Compulsory treatment as an FASD prevention tool?

Image credit: Tamara van Molken, via flickr

Earlier this year, the Finnish government announced draft legislation that would support the compulsory treatment of pregnant women with substance abuse problems. (The final draft of the legislation is expected to be completed at the end of October).

Under this legislation, maternity clinics would be allowed to monitor pregnant women for signs of alcohol misuse. If a woman is suspected of misusing alcohol and/or other substances, a nurse can make a referral to a physician who would then confirm a substance use problem. If a woman refuses voluntary treatment, she could be treated against her will. The initial period of compulsory treatment would be 30 days, but it could be extended for the duration of the pregnancy.

While the supposed goal of the treatment is to address addictions issues in the mother, it appears that the interest in developing this legislation has emerged from a concern with FASD. According research, 25% of Finnish women between ages 15-29 and 20% of women between ages 30-49 drink at ‘risky’ levels.

Compulsory treatment and criminal prosecution of pregnant women who use substances is not something we hear about as much as we used to. For one thing, it really doesn’t seem to work. In fact, it usually makes things worse by creating a climate of fear in which women are reluctant to admit to their substance use and/or avoid prenatal care. So, why this movement in Finland all of a sudden?

Anna Leppo, a researcher at the University of Helskinki, has just published a paper called “The emergence of the foetus: discourses on foetal alcohol syndrome prevention and compulsory treatment in Finland.” She comments:

 [T]he notion of coercion seems curious in the Finnish context for several reasons. First, the Nordic welfare states, including Finland, have been characterised as women-friendly: they score high on gender equality and women’s reproductive rights are strong. Second, alcohol and drug problems have been, in the Nordic context, especially in Finland, Sweden and Norway, tackled on the collective level through control of the affordability and availability of alcohol and on the individual level through the provision of public treatment services. Finally, in Finland, the service user’s rights and autonomy have become key ideals in the care of alcohol and drug problems. Given this policy context and cultural climate, it is intriguing that an individualised and somewhat punitive approach such as the compulsory treatment of pregnant women should gain popularity.” (p. 180).

Leppo traces the emergence of compulsory treatment in medical, public health, and political discussions. She describes two competing views: (1) an urge to help and protect a woman who uses substances, based on the idea of a woman’s right to protection and access to health care and the responsibility of the state to provide this (2) an urge to protect a fetus from the potential harms of maternal substance, which supports compulsory measures. This second view has gradually emerged, for a variety of reasons, as a stronger voice in Finland. Unfortunately, this view conjures up an image of a mother and her child as having opposing needs and in conflict with each other.

Leppo’s article was published earlier this year in the journal Critical Public Health (Vol. 22, No. 2, June 2012, 179–191).

For more on this topic, see earlier posts: