This paper has used realist evaluation to provide an illumination
of the fundamental factors influencing the screening and
alcohol brief intervention programme in routine antenatal care.
It has also showed why the context of antenatal care setting
influenced how the programme works. Particularly, drinking in
pregnancy is an emotive issue and delivering ABIs at the first
antenatal appointment when they are more likely to achieve the
most benefits poses challenges. As such, training of midwives to
screen and deliver ABIs should focus more on improving skills for
example, person-centred communication skills that can help to
overcome barriers associated with discussing sensitive antenatal
alcohol consumption issues. This can facilitate early identification
and ABI delivery at the first antenatal appointment.