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Project Choices program focuses on alcohol, sex and birth control for young women
The Project Choices program has been offered in Winnipeg, Manitoba since September 2010. Originally based on a program developed in the United States in the 1990s, it has continued to evolve to meet the needs of the community.
You can check out the recently launched website which includes FAQs and a great Links section. While the website is targeted at young women, it also includes information for service providers.
Project CHOICES is an FASD prevention program that works with girls/women of any age who are not currently pregnant, drink alcohol, and are sexually active. The goal of the program is to reduce the risk of an alcohol-exposed pregnancy through choosing healthy behaviours around alcohol and birth control use. Program partners include Klinic Community Health Centre, Norwest Co-op Community Health, and Healthy Child Manitoba.
Learn more about Project Choices in Canada and the research evidence to support the program in previous posts:
- College Binge Drinking and FASD Prevention (February 28, 2011)
- More on Project CHOICES (September 24, 2010)
- Project CHOICES Comes to Canada (September 14, 2010)
Asking “Do you drink alcohol?” is not enough
The American College for Obstetricians and Gynecologists is an organization of over 57,000 obstetricians and gynecologists. In 2011, the College did an extensive assessment of the needs of its membership to address at-risk drinking of all women, not only pregnant women. This new website contains tools that were collected and developed in response to this assessment.
The website is designed to support health care providers in screening and brief intervention and offers a cell phone app, downloadable patient information sheets, current news articles, and treatment referral information. Some examples of tools you can find include:
- iPhone app for identifying and intervening with women who drink at high-risk levels
- ACOG committee opinion: At risk drinking and alcohol dependence: Obstetric and gynecologic implications
- FAQs
The website feels a little cluttered (not all the resources are equally good) and not as dynamic and clean as I would like, but it’s great to see the interest in women and alcohol by the College and not just in relation to pregnancy.
Damskaya or "Ladies Vodka" (image via ABC News)
Russia is considered to be a country with one of the highest levels of alcohol consumption in the world. (See the World Health Organization’s Alcohol and Health profile for Russia here). And in a country where rates of alcohol consumption are increasing in general, and in women and youth in particular, it’s interesting to consider the context of FASD prevention.
One report indicates a sharp increase in average alcohol consumption of 80% between 1990 and 2005. Other reports show increasing consumption among women and young people and suggest that alcohol marketing directed at women is becoming more common. (For more on the latter, you might want to check out the 2008 Reuters article New ladies’ vodka gives doctors a headache which discusses the release of Damskaya or “Ladies” vodka, targeted at upwardly mobile women and “designed to be sipped with salad after a workout in the gym.”)
The actual rate of FASD in Russia is unknown (not surprising, as official diagnosis is a problem pretty much everywhere) so estimates vary depending on the sample being considered. In a sample of children in orphanages for children with mental health problems in Moscow in 2006, 7.9% of the children were identified as having FASD (186 children out of 2,352). In 2005, in a high risk maternity hospital, the FASD rate was 3.6/1000 live births (which was up from 1.2/1000 in 2004).
A study published last fall by Tatiana Balachova and her colleagues examined drinking patterns among pregnant and non-pregnant women of childbearing age in Russia. They interviewed 648 pregnant and non-pregnant women of childbearing age (18-44) in 7 public women’s clinics in St Petersburg and the Nizhny Novgorod region. They found that:
- 89% of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months (binge drinking was defined as 4 or more drinks)
- Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant
- There was a significant decline in drinking after women learned they were pregnant – down to 20% of women consuming alcohol
- A high prevalence of binge drinking among women who might become pregnant (e.g., using contraception inconsistently) or who were trying to conceive
Since conducting this survey in 2004-2005, Tatiana Balachova and her colleagues have developed educational materials and online training programs for health care providers and the general public and conducted training for physicians around FASD prevention.
In an interview with Balachova, the reporter commented: “Balachova faced cultural and institutional obstacles to implementing the programs, such as lack of motivation, time constraints of physicians, inadequate training of staff and even the belief that physicians shouldn’t conduct brief interventions. She also encountered misconceptions such as the notion that harm is only caused if parents are intoxicated at conception and the idea that “normal” women don’t drink and are not at risk.”
