles, other distinguishing features of a community (for instance, unique elements of life in rural Australia or on a tea estate in Sri Lanka), religiosity, and community or group characteristics seen in heavy-drinking social worlds. For example, norms that place men in positions of power relative to women have been linked to higher levels of alcohol use among men and to alcohol-related consequences for children and families (Laslett et al., 2021, 2022; Lisco et al., 2015). Hegemonic masculinity norms also can contribute to increased household violence, where children may become direct or indirect victims of violent behavior (Giusto & Puffer, 2018). As discussed above, women’s experiences demonstrate the ways men’s entitlement to drink is inviolable and illustrate how attempts to question it can trigger conflict and risk of significant harm. Thus, research and policy on alcohol-related harm to women and children need to explicitly target the culture of men’s alcohol use that enables such attitudes to persist.
A socio-ecological perspective (Bronfenbrenner, 1979; McLeroy et al., 1988) considers the interplay of these community and societal factors in relation to the impacts on women and children associated with men’s alcohol use. For example, although a community’s cultural norms that privilege men’s alcohol use can facilitate harms to women and children, these harms may be especially pronounced in societies with greater gender inequality (Giusto & Puffer, 2018; Huq et al., 2021; I. M. Wilson et al., 2024). In contrast, legal systems that punish men for alcohol-related violence toward women may decrease the likelihood of such harms, even in communities with norms that support heavy alcohol use by men.
Intersecting Contextual Determinants
Social determinants, poverty, and gender inequality can interact with each other and with men’s alcohol use to determine the harms women and children experience (Blagg et al., 2018; Heise & Kotsadam, 2015; Our Watch, 2021). High rates of poverty have been associated with exacerbated individual and family consequences of men’s alcohol use (Giusto & Puffer, 2018). Societal gender inequalities also can compound harms to women. Gender inequality exists in all societies where men have disproportionate power over women, which is reinforced by physiological differences as well as gendered social norms that ascribe hierarchical roles to men and women. Patriarchal social systems that privilege men’s economic, legal, and political power over women also facilitate gender inequality. The disproportionate power of men, combined with their higher alcohol consumption and a lack of restraint on drinking behavior, may result in significant and frequent harm to both women and children.
The Need for Policies and Gender-Informed Interventions to Reduce Harms to Women and Children
Evaluations that have identified cost-effective alcohol policies have generally not examined the effects of these policies on harms to women and children from men’s alcohol use. This section summarizes a review of global research on the impacts of cost-effective alcohol policies on harms to women and children resulting from men’s alcohol consumption (Karriker-Jaffe et al., 2023) and describes the potential for complementary interventions to enhance gender-responsiveness (World Health Organization, 2024a) and reduce harm.
Policy interventions identified as cost-effective for reducing alcohol-related harms include “best buys” (World Health Organization, 2018b, 2021), such as increasing alcohol taxes and prices, reducing availability of alcohol (regulating density of alcohol outlets, limiting hours and days of sale, establishing or raising the legal purchasing age), and banning or comprehensively restricting alcohol marketing and advertising (Babor et al., 2022; World Health Organization, 2018b, 2021). Gender-responsive extensions of these policies include interventions such as promoting women’s employment outside the alcohol sector and mobilizing civil society groups and local organizations to counteract alcohol advertising targeting certain groups, such as women (World Health Organization, 2024a). At present, however, the effects of these “best buy” policies specifically on the harm to women and children are less-studied than the effects of these policies on the people consuming alcohol, with studies of child abuse and neglect being particularly rare (except for studies by Freisthler et al., 2007, 2008 and by Markowitz & Grossman, 1998, 2000).
Given the secondary effects of men’s alcohol consumption on women and children, one direction might be to pair alcohol policies with comprehensive community interventions and individually focused strategies to facilitate a focus on harms specific to women and children from men’s alcohol use. The model in Figure 2 above suggests possibilities for integrating cost-effective policy interventions (World Health Organization, 2018b, 2021) with evidence-based, theoretically informed interventions to (1) change the drinking context, (2) modify drinking norms, (3) adapt individually focused interventions, and (4) address elements of power that contribute to harms that women and children experience because of men’s alcohol consumption.
Interventions to change the drinking context include bystander intervention training programs for staff of venues that sell alcohol, as well as enhanced policy and enforcement interventions that focus on licensed and unlicensed premises where alcohol is sold for on-site consumption. Interventions to modify drinking norms include comprehensive community approaches. These strategies are most effective when they are based in local leadership and include multiple interventions and alcohol control policies that are both enacted and enforced. These comprehensive strategies can reduce problems associated with public alcohol consumption, including violence (Hauritz et al., 1998; Homel et al., 1997).
