The purpose of this paper is to assess the impact of a series of brief interventions (BIs) on anti-natal alcohol consumption of women from a disadvantaged and high-risk background attending state health clinics in a rural district, Western Cape Province, South Africa. A pragmatic cluster randomised trial design was followed. All pregnant women, who were less than 20 weeks pregnant and more than 15 years of age, were eligible for the study. The intervention comprised a comprehensive assessment for current and lifetime alcohol use plus information (control group) or comprehensive assessment plus four BI sessions over the pregnancy period (intervention group). The Alcohol Use Disorders Identification Test (AUDIT) was completed pre- and post-intervention. Although both groups demonstrated declines in AUDIT scores, findings showed a statistically significant difference in the total AUDIT scores between the intervention and control groups post-intervention (F = 9.54, p = 0.002). The difference was two units (SE = 0.6). The follow-up rate was 92% (N = 179 of the original 194 eligible women). The impact of BIs is shown to be a powerful tool. Information and an understanding, supportive attitude seem to be crucial agents for behaviour change. (Contains 2 figures and 2 tables.)