Substance use and addiction are highly stigmatized, particularly for pregnant women and women of reproductive age. Women who use substances often experience multiple forms of stigma and are required to navigate notions of ‘good’ motherhood. This can contribute to women’s own belief that substance use during pregnancy is an uncaring choice. Despite the pervasiveness of stigma and public health efforts to counter it and to help women prevent Fetal Alcohol Spectrum Disorder (FASD), women’s alcohol use during pregnancy is expected to increase.
Researchers from the Centre of Excellence for Women’s Health, University of Queensland, and the Canada FASD Research Network published a study exploring women’s reasons for continued alcohol use, reduction, and abstinence during pregnancy (1). In their research, they found that there is very little research that highlight’s women’s voices in efforts to understand the barriers and facilitator’s to alcohol use in pregnancy.
To analyze women’s reported barriers and facilitator’s to reducing alcohol use in pregnancy, the authors used the Action Framework for Building an Inclusive Health System. It was released in 2019 with Canada’s Chief Public Health Officer of Health’s 2019 report, and outlines different levels of stigma (individual, interpersonal, institutional, and population) and how they operate.
Stigma remains a pervasive challenge for pregnant and parenting women who use alcohol and other substances when accessing and receiving care. Interestingly, despite the literature’s focus on women’s individual choice about prenatal alcohol use, the barriers and facilitators to women’s alcohol use in pregnancy identified in this study were a result of interpersonal, institutional, and population-level factors, not individual choice.
In Canada, toolkits and policy papers have been developed to contribute to addressing stigma and related barriers. In many countries, interventions are being developed and evidenced by communities and by health and other systems of care that are designed to reduce stigma and support women’s engagement in care, including:
- inclusive awareness building that reaches women, their partners and the public
- relational, trauma-, gender- and culture-informed support offered by health and social care providers; and,
- welcoming, non-judgmental services that wrap a wide range of needed practical supports around mothers and their children.
These interventions act as remedies to the challenges cited by pregnant women who use alcohol and find it difficult to reduce/stop alcohol use in pregnancy. In this way, action to prevent FASD can move beyond the usual recommendations for supporting individual change to be more accurately focused on service and system level changes that have the potential to make individual change possible.
- Lyall V, Wolfson L, Reid N, Poole N, Moritz KM, Egert S, et al. “The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy. Int J Environ Res Public Health. 2021;18(7).