You can take a look at some of the educational materials they’ve developed on this website (in Russian) and an overview of this work here.
And to wrap up this post, I thought I would mention a resource that was just pointed out to me. Some of you might be familiar with the book Best I Can Be: Living with Fetal Alcohol Syndrome or Effects by Liz Kulp. Well, supporters of the book have translated the book into Russian and Ukrainian and the book can be downloaded for FREE as an e-book from the Braided Cord website.
References
Balachova, T., Bonner, B., Chaffin, M., Bard, D., Isurina, G., Tsvetkova, L. and Volkova, E. (2012), Women’s alcohol consumption and risk for alcohol-exposed pregnancies in Russia. Addiction, 107: 109–117. doi: 10.1111/j.1360-0443.2011.03569.x
Balachova, T. and Varavikova, E. (2008). Preventing FAS/FASD in Russian Children. 1st Central and Eastern European Summit on Preconception Health and Prevention of Birth Defects. August 27-30, 2008. (powerpoint presentation)
And now something for your mother, best friend, and neighbor….
There are debates about whether 2010 or 2011 should be called the “Year of the Infographic.” Regardless, infographics seem to be here to stay in 2012.
Info(rmation) graphics are basically visual representations of information, data or knowledge. They can sometimes capture issues in a different way or more fun way or a quicker way than text might.
Here’s our NAT’s attempt to get away from the fury of opinions that exist about drinking alcohol during pregnancy and to present the known facts about the issue. If you click on the image, you can download a PDF version of the infographic – feel free to share with others. You can also download it from the FASD Prevention 101 page.
Enjoy!
Kununurra : Lily Creek Lagoon by Peter Connolly
I first blogged about the Ord Valley Aboriginal Health Service FASD program back in January 2011 (see the post Getting Fathers Involved). Last week, an article called Ord Valley Aboriginal Health Service’s fetal alcohol spectrum disorders program: Big steps, solid outcome was published in the Australian Indigenous HealthBulletin. The author, Bridge, provides an overview of the program and reflects on successes and challenges as the first year draws to a close.
An FASD prevention program was initiated in August 2009 through the Ord Valley Aboriginal Health Service (OVAHS). OVAHS is a comprehensive primary health care (PHC) facility servicing Aboriginal people in the remote township of Kununurra and the surrounding communities. (Kununurra is situated in the far north east Kimberley region of Western Australia). The town has a population of approximately 7,500 people, and of those, approximately 50% are Aboriginal.
The program was developed to take a broad, holistic approach to working with women and their families. It also recognized the links between prenatal alcohol use, other drug taking behaviours and teenage sex/contraception issues. The program they developed targeted five groups:
- All Aboriginal women receiving prenatal care at OVAHS
- All Aboriginal women between the ages of 13 to 45
- OVAHS staff
- Local Aboriginal men
- Local, national and international interest groups and organisations.
The primary focus of the program is working with pregnant women. As part of their prenatal care, women receive FASD education, alcohol and other drug assessment and one-to-one counseling. Brief intervention, motivational interviewing and a three part antenatal assessment are key features of the program. When appropriate, these interventions are extended to include partners, families and the community as a whole. Information is also provided on contraception.
Contraception is viewed in the program as a cornerstone of FASD prevention. The author comments:
Dialogue with young women in the community revealed that their knowledge of puberty, menstruation, pregnancy and contraception varied, with a significant number reporting little knowledge of contraception in particular. Given the incidence of early alcohol use among young women (and its resultant impairment of judgement), and their attitudes and norms around consumption, the program has placed considerable emphasis on the promotion of alcohol awareness, contraception and safe sexual practices as part of all brief interventions.
One of the unique features of this program, I think, is the clear attempt to involve men in FASD prevention. Bridge says that men appear interested in FASD education for a variety of reasons. “The men also believe that Aboriginal culture, knowledge and stories rely heavily on oral tradition, and therefore memory, and that this is potentially lost if many of the next generation suffer neurological damage as a result of pre-natal alcohol exposure. Men within the local community are also aware that too many of their young men are leaving school early and with only basic education, and that rates of imprisonment are high among Aboriginal men. As such the local men have voiced concern that FASD could be a contributing factor, especially as Aboriginal people currently make up 21% of the total number of Australian prisoners, yet only comprise 2.5% of Australia’s population.”
