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Alabama’s Chemical Endangerment Law highlights ongoing tensions about pregnancy and substance use
A couple of weeks ago, the New York Times Magazine published a disturbing article by Ada Calhoun called The Criminalization of Bad Mothers (April 25, 2012).
The article looks at a law enacted in Alabama in 2006 which was designed to protect children from explosive meth labs. It has now been used to prosecute 60 women for exposing their children to substances during pregnancy. Unlike most other states where maternal substance use would be perceived as child protection issue or a health issue, women are being prosecuted.
You can learn more about the issue of criminalizing pregnant women who use substances on the National Advocates for Pregnant Women website. Also, check out a previous post Fear and judgement of pregnant drug-using women: what are the consequences? (July 28, 2010).
The article has generated some pretty heated discussion (which is a good sign!) and has prompted the American Psychiatric Association and 43 other organizations and individuals to publicly condemn the law. They argue that:
the lower court’s decision endangers maternal, fetal, and child health by deterring drug-dependent women from seeking health care, carrying their pregnancies to term, and sharing vital health information with their physicians. Pregnant women who lawfully take prescribed controlled substances would also be subject to arrest under the lower court’s interpretation, as would their prescribing physicians.
For more, read APA Condemns Prosecution of Pregnant Drug Abusers (Jonathan Wolfe, May 4, 2012).
Understanding the history of FASD and the origin of early prevention efforts
Some of you may be familiar with the work of historian, Janet Golden, a professor at Rutgers University. Janet is well known for her book Message in a Bottle: The Making of Fetal Alcohol Syndrome (Harvard University Press, 2005).
One reviewer described the book as “the most comprehensive and easily read text on the history, politics, public health debate, legislation, psychosocial and family dynamics, and media discussion concerning fetal alcohol syndrome (FAS). This is a must-read for any professional involved in the study of alcohol abuse and neurodevelopmental outcomes of children, fetal medicine, pediatrics, social work, psychiatry, and other areas of mental health.”
In case you don’t feel like reading an entire book, Golden gave a one hour lecture a couple of weeks ago that has now been posted on YouTube. The lecture is a cultural biography of FASD in the late 20th century and describes how FASD became viewed as a medical issue and thus a medical problem and how prevention efforts became narrowly defined as activities to support the “crusade to warn” women of the dangers of alcohol.
Read more about the history of FASD by Janet Golden
“Observing the Effects of Alcohol Abuse and Pregnancy in the Late 19th Century.” International Journal of Epidemiology 40, 2 (2011): 292-93. doi:10.1093/ije/dyr005
“A Cultural History of Fetal Alcohol Syndrome, MD Advisor 3 (2010): 22-29.
“Opinion: Stopping Fetal Alcohol Syndrome: Women Who Drink Need Treatment,” in Jacqueline Langworth, ed. Perspectives on Diseases and Disorders: Fetal Alcohol Syndrome (Greenhaven Press, 2010).
“The ‘Tempest in a Cocktail Glass’: Mothers, Alcohol, and Television, 1973-1992″ Journal of Health Politics, Policy and Law 25 (2000): 473-498.
“‘An Argument that Goes Back to the Womb:’ The Demedicalization of Fetal Alcohol Syndrome, 1973-1992,” Journal of Social History 33 (1999): 269-290.
Image by Mike Beauregard, via flickr
The Northern News Services published an article a few weeks ago about a women’s healing and sharing circle program in Kimmirut, Nunavut (see Sewing for baby’s health, February 8, 2012).
The program, run out of the Nunavut Arctic College, started in January and runs until the end of March. Women are invited to learn to make sealskin mitts or fabric snowpants with elders. During the program, elders share their teachings about not using alcohol or other substances during pregnancy.
The reporter interviews Margaret Piercey, territorial FASD co-ordinator, who describes the program as using a ‘relational approach‘ based on equality, empowerment and respect. She’s quoted as saying: “Approaching women from a strength-based perspective demonstrates a belief in their ability and enhances the chances of women staying away from alcohol.”
Kimmirut is located on the southern coast of Baffin Island, about a 30 minute flight from Iqaluit, Nunavut’s capital city. It has a population of 425 people, of which approximately 91 per cent are Inuit.
Image via www.thecanadianencyclopedia.com
Kimmirut was in the news again last week when two communities in Nunavut held plebiscites to change their local liquor regulations (see Two Nunavut communities vote in liquor plebiscites, February 29, 2012). While the community of Resolute Bay voted to maintain their current regulations, Kimmirut voted to end its prohibition system or status as a ‘dry’ community and establish an alcohol committee system.