Another strategy is to declare “dry zones” where no alcohol consumption is permitted. Commonly, these zones are focused on public places such as parks and roads, although some localities declare certain homes or entire municipalities as dry, where alcohol sales are not permitted or where certain sales practices such as “liquor by the drink” are restricted. Individually focused interventions might include strategies such as rationing alcohol or banning alcohol consumption by people convicted of driving under the influence of alcohol. These strategies are similar in many ways to license suspension, which is more common. Finally, increased access to specialized alcohol treatment is another important strategy to reduce harms to women and children resulting from men’s alcohol use.
Interventions also are needed to address elements of power that contribute to harm. Gender-transformative approaches remove structural barriers and reduce gender inequalities to empower women and girls (Marcus et al., 2022). A review of interventions to reduce alcohol consumption found little evidence of the effects of these interventions on intimate partner violence (I. M. Wilson et al., 2014), and none of the interventions specifically addressed the social norms and power structures that can exacerbate these harms. In fact, some research with alcohol policy-makers suggests little interest in addressing gender issues at all (Farrugia et al., 2022). Research on violence has identified the importance of approaches that address gender norms that contribute to violence (Jewkes et al., 2015); however, we found no interventions focused on harms to women, including violence, from men’s drinking that have adopted a gender-transformative approach. As suggested by Jewkes and colleagues (2015), such an approach would, for example, address social roles relating to masculinity and how these relate to men’s drinking. Other approaches might not focus on alcohol at all but rather focus on women’s financial independence, which could mitigate harm from the man’s alcohol use.
Studies highlight multiple disadvantages (intersectionality) for women from men’s alcohol use in low- and middle-income countries, where alcohol use is increasing (Babor et al., 2022) and which carry a disproportionate burden of harmful alcohol use (Room et al., 2022; Sørensen et al., 2022). Thus, future studies and interventions need to tailor prevention and response programs to these heterogeneous contexts and acknowledge the intersectionality of the problems of alcohol use, harms to women, and poverty often found in low- and middle-income countries.
The Way Forward
Reducing men’s alcohol use and alcohol-related harm to women and children will help meet the 2030 Sustainable Development Goals (United Nations, 2015) relating to ending discrimination and violence against women and girls (SDG Targets 5.1 and 5.2) (World Health Organization, 2020). This evidence review has highlighted key findings to inform that path. In summary:
Men’s alcohol use causes a multitude of harms to women and children. Harms often are hidden or unrecognized, and many are cascading, cumulative, and interactive. For example, little research has focused on financial harms from men’s drinking, despite potential impacts on schooling and other opportunities for children and women in the household.
Harms are greater in low- and middle-income countries where women have fewer resources and options and where both women and children tend to be more disempowered. More harms occur in countries and subcultures with greater gender inequality. Women suffer the most harm when they are poor or have few resources and when gender roles in the culture normalize control of women.
Alcohol policies and other interventions to reduce harm should center gender and be gender-transformative to advance women’s and children’s health.
Addressing the issue of harms to women and children from men’s alcohol use requires an intersectoral (e.g., health, legal, social services) and multitiered approach with actionable steps for policy-makers, service providers, community organizations, and researchers. Given the policy, programmatic, research, and requisite funding implications of this work, we provide concrete steps for each of these parties below.
To advance global and regional alcohol policy that includes response to harms that women and children suffer because of men’s alcohol use, decision-makers should explicitly consider evidence on these harms. Increasing resource allocations may help prevent and respond to such harms. More monitoring and evaluation is needed for intersectoral programs to prevent and respond to alcohol-related harms to women and children. In addition to evidence-based alcohol policies, policies that help women and children, such as those that reduce poverty, increase women’s economic empowerment, and protect children, also will reduce the alcohol-related harms they experience. Future research could include impacts on women and children as outcomes examined in any policy or program evaluations.
Civil society and community-based organizations could educate communities about harms experienced by women and children from men’s alcohol use through public awareness and advocacy campaigns. Partnerships with local community and governing bodies may encourage enactment of alcohol control and related policies that protect women and children from alcohol-related harm. Intentional and meaningful inclusion of community members in co-creation and delivery of effective interventions also may help reduce harm to women and children from men’s alcohol use.
Researchers could examine the policies currently designated as effective and evaluate the extent to which these policies reduce harms to women and children from men’s alcohol use. Both quantitative and qualitative research could inform development and evaluation of policies to reduce these harms, including a range of policies and interventions beyond those focused solely on alcohol. Communities may be valuable partners able to identify and prioritize alcohol-related harm using participatory, women- and child-centered methods that amplify the voices of those affected by men’s alcohol use. Cross-cultural studies may help describe and address the intersectionality of alcohol use and its harms to women and children in diverse contexts. Dedicated financial resources for researchers, program developers, clinicians, and others would enable collaboration across sectors to address harms to women and children from men’s alcohol use, using programmatic and policy efforts that have been shown to reduce these alcohol-related harms in societies around the world.
