The First Nations Health Authority (FNHA) in British Columbia is exploring a partnership approach to developing a community-based FASD prevention strategy in the Fraser Salish region.

Inspired by the Marulu Strategy in the Fitzroy Valley of Western Australia and the work of other Indigenous communities in Canada, the FNHA Community Wellness Support team brought together individuals and organizations working in health care, child welfare, early childhood development, community wellness and other related areas for a one-day meeting on December 1, 2017. The meeting was held on the on the traditional territory of the Musqueam people.

The meeting began with an opening prayer and welcome from a Musqueam Elder. In the morning, participants learned about the successful Family Empowerment Team in the Stó:lō Nation (the Stó:lō traditional territory extends from Yale to Langley, BC). The program is based on the Parent Child Assistance Program (PCAP) model developed by Therese Grant at the University of Washington in 1991 which has been shown to an effective approach to preventing FASD.

The Family Empowerment Team has built upon the PCAP model to develop a holistic and culturally relevant approach to FASD prevention in the Stó:lō Nation. Meeting attendees had the unique opportunity to hear from a woman who has participated in the program and to hear how the program has supported her and her family to reach her goals.

In the afternoon, members of Alberta’s Parent-Child Assistance Program Council shared their experiences of working with and supporting over 30 PCAP programs in Alberta and how different agencies, groups, and government departments have collaborated in developing a 10-year provincial strategy to address FASD.


For more on these topics, see these earlier posts:

Alberta Parent-Child Assistance Program Quilt, December 8, 2014

Films from the Lililwan Project: Tristan and Marulu, May 9, 2012

FASD Mentoring Programs in Canada, December 7, 2011

 

Many women who have FASD are able to benefit from tailored support on substance use problems. Audrey McFarlane, Executive Director of Lakeland Centre for FASD in Cold Lake AB recently shared strategies for working on FASD prevention with women who have FASD themselves. One of the LCFASD programs, the 2nd Floor Women’s Recovery Centre, provides residential treatment exclusively to women. She explained how programs can better support women who have FASD.

Challenges

Because of the possible neuro-behavioural and physical health issues associated with FASD, working with women living with FASD may pose particular challenges for the service provider due to:

  • Limited understanding of how their body works and how or why to use birth control;
  • Limited understanding of how to get housing, money and to keep themselves safe;
  • Physical health issues, such as diabetes, STDs, vision, hearing and dental;
  • Limited ability to envision the future;
  • Inability to link actions to consequences, which makes them more likely to be connected to the justice system and to have many children not in their care with multiple partners.

Strategies

McFarlane says that these and other challenges mean it often takes longer to see the benefits of supports. Yet, there are a number of strategies that have proven successful.

  • Take a family alcohol history and ask each woman, specifically, if she has a diagnosis of FASD. Woman will tell you if they do, but are often not even asked.
  • Make suggestions in key areas where they can agree or disagree rather than using client-generated approaches.
  • Prioritize building a relationship so that the woman will come back for support as needed. Reframe returning to treatment as a positive, not a negative.
  • Expect to spend more time on basic life skills and necessities. She may not have connection to family or social services. This means treatment needs to be longer.
  • Approaches that work best include solution-focused counselling, physical activities, positive touch, relaxation, and connections that develop a sense of belonging, like volunteering and cultural practices.

Resources

Here are a number of resources on trauma-informed and FASD-informed approaches for working with women living with FASD.

