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A few of our Prevention Network (pNAT) members recently spotted an online article entitled “Demonising smoking and drinking in pregnancy may lead women to do it in private, says study.” Read the online article about the study here.

This study from the University of Cardiff in Wales has confirmed what most women’s health advocates know – that judging pregnant women for behaviours that may negatively affect fetal and child health, did not cause them to stop, but instead caused them avoid public and professional scrutiny, and to use in private. Women felt judged by healthcare professionals for their smoking and poverty, which made interactions with health care providers awkward. (See journal article on the study here.)

In the research 10 low-income, pregnant women in Wales were asked to “tell their stories” including how pregnancy affects their everyday life. Although smoking was discussed extensively by the women, interviewers did not raise the topic during the interviews. As part of their stories, women described their smoking behaviours, and reactions from the public, family, friends, and health care providers.

  

Liberation: Helping Women Quit Smoking

  

Doorways to Conversation

This study underscores what we know about substance use prevention in general – shame and stigma are not solutions to helping people change use, and specifically that the judgement of health professionals is tied to not accessing the support that is needed and deserved. In that way, the professionals become part of the problem instead of the solution. Evidence has established that using non-judgmental approaches are key to supporting behaviour change. These approaches emphasise harm reduction and employ collaborative and empathic conversations that respect individuals’ self determination and understand the underlying issues of substance use problems. Further to collaborative conversations, it is critical to understand substance use, and challenges to change substance use, as related to the burdens of violence and poverty faced by women – this forces us to move beyond a focus on individual behaviour and instead to action for social justice on these conditions of women’s lives.

Collaborative Approaches for Health Care Professionals

Indigenous Approaches to FASD Prevention

Mothercraft Study: “A Focus on Relationships”

The pNAT has written extensively about the importance of non-judgmental Level 2 discussions with women and their partners about alcohol, other substance use and the determinants of health that affect use. Included here are some resources that can help practitioners to engage in those discussions with women in a way that builds connection and relationship and supports movement toward positive change in alcohol and tobacco use, and related health and social concerns. As well, practitioners can connect to local pregnancy and addictions support programs to learn what community action to address stigma and promote social justice is underway.

References

Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D., & Goodwin, R. D. (2017). Cigarette Smoking is Associated with Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. The Journal of clinical psychiatry, 78(2), e152-e160.

See earlier posts

LINKING CANNABIS USE WITH ALCOHOL AND TOBACCO November 13, 2018
NEW RESOURCES FOR COLLABORATIVE CONVERSATIONS ON SUBSTANCE USE WITH GIRLS AND WOMEN June 18, 2018
REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017
TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017
ADVERSE CHILDHOOD EXPERIENCES AND ALCOHOL USE DURING PREGNANCY August 18, 2015
BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013
LET’S START A CONVERSATION ABOUT HEALTH . . . AND NOT TALK ABOUT HEALTH CARE AT ALL June 23, 2011

The Hope Project app

With most everyone having a smartphone these days, people are using apps to support their health. There are a few apps directed to pregnant women about their substance use and mental health. Some recent efforts developed together by researchers and health providers show how these apps can be used to offer focused information and support to pregnant women.

A perinatal mental health research project in Alberta, The Hope Project, is exploring how e-technology can be used to support pregnant women with mental health concerns. Dr. Dawn Kingston and her team at the University of Calgary developed an app for screening and treating pregnant women experiencing anxiety and depression. It provides information, support, and help to women in the research study whenever they need it. The project will also look at how this intervention affects post-partum depression and the health of their children.

SmartMom Canada, was developed as part of a study from the University of British Columbia. Through text messaging, Optimal Birth BC provides women in Northern BC with prenatal education endorsed by the Society of Obstetricians and Gynaecologists of Canada (SOGC). Many of these women live in rural areas and may have limited access to prenatal care. Women who enroll in the study complete a confidential survey and then receive personalized text messages that include pregnancy tips, info on health topics, and available resources in their own community.

SmartMom Canada app

Women outside of these studies may find it challenging to find similar apps. Popular pregnancy apps do not offer much info or ideas for resources for women with mental health or substance use issues. One that has been positively evaluated is Text4baby in the U.S. The sponsors partner with national, state, and private organizations and offer local resource information in some states. Also available to Spanish speakers, an evaluation of the app can be found here.

