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The Canadian Centre on Substance Abuse (CCSA) is marking November 13-19 as National Addictions Awareness Week. Across Canada, organizations like CEWH and CanFASD are joining with CCSA to bring attention to problematic substance use in Canada. We are highlighting the imbalance between the societal, health and economic costs that substance use problems/addiction brings, and the funding provided for treatment and harm reduction services/supports.
CCSA has been a partner in our efforts to explore how addiction can make it difficult to stop alcohol use during pregnancy, and how women-centred approaches are needed in prevention, harm reduction and treatment. You can help us and the CCSA in promoting treatment, highlighting existing barriers, and finding solutions by supporting this campaign. Download the NAAW Toolkit to get ideas for social media postings and organization activities. You can also join the dialogue over social media by following @CCSACanada and using the hashtag #NAAWCanada.
See these earlier blog posts on addictions or “Search the Blog” on the left of this page:
Honouring our Strengths: Culture as Intervention in Addictions Treatment, June 5, 2014
Young Women United: Campaign to Increase Access to Care and Treatment for Pregnant Women with Addictions, February 18, 2014
New Zealand has published an action plan on how best to address FASD. Described as a “whole of government action plan” by Associate Minister of Health, Peter Dunne, Taking Action on Fetal Alcohol Spectrum Disorder: 2016-1019 builds on the best practices being done across communities and service sectors including government policy and partnerships, as well as front line prevention and intervention. According to Fetal Alcohol Network NZ, the government is earmarking an initial 12 million for these efforts, which will increase support and services to women with alcohol and substance use issues.
New Zealand began the process of building the action plan with a discussion document of principles, priorities and action areas. They spent over a year seeking submissions and comments on the plan from professionals, communities, families and whānau (Maori extended family.) Notable changes to the principles based on those submissions included issues of ethnic and services inequities, as well as stigmatization of women, families and individuals with FASD. The resulting principles defined the core priorities of the plan: prevention, early identification, support and evidence. These priorities framed its action building blocks and designated indications of success of plan outcomes. You can view an analysis of the Ministry of Health action plan submissions here.
By underscoring a collaborative and practical approach, the goal is to make sure that “FASD is prevented and people with FASD and their family/whānau live the best possible lives.”(1) Read more about New Zealand’s efforts:
To read more about New Zealand’s prevention efforts see these previous posts:
First FEBFAST and Debates about Alcohol Labeling in New Zealand, February 1, 2011
- FASD Working Group. 2016. Taking Action on Fetal Alcohol Spectrum Disorder: 2016–2019: An action plan. Wellington, NZ: Ministry of Health.
Elizabeth Elliott recently wrote a short article describing current FASD prevention efforts in Australia for the journal Public Health Research and Practice (available here).
Increasing awareness and understanding of FASD has resulted in a number of positive developments at a national level, including a federal parliamentary inquiry into FASD (2011), the development of an Australian Government action plan to prevent FASD (2013) and the announcement of government funding to progress the plan and appoint a National FASD Technical Network (June 2014).
Some of the earliest FASD prevention activities in Australia were led by indigenous communities. In 2007, a group of Aboriginal women from Fitzroy Crossing in remote northern Western Australia led a campaign to place a ban on the sale of full strength alcohol in their community.
This led to the Lililwan Project, the first ever prevalence study of FASD in Australia and a partnership between Nindilingarri Cultural Health Services, Marninwarntikura Woman’s Resource Centre, the George Institute for Global Health and the Discipline of Paediatrics and Child Health at The University of Sydney Medical School.
This ‘research in action’ project included diagnosis and development of individualised management plans to address the health issues of each child. Earlier this year, the researchers reported that one in eight (or 120 per 1000) children born in 2002 or 2003 in the Fitzroy Valley have FAS.
In 2009, the National Health and Medical Research Council revised the guidelines regarding alcohol use in pregnancy to state “For women who are pregnant or planning a pregnancy, not drinking is the safest option.”
In 2014, the Women Want to Know project was launched. Developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and with support from the Australian Government Department of Health, the project encourages health professionals to routinely discuss alcohol and pregnancy with women in keeping with the revised guidelines.
FARE also launched the Pregnant Pause campaign in 2013 to encourage ‘dads-to-be’ and all Australians to support someone they care about through their pregnancy by taking a break from alcohol.
November 2013 also marked the first Australasian Fetal Alcohol Spectrum Disorders Conference held in Brisbane.
Organizations such as the National Organisation for FASD Australia have taken a leadership role in education and advocacy related to FASD, including advocating for pregnancy warning labels on alcohol.
