Mothers with substance use concerns who access supportive community-based programs are often driven by the desire to be a good parent, to retain custody, and to access care for their children.
Integrating Child Health Supports in Wraparound Programming
Over the years, community-based wraparound programs have grown in their ability to meet these expressed needs of mothers. One key development is infant mental health programming for the children of mothers who are facing substance use and related health and social concerns. Such programming builds on the valuing of integrated support of mothers, of children and the mother child unit, which have often been described in this blog.
Children of substance-involved mothers are at risk for exposure to adverse childhood experiences and their developmental consequences, given that maternal substance use often co-occurs with other risk factors, including partner violence, intergenerational trauma, poverty and maternal mental health concerns. Mothers who have experienced a lack of safety and support in their own childhood often struggle to provide nurturance to their children. Thus, early intervention programs are needed to support positive outcomes for children of substance-involved mothers and the mother-child relationship.
Benefits of Very Early Intervention
We are learning more about the neurodevelopmental trajectories of children with prenatal substance exposure and the implications for support. For example, benefits from interventions for children as early in life as possible, rather than before the age of 6 years more broadly, are being explored. Our increasing understanding of risk and protective profiles, alongside the benefits of early intervention, are informing targeted evidence-based early interventions that contribute to improvement in children’s neurodevelopment.
Building the Evidence for Early Infant Mental Health Intervention
Researchers and service providers in our Prevention Network Action Team (pNAT) are committed to evidencing approaches that promote the wellness of mothers and children (see the Co-Creating Evidence study). Currently, a team involving pNAT researchers and two services, Breaking the Cycle and Maxxine Wright, are engaged in a new study that will examine the effectiveness of enhanced infant mental health components integrated in community-based services for substance involved mothers and children, compared to supportive programming for mothers and children offering basic wellness supports for children. The study aims to establish the comparative effectiveness and mechanisms of change of the enhanced infant mental health components, as well as estimate the long-term social return on investment.
This study will make a much-needed contribution to the evidence for infant mental health interventions in real life settings of programs serving mothers with substance use related health and social challenges, and their children.
When addressing alcohol use during pregnancy and the prevention of FASD, it’s important to remember that alcohol use does not occur in isolation. While it remains crucial to share information about the risks of, and to ask about alcohol use during the perinatal period, service providers should also be prepared to talk about how use of other substances together with alcohol increases risk. To assist service providers in having informed conversations about substances with women, we developed five info sheets on alcohol, cannabis, nicotine and tobacco, and prescription opioids. Originally created in 2017, they were updated in 2024 to reflect the most recent research and practice wisdom. Each sheet includes:
General information about the substance;
Health information that considers sex and gender factors relevant to women; and,
The latest research related to pregnancy, breastfeeding, and parenting.
Below, we outline key updates to each sheet.
Women and Alcohol
The updated version of this sheet incorporates key points from Canada’s Guidance on Alcohol and Health, to think through the continuum of risk associated with alcohol consumption with women and how to reduce harms.
Updates to this info sheet include key findings from a three-year study led by the Centre of Excellence for Women’s Health on sex, gender, and cannabis. The sheet includes information to contextualize why women may be using cannabis, such as for pain management, relief from pregnancy related symptoms and discomfort, and as an alternative to pharmaceuticals.
While the latest research on cannabis use during pregnancy and breastfeeding is presented, we also acknowledge that significant knowledge gaps remain at this time. For more information on this topic, visit the Reproductive Health page of our Sex, Gender & Cannabis Hub.
Nicotine and/or tobacco are often used at the same time as alcohol and have significant health impacts on women, pregnancy, fetuses, and children. The updates to this sheet include the addition of nicotine use and vaping, and information on supporting women through withdrawal and cessation efforts from nicotine and tobacco.
As requested by many service providers, the updated sheet includes emerging research on the impact of vaping nicotine on women’s and perinatal health. For more information on this topic, check out our two resources on vaping during pregnancy and postpartum from a recently completed study on vaping cannabis and nicotine during the pregnancy and postpartum periods:
In the update to this sheet, we include information on the impact of prescription opioids on women’s health, including hormonal changes and other effects, in addition to risks of addiction. Additionally, recent research on pregnancy, breastfeeding and parenting are included, with updated information on Neonatal Opioid Withdrawal Syndrome.