FASD Informed

2 Reports on Substance Using Women with FASD and FASD Prevention: Voices of Women and Perspectives of Providers, prepared by Deborah Rudman

Evaluation of FASD Prevention and FASD Support Programs website

FASD Informed Approach by Mary Mueller, RN, Waterloo Region Public Health and Emergency Services

FASD Informed Practice for Community Based Programs, College of New Caledonia

Working with Women Who May Have FASD Themselves – Webinar View SlidesRecording

Trauma Informed

Pregnancy, Alcohol, and Trauma-informed Practice, The Prevention Conversation

Trauma-informed Approaches to FASD Prevention – Webinar View SlidesRecording

Trauma-Informed Practice Resource List, Centre of Excellence for Women’s Health

_________________________

For more on this topic, see earlier posts:

WEBINAR JUNE 23 – WORKING WITH PREGNANT AND PARENTING WOMEN: LEARNINGS FROM HERWAY HOME, June 16, 2016

NEW CURRICULUM FOR FASD INFORMED PRACTICE, August 1, 2016

THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, March 18, 2015

FACT SHEET ON SUPPORTING WOMEN WITH FASD IN RESIDENTIAL SUBSTANCE ABUSE TREATMENT, April 22, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES, April 17, 2013

 

Back Row (L to R): Simeon Poker, Kathleen Benuen, Brenda Gear, Amanda Mogridge, Nancy Poole, Beverley Nuna, Lyla Andrew, Melody Morton Ninomiya, Gabriel Rich. Front Row (L to R): Ruby Poker, June Fry, Joanna Michel, Elizabeth Antoine, Annie Picard. Missing in Photo: Julia O’Brien. Regrets: Martyne Nui, Pam Gough

Prevention Network Action Team members Melody Morton Ninomiya and Nancy Poole were invited to an Innu community in Labrador, Sheshatshiu, on October 14, 2017 to co-facilitate a day-long session about FASD prevention. The day began with a powerful presentation by Annie Picard of the timeline for the Sheshatshiu and Mushuau (settled in Natuashish) people from pre-1950 times of nomadic living on the land, to settlement, colonization and trauma, as well as many points of resistance and resilience.

The participants from both Sheshatshiu and Natuashish communities who attended the session described how FASD has touched their lives as community leaders, parents of children with FASD, and service providers.

The group viewed an online clip from a remote Australian community which had built a community-wide FASD prevention and intervention model (see the Marulu Strategy at https://www.mwrc.com.au/pages/the-marulu-strategy).  There are many parallels between the remote Labrador and the Fitzroy Valley communities, and the successful community-wide action on FASD prevention screening, diagnosis and support, capacity-building and resourcing in Australia was inspiring.

The group discussed how/where the 4 levels of FASD prevention model fit for their community.  The group identified a number of locations in the community where education and action of FASD prevention might be introduced or enhanced. Melody and Nancy will continue to act as resources for these communities as they begin to develop community-wide FASD prevention strategies.

4 Levels of FASD Prevention – Innu and English

 


For more on this topic, see earlier posts below:

FILMS FROM THE LILILWAN PROJECT: TRISTAN AND MARULU May 9, 2012

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

How to discuss alcohol use with women of childbearing age is a topic in women’s health that is getting more attention and focus. Within FASD prevention circles, we have understood that women and their partners may not know about the risks of alcohol consumption during pregnancy or may drink before they realize they are pregnant.  Thus, they benefit from discussion of what they know, what the evidence says and options for action.

Screening, Brief Intervention, and Referral (SBIR) has long been known as an approach to guide clinicians when assessing risky alcohol use. But is the SBIR model the best approach to discussing alcohol with women of childbearing age and their partners? What are the approaches currently used across Canada? How should we discuss alcohol with women and who should do it? What works best according to the evidence?

The Centre of Excellence for Women’s Health (CEWH), the Canadian Centre on Substance Use and Addiction (CCSA), and the University of British Columbia Midwifery Program have teamed up to answer these questions. The Dialogue to Action on Discussing Alcohol with Women project has three high-level objectives: to identify current approaches; to summarize and share the available evidence; and, to promote best practices.

Nancy Poole of CEWH and Audrey McFarlane of CanFASD and Lakeland Centre for FASD at the Dialogue to Action regional meeting in Edmonton.

In order to meet their first objective, project researchers are currently conducting 12 regional meetings across Canada with physicians, midwives, nurses, and service providers in, sexual health clinics, violence against women services, alcohol and drug services, and Indigenous health services.