As well, apps are being targeted to health care providers on improving the care they provide. A preconception care app available to physicians provides them with information from the National Preconception Health and Health Care Initiative and makes suggestions for responding to patient questions. Research is being done on using an app to provide motivational interviewing interventions to pregnant women who use substances.

Most apps available on smartphones are directed toward the general population and seek a large user base. Mental health apps and substance use apps that might support prevention, are not designed specifically for women, pregnant or not. And most pregnancy apps focus on fetal growth and “kick counters”, the woman’s weight and blood pressure, and checklists to get ready for a child.

So, while there is an app for everything, they may not an app for everyone. However, healthcare technology is growing at a fast pace, so hopefully we will see more apps in future that can expand FASD prevention efforts.

Related topics:

TEXT4BABY PROGRAM IN THE UNITED STATES: CAN TEXT MESSAGING BE AN EFFECTIVE ALCOHOL BRIEF INTERVENTION? February 2, 2015

HEALTHY PREGNANCY, HEALTHY BABY TEXT MESSAGING SERVICE IN TANZANIA December 17, 2013

Because alcohol and tobacco have long been legal substances, there is a lot of evidence about their use during the preconception, pregnancy and perinatal periods. With the legalization of cannabis in Canada, new research on cannabis use may begin to fill the existing evidence gaps and better define its risks.

Because of its illegal status, women may have been reluctant to report using cannabis during pregnancy unless it was being used medically, and research ethics may have prohibited its study. Consequently, much of what we know about cannabis use in pregnancy has come from data gathered during studies on alcohol and tobacco. That is why it now makes sense to link the work of all three substances.

For instance, research shows that women who use cannabis during pregnancy are more likely to smoke cigarettes and use alcohol.1 As well, co-use of tobacco and cannabis is associated small head circumference and may increase other birth defects (cardio, musculoskeletal, and gastrointestinal) compared to no-use and single-use groups.2 This finding of association should be interpreted with some caution based on the number of limitations of the study. Still, it does underscore the need for more robust research in order to understand the association.

Researching all three substances allows for understanding the “clustering of risks” and the interactions between those risks in a way that targeting individual substances cannot do.3 By looking at the clustering of risk as described by researchers, holistic prevention efforts can target social determinants of health that affect poly-substance use.

Linking the findings on the three substances allows researchers to parse out the differences among those who use substances in pregnancy, and the clusters of risk for the substances they use. That will help to further prevention efforts in messaging, discussing substance use with women and their partners, and supporting women with holistic and safe approaches.

References

1. Ko, J.Y., Tong, V.T., Bombard, J.M., Hayes, D.K., Davy, J., & Perham-Hester, K.A. (2018). Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Drug and alcohol dependence, 187, 72-78.
2. Coleman-Cowger, V.H., Oga, E.A., Peters, E.N., & Mark, K. (2018). Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicology and teratology, 68, 84-90.
3. Passey, Megan E. et al. (2014). Tobacco, alcohol and cannabis use during pregnancy: Clustering of risks. Drug & Alcohol Dependence, Volume 134, 44–50. https://www.sciencedirect.com/science/article/pii/S0376871613003700#bib0185

For more on these topics, see earlier posts:

DISCUSSING ALCOHOL USE WITH WOMEN – DOES THE SBIR MODEL NEED REARRANGING? October 4, 2017
ALCOHOL, COCAINE, MARIJUANA, AND CIGARETTE USE DURING PREGNANCY: LOOKING AT RELATIVE HARMS March 17, 2014

With marketing of alcohol and nicotine delivery products to youth, legalization of cannabis, and the crisis in prescription pain medication use, there are new opportunities to have conversations with youth about substance use and pregnancy, with the aim of reducing the harms and improving their overall health.

What do we know about youth understanding of substance use and pregnancy?

Existing research and data on youth behaviour provide a window.

One U.S. study showed a relationship between pregnancy and prior substance use among adolescents, and among younger adolescents in particular.

  • 59% of pregnant teens and 35% of nonpregnant teens reported having used substances in the previous 12 months.
  • Some substance use continued in pregnancy particularly among younger pregnant adolescents ages 12-14. (1)

The McCreary Centre Society conducts an adolescent health survey in BC every 5 years. The 2018 evaluation is underway, but findings from 2013 indicated a number of factors related to youth substance use and pregnancy.

Those at higher risk for harmful alcohol use include:

  • Youth in rural areas
  • Youth who were born in Canada
  • Youth who were employed
  • Youth living in poverty
  • Youth experiencing abuse or violence
  • Sexual minority youth
  • Peer relationships have risks in terms of starting drinking earlier and binge drinking particularly when friend groups are large.

Those at greater risk of being involved in a pregnancy include:

  • Youth who first had sex before their 14th birthday
  • Youth in rural areas
  • Youth who had been in government care. Among these youth, girls were more likely than boys to be have been involved in a pregnancy
  • Youth who had been physically abused
  • Youth who had been sexually abused. Among these youth, males who were more likely to have been involved in a pregnancy.

The Ontario Student Drug Use and Health Survey (OSDUHS) from 2017 shows that:

  • 17% of youth have participated in binge drinking and 16% cannot remember what happened during that time
  • Boys are more likely to use e-cigarettes and all forms of tobacco, over-the-counter cold/cough medications, energy drinks, cannabis, and psychedelics
  • Girls are more likely to use prescription opioids for pain relief and tranquilizers medically

IMPART info sheet on “Youth, Gender and Substance Use” recaps how the harms of early substance use are gender-specific.

How do we approach building awareness and prevention?

Opening “Doorways to Conversation” about substance use and pregnancy allows for brief interventions and support for youth as well as women and girls. Many providers think that they need to have appropriately tested screening tools along with the knowledge, skills and confidence to conduct them. As one United Nations study found, less than 30% of health providers routinely screened youth for substance use for these reasons.(2)

Trauma-informed, culturally relevant, and gender-specific relational approaches build trusting relationships that can support youth who may be dealing with more complex issues like violence and abuse, gender identity, or the foster care system.

Promising Approaches for Reaching Youth on Substance Use and Pregnancy

Here are some current promising approaches to improving youth understanding of substance use and pregnancy in Canada.

Projects like “Let’s Get Real About Drinking Alcohol” are trainings for youth focusing on the interconnection of substance use, safe sex, birth control, and drinking during pregnancy. You can view a webcast about the project here.
This handout offers conversation starters on substance use for group facilitators. Girls Action Foundation “Take Care” program provides a curriculum and resources for facilitators of girls’ groups to promote critical thinking about healthy living including substance use and sexuality.
Canadian Centre on Substance Use and Addiction (CCSA) has created a low-risk drinking guide for youth.

Online sexual health resources for youth:

Teen Health Source Native Youth Sexual Health Network

  1. Christopher P. Salas-Wright, Michael G. Vaughn, Jenny Ugalde, Jelena Todic. Substance Use and Teen Pregnancy in the United States: Evidence from the NSDUH 2002–2012. Addictive Behaviors, 2015; DOI: 10.1016/j.addbeh.2015.01.039
  2. Chakravarthy, B., Shah, S., & Lotfipour, S. (2013). Adolescent drug abuse – Awareness & prevention. The Indian Journal of Medical Research, 137(6), 1021–1023.

Research has shown that everyone has a role to play in preventing FASD and that positive messaging is most effective for promoting awareness and discussion of alcohol use during pregnancy. Understanding positive messaging can help avoid the unintended negative consequences we have seen from previous efforts. Prevention-positive principles include:

  • Using non-exploitative imagery. Prevention campaigns are replacing lone naked-belly images with those that emphasize the mother-child dyad within a supportive network.
  • Respectful messaging that encourages women to access help if they need it rather than fear-based or blaming messaging like “if you loved your baby, you wouldn’t drink.”
  • Linking to where information and help is available.
  • Not describing FASD as “100% preventable” as this may lead women to think that the system of care won’t welcome them if they have already consumed alcohol in pregnancy.

Here are some recent examples of prevention-positive efforts from across Canada.

Yukon

The Yukon FASD Interagency Advisory Committee is taking a prevention-positive approach with their “Alcohol-free is supportive” campaign. It consists of posters in English and French, ads in the local theatres, online ads, and a radio ad as featured on CKRW. Below is an example of one poster with plans for others in the coming months. Partners in this project are the Yukon Government, Fetal Alcohol Syndrome Society of the Yukon (FASSY), and Child Development Centre.