Under a committee system, community members who want to purchase liquor will have to go before a committee and make a case for their order. If they receive approval, they can order and have alcohol shipped to the community
According to coverage in The Star, this plebiscite vote means that 14 of Nunavut’s 25 communities will operate with an alcohol education committee. (See Baffin Island community votes for alcohol committee that decides who gets booze, March 1, 2012).
Alcohol sales in Nunavut are controlled by the Nunavut Liquor Commission. The Commission website describes the unique challenges of selling alcohol in Nunavut: “The major challenge for liquor retailing in Nunavut is the need to service a very limited market spread out over a fifth of Canada’s land mass and connected only by air and limited seasonal sea access.”
There are no liquor stores in Nunavut so all orders are placed through the Commission headquarters in Rankin Inlet and distributed via air cargo.
For more on northern Canada and alcohol policy, see an earlier post Community-driven alcohol policy in Canada’s North (December 15, 2011).
The women’s sewing circle is funded by the Department of Health and Social Services (see brochure below) and you can learn more about Nunavut’s FASD Initiative here.
Drinking age policies can have a long-term impact on birth outcomes
Recent research is suggesting that changes in legal drinking age laws can alter the broader social contexts of young women in a way that affects their alcohol use and the health of their children.
In general, research has shown that alcohol policies that affect the availability of alcohol in certain environments (e.g., taxes, retail regulations) can influence drinking practices.
A recent paper by Ning Zhang and Eric Caine from the University of Rochester School of Medicine explored how one type of alcohol policy – minimum legal drinking age – could influence the context of alcohol consumption in young women. In general, research has found that older minimum legal drinking age “has both intended effects, i.e., decreasing youth alcohol consumption and drunk driving, and unintended social and health benefits, such as decreasing high school dropouts, teen births, and the prevalence of sexually transmitted diseases.” (p. 3797)
Not only were Zhang and Caine interested in how changes in minimum legal drinking age might affect things like binge drinking and transmission of sexually transmitted infections, they also wanted to know if the effects of these policies could be intergenerational and affect health outcomes for infants born to mothers who would have been affected by changes in minimum legal drinking age.
During the late 1980s, the minimum legal drinking age was increased in the U.S. from ages 18–20 to 21 years. This created a series of “natural experiments” in which the researchers could examine the effects of different minimum legal drinking age.
Overall, they found that a minimum legal drinking age of 18 years old increased the prevalence of low birth weight, low Apgar scores, and premature births in infants who were born to young women that came into childbearing age when the laws varied between 18–21 years of age. The researchers present some theories on the pathways for these outcomes.
While it’s not yet clear if one pathway or multiple pathways are at play, it does suggest that alcohol policies that influence the “environment” in which alcohol is consumed can indirectly infant health outcomes, too. The researchers were unable to make direct links to alcohol consumption during pregnancy or FASD rates, but it does support the idea that overall alcohol policy is an important aspect of FASD prevention.
For more on this, see an earlier post Integrating FASD Prevention and Alcohol Policy (March 11, 2011).
References
Watson, T. and Fertig, A. (2009). Minimum drinking age laws and infant health outcomes. Journal of Health Economics, 28, 737-747. (Download a free NBER Working Paper version of this paper here).
Zhang N., Caine E. (2011). Alcohol Policy, Social Context, and Infant Health: The Impact of Minimum Legal Drinking Age. International Journal of Environmental Research and Public Health, 8(9):3796-3809. ISSN 1660-4601 doi:10.3390/ijerph8093796. (Open Access journal, free full-text available here).
Information Sheets from the BC Partners for Mental Health and Addictions Information
Last November, Canada’s first Low-Risk Alcohol Drinking Guidelines were released. (These have been supported by the federal, provincial and territorial health ministers as well as leading public health and addictions agencies).
HeretoHelp, which provides high quality mental health and addictions information on a range of topics, has developed one-page fact sheets on aspects of these guidelines. The topics include:
- A Standard Drink
- Alcohol Screening
- Alcohol and Youth
- Alcohol and Women
- Alcohol and Pregnancy
- Alcohol and Chronic Disease
These information sheets were prepared by the Centre for Addictions Research of BC and the British Columbia Centre of Excellence for Women’s Health for www.heretohelp.bc.ca. HeretoHelp is a project of the BC Partners for Mental Health and Addictions Information which is composed of seven mental health and addictions nonprofit agencies.