They are learning what is already being done and sharing what is known about promising practices and existing resources that can guide discussions and referrals. Participants are suggesting resources and tools – such as webinars, guidelines, policies and programs – that will be helpful in conducting meaningful discussions and support in their communities with women who use legal substances – or soon to be legal, like cannabis.

One early emerging idea arising from this project is that “screening” may be currently placed in the wrong location in the mnemonic list of SBIR.  Starting with brief information sharing and support (the relationship first), followed by screening/referral can be more engaging, trauma-informed, collaborative and person-centred. The rearranged approach prioritizes eliciting and appreciating individual needs and perspectives.

So the list might become BISR or even BISBIRT – repeating the conversation about substance use and ideas for action after screening as well as before it.

Participants from a regional meeting in Winnipeg, MB, discuss approaches to discussing alcohol with women that are working in their communities.

This project is one of several projects addressing FASD in Canada being funded by the Public Health Agency of Canada. You can learn more about all the projects here: https://www.canada.ca/en/public-health/news/2017/05/fetal_alcohol_spectrumdisorderincanadanewprojectfunding1.html

Read more:

Conversations on alcohol: Women, their partners, and professionals – April 23, 2017

Preconception Interventions: Trending or Mainstream? – July 21, 2016

Alcohol and FASD: It’s not just about women  – June 6, 2017

 

 

For International FASD Awareness Day on September 9th, the CanFASD Research Network, through its Prevention Network Action Team (pNAT) and the Centre of Excellence for Women’s Health, developed this infographic on what we know about alcohol use and preventing FASD. You can download a PDF version here.

CanFASD focuses on all aspects of FASD that impact women, individuals, caregivers, and service providers through its network action teams, each with a different focus – prevention, intervention, research, and policy and service providers. These teams aim to put forth knowledge in a way that is useful to communities and organizations in Canada in developing effective programs and policies.

You can search hashtags #FASDay2017 #CanFASD on Twitter to see examples of what others in Canada, or visit some of our pNAT partners using the links on the left side of this blog.

 

Sheway is well-known in Canada for its success in providing wrap-around services for pregnant and newly parenting women who are dealing with complex personal and social circumstances. It is trauma-informed, women-centred, culturally responsive and uses a harm reduction approach with a focus on connection with self and others. Women and their children can remain in the program up to 18 months post-partum. Last December, Lenora Marcellus, University of Victoria, and Sheway published findings to their study on how women make the transition from Sheway to living on their own – Supporting Families at Sheway and Beyond. Additionally, Dr. Marcellus has published a journal article:

Marcellus, L. (2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing. E-print ahead of press. 

In order to learn what elements of a positive transition could be identified and built upon, they followed 18 women for 3 years after leaving Sheway. These women faced multiple obstacles in this transition process with the overarching theme being “holding it together.” Their daily efforts are explored in these 3 ways:

Download Sheway Report

Restoring Self: gaining recovery and taking care of self, reconnecting with self and others, and rebuilding trust and credibility.

Centering Family: parenting their children, preserving a routine, dealing with partners, and handling custody issues.

Creating  Home: “chasing housing”, having to take whatever housing is available even if inadequate, and maintaining not only a physical space but a feeling of home for the family

While acknowledging the value for pregnancy and postpartum support as most often provided in maternity programs, their findings underscore that secure housing is a key component to a successful transition for women and their families. Yet, although housing is important to the overall health of women and their families, the choices they must make often result in a double bind. For example, women often are faced with choosing between affordable housing that is far from supports versus more expensive housing that is near supports. Some women must choose between staying in an unsafe relationship or losing housing. As well, some women must accept inadequate housing because of their substance use history, which serves to undermine their recovery and their maintaining custody of their children.

“Poor housing was identified by women as a potential trigger to relapse in their recovery.” – [1] p. 39

Complete findings are detailed within the report and recommendations are framed within the Levels of Prevention model developed by this prevention network.  Among the research team recommendations is to extend the time women can stay in the program in order to solidify recovery, supports and resources. As well, they stress that housing needs to be a core component of intensive, integrated maternity programs.