Drinkwise, an alcohol industry-funded organization, has voluntarily developed ‘consumer information messages’ such as ‘It is safest not to drink while pregnant’ and ‘Kids and Alcohol Don’t Mix.’ However, an audit found that 26% of products carried a DrinkWise alcohol pregnancy warning label. (Visit Drink Tank for a discussion of alcohol industry led product labeling in Australia).
For more on FASD prevention in Australia, see earlier posts:
- “Women Want To Know” Campaign for Health Professionals from Australia (July 9, 2014)
- Strong Spirit Strong Future campaign in Western Australia (December 19, 2013)
- Pregnant Pause Campaign for Aussie Dads (October 1, 2013)
- FASD Campaign from Kimberley and Pilbara regions of Western Australia (October 22, 2012)
- Grannies Group in South Australia addressing alcohol misuse (September 27, 2012)
- Understanding the links between FASD and early life trauma in indigenous communities in Australia (July 11, 2012)
- Alcohol Think Again Campaign in Western Australia (June 19, 2012)
- Films from the Lililwan Project: Tristan and Marulu (May 9, 2012)
- FASD Prevention in Australia’s Ord Valley (October 13, 2011)
- Yajilarra: the story of the women of Fitzroy Crossing (October 15, 2010)
Alcohol warning labels have been used by a number of provinces, states, and countries as a way of trying to prevent FASD by encouraging women to abstain from alcohol consumption during pregnancy.
While popular with the general public and widely promoted by many groups and organizations, their use remains controversial as there is limited evidence for their effectiveness. A scoping review published last year (Thomas et al, 2014) concluded that alcohol warning messages have the most influence on low-risk drinkers and have not been shown to change the drinking behavior of those who drink heavily or binge during pregnancy.
In a recent article published in The American Journal of Bioethics, Emily Bell, Natalie Zizzo & Eric Racine (2015) discuss ethical concerns stemming from the questionable effectiveness of alcohol and pregnancy warning labels:
There are good reasons to question the use of alcohol labels and the narrow messages they convey as methods of primary prevention for FASD. They risk perpetuating restrictive and unsupportive policies toward pregnant women with alcohol abuse issues. They may create fear and anxiety among women who drink before realizing they are pregnant, and they fail to support a comprehensive picture of FASD prevention (i.e., no information resources, no focus on the family’s, partner’s, or society’s roles). (p.19)
They comment on how the promotion of alcohol and pregnancy warning labels may be related to a belief that “doing something is better than doing nothing.” And, while it could be argued that alcohol warning labels support longer term changes in the acceptability of drinking patterns among women and the public, research has failed to demonstrate measurable changes in drinking since they were introduced.
For more on warning labels, see earlier posts:
- Alcohol and Pregnancy: Warning Signage Information Kit for Local Governments from British Columbia (October 20, 2014)
- FASD prevention signs required in all Alberta liquor stores, bars, restaurants, and night clubs (April 15, 2014)
- Politics of alcohol warning labels: Australia and Canada (July 20, 2011)
Bell, E., Zizzo, N. and Racine, E. (2015) Caution! Warning Labels About Alcohol and Pregnancy: Unintended Consequences and Questionable Effectiveness. The American Journal of Bioethics, 15:3, 18-20, DOI:10.1080/15265161.2014.998376
Thomas, G., Gonneau, G., Poole, N., and Cook, J. (2014). The effectiveness of alcohol warning labels in the prevention of Fetal Alcohol Spectrum Disorder: A brief review. International Journal of Alcohol and Drug Research, 3(1):91-103. doi: 10.7895/ijadr.v3i1.[Open Access]
The Global status report on alcohol and health 2014 from the World Health Organization provides a global overview of alcohol consumption.
It looks at patterns of alcohol use, including binge drinking, and the relationship between alcohol and over 200 health conditions. It also looks at alcohol policy and interventions and provides country-by-country profiles of patterns and trends.
- Globally, alcohol causes approximately 3.3 million deaths every year (or 5.9% of all deaths); and 5.1% of the global burden of disease is attributable to alcohol consumption. In 2012, 7.6% of deaths among males and 4.0% of deaths among females were attributable to alcohol.
- While alcohol is the leading risk factor for death in males aged 15–59 years, women are more vulnerable to alcohol-related harm for a given level of alcohol use or a particular drinking pattern. As well, alcohol use among women is continuing to increase and is linked to economic development and changing gender roles.
- Worldwide, 61.7% of the population (ages 15+) had not drunk alcohol in the past 12 months, and 13.7% had ceased alcohol consumption (i.e. they have consumed alcohol earlier in life but not in the past 12 months).
- Almost half of the global adult population (48.0%) has never consumed alcohol.