Alberta

Women can sign up to do a “Dry 9” and receive a t-shirt and emails of support during their pregnancy. The Dry 9 movement encourages others to support women who decide not to drink any alcohol during their pregnancy. Short videos on topics such as the “Persistent Friend”, “Co-Parent to Be”, and the “Previous Generation” can be shared with others. The Alberta Gaming and Liquor Commission launched the Dry 9 movement last December as part of DrinkSense.

Saskatchewan

The Saskatchewan Prevention Institute focused on positive partner support in their “This is why I supported her not to drink” campaign. The information card is available as a poster and there are also versions in Dene and Cree. Learn more about partner influence and support on their “How To Help” page http://skprevention.ca/how-to-help/

Saskatchewan Prevention Institute http://skprevention.ca/

Québec

Health professionals in Québec City will use printable pamphlets to have discussions with women and their partners about alcohol and pregnancy. Besides information on alcohol and FASD, the pamphlets, published with the help of Public Heath Agency of Canada, describe fetal development, and resources and support. Link to brochures and posters can be found on the Dispensaire Diététique de Montréal site.

Montreal Diet Dispensary and the Public Health Agency of Canada

Ontario

Having discussions about alcohol and birth control with all women of childbearing age and their partners has proven to be an effective FASD prevention strategy. This FASD ONE prevention poster aims to encourage health and social service providers to have discussions and to support a universal screening approach.

FASD ONE

For previous posts about other prevention campaigns, see:

ARE SHOCK TACTICS EFFECTIVE? March 22, 2011

SHOULD AWARENESS CAMPAIGNS BE FEAR-BASED OR SUPPORT-BASED? April 20, 2011

STRONG SPIRIT STRONG FUTURE CAMPAIGN IN WESTERN AUSTRALIA December 19, 2013

ALCOHOL AND PREGNANCY CAMPAIGN FROM NUNAVUT, CANADA September 23, 2014

ONTARIO ALCOHOL AND PREGNANCY AWARENESS CAMPAIGN DRAWS MIXED REACTIONS September 16, 2014

“SWAP THE PUB FOR YOUR BUB” – PREGNANT PAUSE CAMPAIGN LAUNCHES IN CANBERRA August 21, 2014

FASD AWARENESS CAMPAIGNS: CREATING EFFECTIVE MESSAGES July 14, 2014

“WOMEN WANT TO KNOW” CAMPAIGN FOR HEALTH PROFESSIONALS FROM AUSTRALIA July 9, 2014

RETHINK YOUR DRINKING CAMPAIGN FROM SOUTHWESTERN ONTARIO January 13, 2014

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

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.

 

3rd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 2

“International Research on Discussing Alcohol with Women and Their Partners, and Empowering Professionals to Have These Conversations”: Tatiana Balachova, PhD, Associate Professor, University of Oklahoma Health Sciences Center & Prevent FAS Research Group; Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists; Lisa Schölin, Consultant at WHO Regional Office for Europe – Alcohol, Illicit Drugs and Prison Health; Leana Oliver, CEO of FARR; Cheryl Tan, Health Scientist CDC

Research shows that building awareness and offering brief interventions can help women reduce alcohol-exposed pregnancies. For a variety of reasons, not all providers feel comfortable or confident in giving information or asking about alcohol use, and they may not be sure it makes a difference in preventing alcohol-exposed pregnancies. Consequently, researchers from around the world presented their findings at the 7th International FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.

Russian study picRussia – Positive Messaging Improves Knowledge and Action

Tatiana Balachova, PhD, and her research group conducted a 3-part study to develop, implement, and test a prevention program in Russia. They found that women in Russia most trusted their OB/GYN physicians, so they developed FASD educational materials and trained physicians to deliver prevention information in two face-to-face structured interventions. FASD brochures using positive messages and images improved women’s knowledge of FASD and reduced risk for alcohol-exposed pregnancies. As well, they found that women who received the intervention reduced their frequency of alcohol use – most quitting – during in pregnancy.