Results from the program clearly demonstrate the role that men/fathers have in supporting women to make alcohol-free choices:
In some families, women report that men hold the power-base and as such strongly influence the choices made regarding alcohol use in their pregnancies. Through conversation with antenatal clients, a number of women identified pressure from their partners as being significant in determining drinking behaviours during pregnancy. The women reported they would like to stop drinking, but were often pressured to stay with their partners in the ‘drinking circle as a show of family loyalty and their commitment and faithfulness to the relationship. Some female clients also report that to remove themselves from this social circle and ‘sit’ with non-drinking family members or friends, or spend time doing activities such as fishing potentially results in relationship problems, arguments or even violence. The role men play in the decision making of some clients was not initially anticipated, but it was recognised early on that the success of the program lay in part in the inclusion and education of men.
You can read the full-text of the article here.
Read more on FASD prevention in Western Australia:
Bridge, P. (2011). Ord Valley Aboriginal Health Service’s fetal alcohol spectrum disorders program: Big steps, solid outcome. Australian Indigenous HealthBulletin 11 (4). Free full-text.
GG makes historic visit to Kimberley town (The West Australian, August 11, 2011)
Ch. 3: From community crisis to community control in the Fitzroy Valley. In The Aboriginal and Torres Strait Islander Social Justice Commissioner. (2011). Social Justice Report 2010. Australian Human Rights Commission.
CTIS applauds new efforts to prevent FASD in rural Australia (December 15, 2010)
Marulu: The Liliwan Project (The George Institute for Global Health)
Paula Simons has just written an interesting piece for the Edmonton Journal called Alberta should fund safe, reliable birth control (October 11, 2011).
The article discusses funding debates about a permanent birth control procedure called hysteroscopic sterilization. The procedure uses a device called Essure – tiny springs which are placed inside a woman’s Fallopian tubes. Over a period of three months, the body responds by creating tissue around the inserts which blocks the tubes and makes a woman infertile. The procedure is considered a non-surgical alternative to tubal ligation.
While sterilization procedures are a wonderful thing for many women, especially women who have had children and are certain they do not want to have more, sterilization procedures always seem to lead to paternalistic discussions of how this procedure might make sense for “certain groups of women.” As Simons says in the article, sterilization is often described as a “good option for women who have high-risk lifestyles, some of whom don’t manage conventional birth control well, have multiple abortions, and don’t have regular access to a family physician or gynecologist. “
Women with serious addictions issues often get thrown into this category of “high risk lifestyles.” Sometimes, it seems like sterilization is the preferred solution to addressing maternal substance use rather than the underlying roots of addiction and providing appropriate treatment and care.
Simons comments:
“Hysteroscopic sterilization isn’t the answer for every woman or couple. It is irreversible. No woman, including a woman wrestling with mental health issues or addictions, should undergo such a procedure under social duress. While the procedure could reduce the number of unwanted pregnancies, and, potentially, the incidence of babies born with fetal alcohol syndrome and other brain damage caused by substance abuse, it offers women no protection against sexually transmitted diseases.“
See an earlier post Project Prevention: Paying women with addictions to get sterilized (April 27, 2011) for more on sterilization and women with addictions.
Boyle Street Community Services has just received $900,000 through Alberta’s Safe Communities’ three-year innovation fund to support a program for pregnant, homeless women living in Edmonton’s inner city core.
The agency runs the Streetworks program which is based on the principles of harm reduction, health promotion, and primary health care. The new funding will be used to support pregnant women who are dealing with issues such as addictions, poverty, and family violence and to support them in addressing these issues and ultimately support healthy births.
Marliss Taylor, Streetworks Project Manager, says in the Alberta government press release:“Women who are street-involved and pregnant face multiple barriers in staying healthy throughout their pregnancy. Often survival issues have a higher priority than pregnancy issues for this group of women. This can lead to negative judgments by people who don’t understand the struggles they face. This program will work with women where they are at, in a harm reduction context, building upon their strengths and enabling moms to meet their full potential. It has a large outreach component and will work with other agencies that provide services to this population.”