Just over 70 countries reported nationwide awareness-raising activities related to alcohol and pregnancy. The report also discusses the role of health services in reducing alcohol-related harm and supports:
- initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings, including early identification and management of harmful drinking among pregnant women and women of child-bearing age;
- improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome and a spectrum of associated disorders
For more on global alcohol patterns and trends, see earlier posts:
- Gender Convergence in Youth Binge Drinking (October 20, 2011)
- Test your knowledge with a quick look inside the Global Status Report on Alcohol and Health (February 17, 2011)
The Women Want to Know project encourages health professionals to routinely discuss alcohol and pregnancy with women and to provide advice that is consistent with the National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol. This is the first national campaign targeted at health professionals since the Alcohol Guidelines were last updated in 2009.
A survey of 300 health professionals conducted prior to the project found that one in five health professionals had not heard of the Guidelines and more than two in five (45%) were aware of the Guidelines but not familiar with the content.
The guidelines state that ‘Maternal alcohol consumption can harm the developing fetus or breastfeeding baby’ and ‘For woman who are pregnant or planning a pregnancy, not drinking is the safest option’ and ‘For women who are breastfeeding, not drinking is the safest option’.
Research has also shown that 97 per cent of Australian women want to be asked about alcohol use during pregnancy.
The Women Want to Know project was developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and is supported by funding from the Australian Government Department of Health.
There are two main components to the project: (1) resources to support health professionals in discussing alcohol use and pregnancy with women, and (2) accredited training.
Resources from the Women Want to Know project include:
- A leaflet for health professionals on pregnancy and alcohol HTML | PDF 359 KB
- A leaflet on assessing alcohol consumption in pregnancy using AUDIT-C HTML | (PDF 332 KB)
- A leaflet for women on pregnancy and alcohol HTML | (PDF 309 KB)
- A leaflet on the Women Want to Know project HTML | (PDF 331 KB)
- Videos demonstrating health professionals discussing alcohol and pregnancy with women
- Videos of women and health professionals reflecting on this experience
In addition three online e-Learning courses with Continuing Professional Development accreditation are available for health professionals through the:
- Royal Australian College of General Practitioners
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Australian College of Midwives
Read the press release from the Foundation for Alcohol Research and Education here. Learn more about the project and recently developed resources here.
Capturing the voices of women living though pregnancy and addiction
I blogged earlier this year about an organization in New Mexico called Young Women United (see the post: Young Women United: Campaign to Increase Access to Care and Treatment for Pregnant Women with Addictions, February 18, 2014).
The organization has released a new report called “Everyday Struggles, Everyday Strengths: Capturing the voices of women living though pregnancy and addiction.”
Some of the key findings from their work with women include:
1. Most women described intense feelings of fear as guiding their decisions.
- They were fearful their kids would not be healthy and that they would be at fault.
- They were scared of being reported to child welfare authorities and losing custody of their baby as well as other children.
- While some women disclosed their substance use and others hid their substance use, almost all women were scared to talk about their substance use due to risk to their families.
2. The majority of women reported judgement and discrimination while trying to access prenatal care.
- Some women reported that their health care providers allowed their own opinions on addiction to impact the care they provided, regardless of whether those decisions were sound or legal.
- Many women said they were not treated respectfully or kindly.
- Several women reported being threatened with inaccurate information (e.g., “You know they’re going to take those kids away from you?”)
3. Women reported not being able to access the care and support they needed.
- It was difficult to access prenatal care that incorporated addiction treatment or addiction treatment that considered pregnancy.
- For many families, treatment was only affordable when facing criminal charges.
- For women who are mothers, residential treatment was usually inaccessible because they could not take their children with them and/or they did not have a safe place for their children to stay in their absence.
This report seems especially timely given the announcement a couple of weeks ago when the governor of Tennessee announced a new law to authorize the arrest and incarceration of women who use drugs while pregnant. (See the coverage in the Huffington Post here and the Washington Post coverage here).
While the Tennessee bill is the first state to actually criminalize drug use among pregnant women, other states have been prosecuting pregnant women under different kinds of laws for years. The criminalization and prosecution of pregnant women who use alcohol and drugs has been critiqued by hundreds of health and other organizations as poor public policy and has not been shown to lead to positive outcomes.
For more on this issue, see earlier posts:
- European FASD Alliance Position Paper: Mothers who drank during pregnancy should not be punished (April 7, 2014)
- State Policies on Substance Abuse During Pregnancy (February 4, 2014)
- Legal Measures to Prevent Fetal Alcohol Spectrum Disorder (December 4, 2013)
- Prosecuting Pregnant Women with Addictions (May 14, 2012)