JOGC picCanada – Care/Service Provider Education is key

Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists of Canada (SOGC) detailed the Vision 2020 strategies: advocacy, quality of care, education, and growing stronger. These strategies underpin their goals for care providers to focus on preconception as well as pregnancy, and deliver consistent messaging. In line with these goals. Alcohol Use and Pregnancy Consensus Clinical Guidelines that were first published by the SOGC in August 2010 were updated in 2016. The guidelines highlight the value of brief interventions and will be supported in the coming year with online education and training that recognizes “red flags” and provide best practices for supporting women’s health and engagement in discussions on potentially stigmatizing topics such as alcohol use.

who-coverWorld Health Organization – Prevalence Rates Inform Strategy

Lisa Schӧlin, consultant with the World Health Organization’s European office, described the data from Europe on alcohol consumption and drinking during pregnancy. The most recent prevalence data shows that Europe has the highest consumption rate of alcohol per capita of anywhere else in the world. As well, at 25.2%, it has the highest rate of alcohol consumption during pregnancy and the highest rate of FAS (37.4 per 10,000). These data were published in a review of the evidence and case studies illustrating good practices and areas of European action called “Prevention of harm caused by alcohol exposure in pregnancy” – you can view or download here.

FARR picSouth Africa – Short Messages Can Build Awareness

Leana Oliver, CEO of Foundation for Alcohol Related Research (FARR), explained how FARR builds upon existing health services by providing prenatal support, pregnancy planning and teaching of coping strategies to women through their programmes. Their “Do you have 3 Minutes?” campaign has been successful in building awareness within communities and in supporting prevention programmes (learn more here). As well, the FARR Training Academy offers accredited trainings and continued professional development on FASD to professionals, providers and educators. Research projects and FARR publications detail what has been learned such as the benefits of motivational interviewing and the need for preconception care and planning.

CDC picU.S. – Promoting Universal Screening and Brief Intervention

Cheryl Tan, Health Scientist, Centers for Disease Control and Prevention reviewed FASD activities currently underway. Surveillance of alcohol consumption by women of reproductive age is ongoing alongside efforts by the CDC to promote universal screening and brief interventions (aSBI) of adults 18+ years. She noted the wide discrepancy between how often providers say they conduct SBI (85%) and how often patients say they receive it (25%). As well, as a partner of the Collaborative of Alcohol-free Pregnancy, the CDC is helping to change healthcare practice through high-impact projects: 1) implement interprofessional model for prevention of AEP; 2) provide evidence for aSBI to insurers in the US; and, 3) reduce stigma associated with drinking during pregnancy.

For more these topics see earlier posts:

First-ever FASD Prevention Plenary at the 7th International Conference on FASD, March 22, 2017
WHO Europe: Prevention of harm caused by alcohol exposure in pregnancy, December 22, 2016
“Supporting pregnant women who use alcohol or other drugs: A guide for primary health care professionals”, May 15, 2016
How do partners affect women’s alcohol use during pregnancy?, August 11, 2014
Empowering Conversations to Prevent Alcohol Exposed Pregnancies: Extended Learning Webinars, May 8, 2014
The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series), December 15, 2014
Alcohol and Pregnancy campaign from Norway, December 12, 2011
FASD Prevention in Russia, February 15, 2012

why-do-girls-and-women-drinkThe Washington Post recently featured an article on the normalisation of heavy drinking for women. Citing targeted advertising and multiple media, particularly to girls on social media, the article outlines the dangers in this trend of treating alcohol as a lifestyle rather than a drug. The obvious dangers are that normalising heavy drinking will increase the number of alcohol-exposed pregnancies and have a negative impact on girls’ and women’s health. Advertising exploits the positive connections women seek with each other, making it about drinking together and promoting it on t-shirts, cups, cards and even wine labels.

The liquor industry is attempting to link drinking with gender equality. But there is nothing equal or liberating about the risks women and girls face, or the distain that is heaped upon them for drunkenness. A recent article in the Daily Mail supported public shaming of binge drinking by young women in particular, and featured numerous denigrating photos of them on New Year’s Eve. Many pointed out the hypocrisy of moralising (Suzanne Moore, The Guardian). A different dialogue is needed: one that focuses on facts, health, education, and creates platforms of conversation and support.

It’s science not sexism that reveals the risks and consequences of heavy drinking for women and girls, and ways to reduce harm. We have learned why women may drink, the effectiveness of non-judgmental approaches to reducing harm, and best practices and policies for promoting health. The facts are not as confusing as some suggest and by focusing on them, we can counter normalising and moralising.