For more on these topics, see earlier posts:

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016
THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, MARCH 18, 2015
SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES: WHAT COMMUNITIES ARE DOING TO HELP, OCTOBER 1, 2012
HERWAY HOME ‘ONE-STOP ACCESS’ PROGRAM IN VICTORIA SET TO OPEN, MAY 20, 2012
“NEW CHOICES” FOR PREGNANT AND PARENTING WOMEN WITH ADDICTIONS, JANUARY 9, 2012
TORONTO CENTRE FOR SUBSTANCE USE IN PREGNANCY (T-CUP), DECEMBER 19, 2011
CLINICAL WEBCAST ON BREAKING THE CYCLE PROGRAM: SEPTEMBER 20, 2011, AUGUST 2, 2011

  1. Marcellus, L., Supporting families at Sheway and beyond: Self, recovery, family home. 2016, Sheway: Vancouver, BC.

 

negative-space-macbook-graphs-chartsWhen you sign up for online alerts regarding new FASD research, a lot of research articles come your way. Some offer hope like the recent article on a possible future treatment for newborns diagnosed with FASD (see Common drugs reverse signs of fetal alcohol syndrome in rats). But most are headlines about newly identified risks associated with alcohol-exposed pregnancies.

For instance, these four recent headlines:

Drinking alcohol during pregnancy could have transgenerational effects

Prenatal exposure to alcohol increases likelihood of addiction later in life

Any alcohol consumption during pregnancy affects craniofacial development

Foetus absorbs mother’s alcohol and nicotine intake in just 2 hours

From a scientific research standpoint, it’s important to fully understand effects of alcohol -exposed pregnancies. But, from a prevention point of view, does it add anything to our efforts to know one more reason drinking alcohol during pregnancy is risky? Does it lessen the stigma these women face? Would one more identified risk be the thing a woman needed to hear in order to stop drinking in her pregnancy or while trying to become pregnant?

Obviously, the full picture of effects is important, and this kind of medical and scientific research should continue. At the same itme, it would be helpful to see more headlines on what has been discovered around prevention – focusing on programs that support the mother child dyad, efforts to reduce stigma, and implementation of trauma-informed and FASD-informed practices and policies.

How about five headlines like these?

Relational treatment programs reduce risk of alcohol-exposed pregnancies and FASD

Connection to culture is key to prevention for many women

Changes in alcohol policy contribute to reduction of violence against women and incidence of alcohol-exposed pregnancies

Secure housing contributes to reduction in alcohol-exposed pregnancies

Women who can safely discuss alcohol with their health provider are  more likely to stop risky drinking

This real headline deserves more coverage: “ If we want to save lives, control alcohol. ”

We have lots of information of the risks of alcohol-exposed pregnancies. The work now is about prevention and we will work to bring you those “headlines.”


For more information on these topics, see these previous posts:

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017

THUNDER BAY’S FAMILY HEALTH PROGRAM PUBLISHES RESEARCH REPORT FOR PREVENTING ALCOHOL-EXPOSED PREGNANCY October 4, 2016>

THE WORK OF THE NETWORK ACTION TEAM ON FASD PREVENTION FROM A WOMEN’S HEALTH DETERMINANTS PERSPECTIVE (CANFASD RESEARCH NETWORK) April 11, 2016

FASD ISSUE PAPERS FROM THE CANADA FASD RESEARCH NETWORK PROVIDE A QUICK OVERVIEW OF RECENT RESEARCH December 1, 2014

SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS MAY 15, 2016

FREE WEBINAR: UPDATED RESOURCES ON WOMEN AND ALCOHOL: APPLYING RESEARCH TO PRACTICE – MAY 8, 2014 April 21, 2014

FASD PREVENTION RESEARCH AND KNOWLEDGE TRANSLATION: DEVELOPING A PAN-CANADIAN AGENDA WORKSHOP January 29, 2014

FASD INFORMED PRACTICE FOR COMMUNITY BASED PROGRAMS March 27, 2014

RESEARCH MAKES LINKS BETWEEN GENDER, ETHNICITY, CHILDHOOD ABUSE AND ALCOHOL USE April 2, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES April 17, 2013