The program includes four staff: a social worker, a nurse and two outreach workers.
Read media coverage of the program, Boyle Street aims to help pregnant women (Edmonton Sun, August 30, 2011) and H.E.R. helps pregnant women in need (Edmonton Journal, August 31, 2011).
Read the Alberta government press release Innovative project reaches out to homeless, pregnant women (August 30, 2011).
The Edmonton Sun also has a video clip of an interview with Marissa Nakooche, one of the program staff.
New UNESCO study on multiple benefits of sex education programs
A study conducted by UNESCO on sexuality education programmes in Estonia, India, Indonesia, Kenya, the Netherlands and Nigeria shows that investing in sexuality education programs for youth can be very cost-effective. The study is called Cost and cost-effectiveness: Analysis of school-based sexuality education programmes in six countries.
For example, between 2001 and 2009, a national sexuality education programme in Estonia was found to ‘avert’ nearly 2 000 HIV infections (at a potential lifetime cost of US$ 67 825 per patient), approximately 4 300 unintended pregnancies and more than 7 000 sexually transmitted infections.
A couple of weeks ago, I mentioned in a post that rates of intended pregnancies remain high in Canada and that teens are an important group to think about in terms of FASD prevention (see the post here). Recent stats suggest that 75.5% of youth report consuming alcohol in the past year and that the prevalence of heavy frequent drinking among youth 15 to 24 years of age is about 12% (as compared to 4% for adults 25 years and older).
Since most youth are not planning to get pregnant at this particular time of their lives, addressing contraception through sex education programs makes good sense and is an alternative to focusing on alcohol and substance use.
Non-profit organization in Nova Scotia launches a new campaign
Injury Free Nova Scotia has launched a cinema and online campaign to warn youth against the dangers of excessive drinking.
Marketing Magazine (Injury Free Nova Scotia brings the goat, June 7, 2011, Matt Semansky) describes the campaign:
The “No Magic Goat” campaign features a two-minute house party scene. Set to thumping electronic music, the video depicts teens drinking, dancing and making out with each other, but also vomiting and capturing each other’s vulnerable moments on mobile phone cameras.
According to this article, Shirley Ann Rogers, executive director of Injury Free Nova Scotia, says reckless drinking was a logical topic for the organization to address given the role alcohol plays in various kinds of accidents.
In terms of FASD prevention, collaboration with diverse organizations that are working more broadly to change the culture of drinking is interesting to explore. Rates of unplanned pregnancies remain high in Canada (stats usually suggest the rate is between 30-40%). For example, a recent article in CBC News reports that teen pregnancies in Canada continue to decline; however, in 2006, the teen pregnancy rate was 27.9 per 1000 women aged 15-19 years (Canada’s teen pregnancy rate fall, May 27, 2011). An important group to think about in terms of FASD prevention!
The No Magic Goat video began appearing in movie theatres in the Halifax and Sydney, N.S. areas on May 27. It can also be viewed on YouTube and TV spots will air in the near future.
Visit the the Injury Free Nova Scotia microsite NoMagicGoat.ca. You can read the 2007 report Changing the Culture of Alcohol Use in Nova Scotia: An Alcohol Strategy to Prevent and Reduce the Burden of Alcohol-Related Harm in Nova Scotia here and read the CBC coverage (Video aimed at reducing teen binge drinking, June 8, 2011) of the campaign here.
Sterilization as a prevention strategy. Really??
The Fix has an interesting and rather horrifying piece on a “charitable” organization that is encouraging and paying women who are addicted to drugs and alcohol to get sterilized (See “Charity” Pays Thousands of Addicts to Get Sterilized, April 20, 2011). Project Prevention pays women $300 to be “responsible” and get sterilized. The goal of the organization is to “reduce the number of substance-exposed births to zero.”
I first read about efforts to encourage women with addictions to get sterilised in February when Denmark’s health minister discussed waiving the fee for sterilization for “vulnerable groups” as the cost of sterilization would cost society considerably less than women giving birth to “deformed babies.” (See Minister calls for free sterilisation for addicts, February 25, 2011).
Project Prevention has now spread from the US to the UK and has received allegations of being a form of eugenics. If the shoe fits?