  • Women’s bodies process alcohol differently, so woman’s alcohol level will be higher than a man drinking the same amount. Canada’s low-risk drinking guidelines reflect this sex difference.girls-alcohol-pregnancy-picture
  • Men, in general, are riskier drinkers than women as evidenced by rates of alcohol-related injury and mortality, but women have more chronic health risks related to heavy drinking (Wilsnack & Wilsnack, 2013).
  • Beyond the risk of addiction, Jennie Cook’s research found a causal link between drinking and at least 7 forms of cancer for both sexes (Connor, 2017).
  • Claims of protective factors for cardiovascular disease are coming under scrutiny and skepticism even as these claims remain a core industry research topic and argument for drinking (Chikritzhs, Fillmore, & Stockwell, 2009)
  • How and when we present the facts of drinking alcohol to women and their partners makes a difference to the health of women and their families (See 10 Fundamental components of FASD Prevention from a women’s health determinant perspective).
  • Prevention of alcohol harms requires a tiered response in policy, practice, and messaging (See FASD Prevention: Canadian Perspectives)
  • Comprehensive and integrated programs that build relationships work best for supporting women in making healthy choices for themselves and their families (See Mothercraft’s Mother-Child Study)

References

Chikritzhs, T., Fillmore, K., & Stockwell, T. I. M. (2009). A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug and Alcohol Review, 28(4), 441-444. doi:10.1111/j.1465-3362.2009.00052.x

Coalescing on Women and Substance Use. http://coalescing-vc.org/virtualLearning/section2/documents/GirlsAlcoholPregnancyinfographic7.pdf

Connor, J. (2017). Alcohol consumption as a cause of cancer. Addiction, 112(2), 222-228. doi:10.1111/add.13477

Wilsnack, R. W., & Wilsnack, S. C. (2013). Gender and alcohol: consumption and consequences. In P. B. Peter Boyle, Albert B. Lowenfels, Harry Burns, Otis Brawley, Witold Zatonski, Jürgen Rehm (Ed.), Alcohol: Science, policy and public health (pp. 153-160). Oxford, England: Oxford University Press.

 

 

Since 1999, FASD activists have held World FASD Awareness Day events on 09/09 to represent the nine months of pregnancy, often highlighted with a bell ringing ceremony at 9:09 am. September 9, 2016 is approaching, and this year activists want to use social media because it provides a unique and far-reaching means of building awareness.

You can help build FASD awareness by posting a message, reposting theirs, or bringing attention to their events on your own social media accounts.

FASD Awareness Day Share with CanFASD

Canada

This year Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) is providing an online forum for organizations to post their initiatives on the CanFASD website. Include a description and a picture or video and they will re-post and Tweet it out to all of their followers. You can post using #FASDAwarenessDay #CanFASD and win prizes.

The Executive Director of CanFASD , Audrey McFarlane says “ CanFASD is very pleased to be able to highlight the fantastic work that the local communities are doing to raise awareness of FASD on September 9 as the local FASD service providers and caregivers are the hardworking folks that manage this work everyday.”

United States

NOFAS US has developed a FASD Awareness Day Packet for 2016 to assist organizations with planning activities for the month of September – FASD Awareness Month.

Their social media campaign includes:

  • A Twitter Chat using the hashtag #FASDMonth as well as offering tweets you can use to send out to others.
  • A one-time message commemorating FASD Awareness Day can be posted to your social media accounts using ThunderClap – a crowd-speaking platform using social media. Learn more here.
  • A campaign to create a video that will feature an inflatable globe being “passed” around the world. Click here to learn more about the campaign.

New Zealand

The University of Auckland is hosting a FASD Policy and Research Forum starting at 9 a.m. on FASD Awareness Day. Find out more here. To find more information, links, and downloads from New Zealand, visit the Fetal Alcohol Network NZ and the Ako Aotearoa learning website for the Pregnancy and Alcohol Cessation Toolkit for providers.

Australia

NOFAS Australia is encouraging people to take a pledge not drink on Sept 9 and to post it on social media as a way to spread the word about FASD.

Also on the Pregnancy Birth & Baby website, there is a call to join the Pregnant Pause Campaign for FASD Awareness Day.

United Kingdom

The FASD Trust is asking people to get involved in a number of ways – raising awareness in school using the Trust’s School Pack, writing their MP. Click here to see their efforts.

To learn more about the history of FASD Awareness Day and get more ideas for events, click on FASD Awareness Day website.

Is your group, organization, or country planning a FASD Awareness Day event? Please share them in the Comments section below.


Previous postings about FASD Awareness Day

Today is International FASD Awareness Day, September 9, 2015

Today is International FASD Awareness Day, September 9, 2014

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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