For more on low-risk drinking guidelines, see previous posts:
- Canada’s new Low-Risk Alcohol Drinking Guidelines (December 9, 2011)
- What are low risk drinking guidelines? (November 25, 2011)
Check out this article from The Fix, Pregnant South Africans May Be Banned From Buying Booze (February 7, 2012).
The legislature of the South African province of Gauteng (which includes the country’s capital Pretoria and its largest city, Johannesburg) released a draft bill on Monday to restrict sales of alcohol as one way of addressing concerns about the high rates of alcohol misuse and FASD in the country.
One section of the bill states: “A [liquor] licensee must not sell, supply or give liquor to (a) a minor; (b) a person who is dressed in a school uniform; (c) a person who appears to be intoxicated; or (d) a pregnant woman.”
This is raising all sorts of questions (rightly so). How do you know if someone is pregnant? Are pregnant women really in the same category as students and people who appear intoxicated? What if a pregnant woman wants to buy some wine for her partner or as a gift? And, wait a second, isn’t this a gender equality issue? Why are we trying to control women’s decisions and actions in this way?
Alcohol legislation that restricts the ways in which alcohol is sold has been shown to be very effective in reducing harms related to alcohol use. But this particular law raises questions about weighing societal benefits and individual choice. As an attempt at reducing rates of FASD, it’s concerning because it suggests that possible harms to the fetus and costs to society are more important than focusing on supporting women and addressing the reasons and contexts for alcohol use. Historically, FASD prevention has been child-centred and this has not been an effective approach – in fact, it can sometimes cause more harm than good.
For more news coverage, see
- Ban on Pregnant Women Buying Alcohol Is Outrageous (Feb 6, 2012)
- Gauteng plans new law to insult women (Times Live, Feb 7, 2012)
- Alcohol ban plan for moms-to-be (Times Live, Feb 7, 2012)
- South Africa considers law banning sale of alcohol to pregnant women (The Telegraph, Feb 7, 2012)
Postcard from a campaign by the European FASD Alliance supporting labels on alcohol beverages to warn women not to consume alcohol during pregnancy.
Last fall, 15,000 postcards were reportedly sent to national and EU health ministers and policymakers throughout Europe.
The postcards show outlines of bottles of alcoholic drinks with stickers provided to stick onto the bottles. The pictogram is the same one that is mandatory on alcoholic beverages sold in France. (See an earlier post, FASD Prevention in France, May 12, 2011). In other countries, some beverages have warning labels and others don’t. The group states: “We believe that all European women have the right to know of the dangers of drinking during pregnancy. We support standardized, mandatory health warning labels on containers of alcoholic drinks and on advertisements for these products.”
The European FASD Alliance includes organizations and individuals in over 20 European countries. Visit their website here for more information about the campaign (including links to Facebook and Twitter so you can follow the progress of the campaign).
What do they say about women and pregnancy?
Canada’s first Low-Risk Alcohol Drinking Guidelines were released on November 25, 2011. You can take a look at them on the Canadian Centre on Substance Use web site here. (If you’re wondering what these guidelines are all about, see an earlier post What are low risk drinking guidelines?)
The new guidelines recommend that women drink no more than:
- 10 drinks a week, with no more than 2 drinks a day most days
- 3 drinks on any single occasion.
Unlike low-risk drinking guidelines developed in other jurisdictions and countries, these new guidelines include information about pregnancy and breastfeeding. Women are advised:
If you are pregnant, planning to become pregnant, or before breastfeeding, the safest choice is to drink no alcohol at all.
The Guidelines were developed by an independent expert working group with members drawn from Canadian addiction research agencies. They further elaborate on the pregnancy guideline with: “The safest option during pregnancy or when planning to become pregnant is to not drink alcohol at all. Alcohol in the mother’s bloodstream can harm the developing fetus. While the risk from light consumption during pregnancy appears very low, there is no threshold of alcohol use in pregnancy that has been definitively proven to be safe.” (Butt et al, 2011, p. 8 )
Canada’s Low-Risk Alcohol Drinking Guidelines are a key component of the National Alcohol Strategy. They have received the support of many organizations, including: Canadian Association of Chiefs of Police, Canadian Centre on Substance Abuse, Canadian Medical Association, Canadian Paediatric Society, Canadian Public Health Association, Centre for Addictions Research of British Columbia, Centre for Addiction and Mental Health, College of Family Physicians of Canada, Educ’alcool, MADD Canada, and Society of Obstetricians and Gynaecologists of Canada.