Individuals with FASD and women who use alcohol and drugs during pregnancy have long been targets of both overt and unconscious stigma.  We know that stigma can undermine FASD prevention and intervention efforts by assigning underserved blame, simplifying a complicated issue, and focusing on deficits rather than building on strengths. Women who are shamed are often afraid to seek services, which undermines prevention efforts. Recognizing this problem, the 14 Manitoba FASD Coalitions across the province created the “Looking After Each Other: A Dignity Promotion Project” in 2014 to “promote the dignity of those with FASD and their families.”

The Looking After Each Other project completed two new resources recently to add to their previous activities. One is the FASD Language Guide in both English and French that explains how and why the way we talk about FASD can be stigmatizing. The guide reviews certain commonly used words and phrases and offers alternatives. Some phrases were once the preferred term, but have been rethought over time. For instance, framing the issue of women using alcohol and drugs as “choosing to use” blames women by failing to recognize complicating factors such as mental health, addiction, or abuse issues that make it difficult to stop using during pregnancy.

The other new resource is a mini documentary that was made in collaboration with The Mothering Project in Winnipeg. Entitled “Meeting Women Where They Are At: Community Making a Difference,” it features several women who participate in the programs and services of the Mothering Project. By sharing their stories, viewers come to understand what these women have overcome, how they have built healthy relationships with themselves, their communities, and their children, which helps to dispel conscious and unconscious biases. As Tammy Rowan, Program Manager, explain the Mothering Project takes a relational approach to supporting women in their lives and as parents. Watch the mini documentary here.

For more information, see earlier posts:

COERCIVE MESSAGING FOR PREGNANT WOMEN? June 2, 2017

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017

CONVERSATIONS ON ALCOHOL: WOMEN, THEIR PARTNERS, AND PROFESSIONALS April 23, 2017

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

FIRST-EVER FASD PREVENTION PLENARY AT THE 7TH INTERNATIONAL CONFERENCE ON FASD March 22, 2017

NEW FACILITATOR’S FASD TRAINING GUIDE FOR FIRST NATIONS WOMEN January 3, 2017

NEW ZEALAND’S NEW ACTION PLAN TO ADDRESS FASD September 17, 2016

“SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS” May 15, 2016

THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015

In 2016, the UK Chief Medical Officer with endorsement from the Royal College of Midwives updated advice on drinking alcohol during pregnancy, stating:

“I want pregnant women to be very clear that they should avoid alcohol as a precaution. Although the risk of harm to the baby is low if they have drunk small amounts of alcohol before becoming aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant.”

This month, the Centre for Pregnancy Culture Studies (CPCS) and others have been getting a lot of press for the claim that women are being unnecessarily frightened by this most recent advice and may be terminating pregnancies because of it (see post below for facts on this). They say that women who choose to drink at low levels during pregnancy are being stigmatized when the facts don’t support the guidelines.  Further, they claim “the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign.” (The Guardian, May 17, 2017)

That they see alcohol as a normal activity that women should have a right to, does a disservice to both feminism and to alcohol education. There is definitely here a reluctance to examine alcohol as a substance that has the potential to negatively affect health in all situations, and is a teratogen in the context of pregnancy.  More, rather than less, discussion of alcohol on men’s and women’s health, and not only in relation to preconception and pregnancy would be welcome.  Canada’s Low Risk Drinking Guidelines could inspire more public consideration of what we know and don’t know about alcohol.

CPCS’s comments were in tandem with a larger Policing Pregnancy conference held last week. And on points of pregnancy policing, we agree. Facts show that policing pregnancy increases stigma and pushes women to the margins so that they don’t get the help they want [1]. Women should not be policed for their actions in pregnancy, rather they should have access to information and conversations that can support their decisions.

Preconception and prenatal health care with a caring and knowledgeable health care provider is critical to helping women have the best health and pregnancy possible. How many women have the kind of discussion of alcohol and the care they deserve?

As one opinion writer noted in response to the coverage, the tinkering with alcohol guidelines for pregnant women is not the harm here – it is the lack of services and care that pregnant women receive. https://www.theguardian.com/commentisfree/2017/may/20/i-can-cope-with-drinking-advice-but-not-bad-care

 

For more information, see these earlier posts:

Policing or Supportive? Why We Should Test Pregnant Women for Alcohol Use, July 7, 2015

Do Concerns about Alcohol Use during Pregnancy Lead Women to Consider having an Abortion? February 1, 2013

References

  1. Poole, N. and B. Isaac, Apprehensions: Barriers to Treatment for Substance-Using Mothers. 2001, British Columbia Centre of Excellence for Women’s Health: Vancouver, BC.

 

4th in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 3

“Research on Reaching and Engaging Women and Children using Approaches that are Theory Based, and have an Equity Lens” – Janet Christie, Addiction Recovery Coach, Canada; Anne Russell of the Russell Family Fetal Alcohol Disorders, Australia; Pippa Williams of UK and European Mothers Network-FASD; Margaret Leslie and Dr. Mary Motz of the Mothercraft/Breaking the Cycle, Canada

L to R: Janet Christie, Anne Russell, Pippa Williams, Margaret Leslie, Dr. Mary Motz with Dr. Nancy Poole, Prevention Plenary Co-Lead

One of the highlights of the first Plenary on Prevention at the 2017 International Conference on FASD, was the presentation on supporting women and families dealing with issues of alcohol and FASD.

Janet Christie, Anne Russell and Pippa Williams are three birth mothers who have created supports for women and families dealing with issues of alcohol or FASD. Their experiences have informed and are reflected in many reports and studies: that no woman intends to harm her child; that there are multiple and complex issues that affect women at risk for alcohol-exposed pregnancies; and, that fragmented and inflexible services make it difficult for women and families to get help.

Stigma is one of the biggest barriers affecting access to services. Addiction is still viewed by many as a moral failing rather than a public health issue. Meanwhile the alcohol industry normalizes and glamourizes drinking to women through targeted marketing campaigns. Women are often met with judgement and blame, and fear losing their children if they seek help for an addiction. As well, mothers whose children have FASD need support in dealing with their feelings of guilt and with parenting their children. Often women have complex and intersecting issues, including FASD, that affect their ability to accept support. While these three mothers/advocates are from different countries, they all identify these same issues, and call for programs with wrap-around services to support women and their families.

Margaret Leslie and Dr. Mary Motz then described such a program – Breaking the Cycle in Toronto and its mother-child study “Focus on Relationships”. Based upon well-researched attachment theory, the program focuses on the mother-child dyad during the pre- and post-partum period and on building trust, safety and relational capacity. Relationships extend to staff and service providers. Program efforts to develop collaborative relationships between child welfare, addiction recovery and mental health service agencies have successfully created an integrated and flexible program with the goal of supporting the whole family.

 

For more on these topics, see earlier posts:

The Mother-Child Study: Evaluating Treatments for Substance-Using Women, March 18, 2015
Supporting Pregnant and Parenting Women Who Use Substances: What Communities are Doing to Help, October 1, 2012
Herway Home ‘One-Stop Access’ Program in Victoria Set to Open, May 20, 2012
“New Choices” for Pregnant and Parenting Women with Addictions, January 9, 2012
Toronto Centre for Substance Use in Pregnancy (T-CUP), December 19, 2011
Clinical Webcast on Breaking the Cycle Program: September 20, 2011, August 2, 2011
Why Would She Drink? Winnipeg Free Press Articles Explore Drinking during Pregnancy, April 4, 2011

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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