Over the next few months, you can expect to see various provinces and health agencies work to get the guidelines into practice.
Further Reading on Low-Risk Guidelines
Butt, P., Beirness, D., Cesa, F., Gliksman, L, Paradis, C., and Stockwell, T. (2011). Alcohol and health in Canada: A Summary of evidence and guidelines for low-risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.
Fischer, B., Jeffries, V., Hall, W., Room, R., Goldner, E., and Rehm, J. (2011). Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A Narrative Review of Evidence and Recommendations. Canadian Journal of Public Health, 102(5): 324-327.
Thompson, K.D., Stockwell, T., and MacDonald, S. (2011). Is there a ‘low-risk’ drinking level for youth? The risk of acute harm as a function of quantity and frequency of drinking. Drug and Alcohol Review. doi: 10.1111/j.1465-3362.2011.00378.x
Toronto Star’s 2011 Atkinson Series on how women are driving a growth in alcohol consumption around the world
NAT member Janet Christie, Addiction Recovery Coach of Canada Society
This month, the Toronto Star has been publishing a series of articles by 2011 Atkinson fellow, Ann Dowsett Johnston, on women and alcohol consumption. As part of the Atkinson Fellowship in Public Policy, Johnston spent a year researching and writing on the issue of women and alcohol.
Several of the articles in the series address alcohol and pregnancy and include interviews with members of our NAT and the Canada Northwest FASD Research Network. Check out some of the links below:
- Her 15-year-old son couldn’t read and he couldn’t add. She knows she caused this. (Nov 22 2011) – A profile of NAT member, Janet Christie, who shares her experiences as a birth mother and work with the Moms Mentoring Moms program; check out the great interview on video (7 min)
- Better testing needed to diagnose fetal alcohol spectrum disorder, Canadian expert Sterling Clarren says (Nov 22 2011) – An interview with Sterling Clarren, Scientific Director of the Canada Northwest FASD Research Network; check out some of the work of the NAT on diagnostics.
- How much is too much when you’re pregnant? (Nov 23, 2011) – Some of the challenges of risk and communication in this area.
- Women and Alcohol: Solutions (Nov 25, 2011) – 10 policy solutions; includes interviews with NAT lead, Nancy Poole, and Sharon Wilsnack, from the GENACIS project.
If you move in certain circles, you may have heard that the Canadian government will be releasing new “low-risk drinking guidelines” in the near future. So, what are they exactly?
Low risk drinking guidelines have been developed in various provinces and countries as a way of helping adults to make informed decisions about the amount of alcohol they consume. As we know, there is a lot of information and misinformation out there. Should you drink some wine for your heart? Or, does any alcohol use at all increase your risk of breast cancer? How much should you drink at a time? And is wine better than vodka?
Low risk drinking guidelines give suggestions for daily and weekly drinking limits (for men and women) and other suggestions for minimizing the risks associated with drinking alcohol (e.g., drinking slowly, drinking with food, alternating between alcoholic and non-alcoholic beverages).
Low risk drinking guidelines are not without controversy. If you’re familiar with the concept of the prevention paradox, it could be argued that the real message people should be given is to “Drink less” – no matter who you are or how much you currently drink. Supporters of low risk drinking guidelines argue that people just won’t listen to this message and that it’s more pragmatic to recommend a threshold at which most Canadian drinkers are at low risk. You can read about how the expert advisory panel determined these guidelines for the Canadian population in the article listed below.
While low risk drinking guidelines are generally directed at the general population, the new guidelines will include information on alcohol and pregnancy.
Stockwell et al (2011) comment on what would happen if the new low risk drinking guidelines were adopted by all Canadians:
- the annual numbers of alcohol-caused deaths in Canada would be reduced by approximately 4600
- overall consumption of alcohol in Canada would be reduced by at least 50%
References
Website (2003): Low-risk Drinking Guidelines: Maximize life, minimize risk.
Stockwell T, Butt P, Beirness D, Gliksman L, Paradis C. (2011). The basis for Canada’s new low-risk drinking guidelines: A relative risk approach to estimating hazardous levels and patterns of alcohol use. Drug and Alcohol Review, DOI: 10.1111/j.1465-3362.2011.00342.x.