As we updated Women and Prescription Opioid info sheet, we were also concluding a two-year project centred on women’s chronic pain and prescription opioid use, which prompted us to create a complementary info sheet with a special focus on chronic pain. It provides some reasons why women use prescription opioids for chronic pain, highlights women’s experiences of benefits and harms, and provides some guidance on comprehensive pain management. For more information on this topic, check out the project page on our website.
Our hope is that service providers can use these sheets in their conversations with women, providing a tangible resource to ground discussions and for women to take home for further reflection. Designed to be user friendly, each sheet offers a concise yet comprehensive overview of the substance, accompanied by essential insights and information relevant to women’s general and perinatal health. Find all the sheets and explore more resources here.
Margaret Leslie and Nancy Poole at her retirement event at Hart House, University of Toronto, January 24, 2024
In the lead-up to International Women’s Day, this blog celebrates the impressive contribution of Margaret Leslie to FASD prevention program development, delivery, evaluation and research. This year, the theme for International Women’s Day is about investing in women. Margaret recently retired after 3+ decades of embodying this theme in her leadership of the Breaking the Cycle program in Toronto.
“Breaking the Cycle (BTC) is an early identification and prevention program designed to reduce risk and to enhance the development for substance-exposed children (prenatal – 6 years) by providing services which address maternal addiction problems and the mother-child relationship through a community based cross-systemic model. Families receive integrated addictions counselling, health/medical services, parenting support, development screening and assessment, early childhood interventions, child care, access to FASD Diagnostic Clinic, and basic needs support in a single access setting in downtown Toronto, with home visitation and street outreach components.” (mothercraft.ca)
Since 1995, Margaret and her colleagues have been committed to research and evaluation to guide the multifaceted program development at BTC. Their early and ongoing research and evaluation work has yielded rich practice-based lessons that have been shared with, and influenced, all of us at the national level.
Margaret also led several strategies about trauma-informed and relational approaches, that have supported community based programs nationally and internationally, to assist women and their children who face intersecting issues of violence, trauma and substance use. That, and related work to advance comprehensive and intersectional approaches, caused BTC under her leadership to be recognized as offering best practice by the United Nations Office on Drugs and Crime.
Research and program evaluation continue to provide additional insights into the outcomes and underlying processes of the BTC approach. BTC recently published its fourth evaluation report and fact sheets about The Mother-Child Study: Evaluating Treatments for Substance-Using Women – A Focus on Relationships. The study examined and validated BTC’s seminal 3-pronged relational approach designed to help mothers, their children and the mother-child unit. It also underlines the importance of harm reduction, trauma informed and integrated approaches.
Through all these avenues and resources, Margaret has made a profound contribution to the field of FASD prevention. Brava Margaret and happy International Women’s Day!
For some women, not drinking in pregnancy is about making a very profound change: it means finding recovery from a serious alcohol problem and all the health and social issues that accompany having a serious alcohol problem. No small task.
Books about recovery from women’s perspectives can be incredibly helpful to those embarking on this journey, as an adjunct or alternative to finding treatment and other supports.
Writing on women and recovery
Beginning in the 1970s, through writings, trailblazing women have helped us see recovery from the perspective of women, and to take a critical view of how addiction-related groups, programs and systems have failed to take women’s lived experience into account. In the New Lifebooklet and the Women for Sobriety program, Jean Kirkpatrick catalysed women to see themselves as capable and competent as women, connected to other women in collective recovery. Stephanie Covington, in the initial and subsequentAWoman’s Way through the 12 Steps books, has done the invaluable service of helping many women find within AA, what can work for them as women. Charlotte Kasl wrote the Many Roads One Journey book and designed the 16 Steps for Discovery and Empowerment program as an alternative recovery model for women that links the experience of trauma and substance use. In the book Drink: The Intimate Relationship Between Women and Alcohol, Canadian journalist Ann Dowsett Johnston provided both personal reflections on recovery, but also a solid critique of how alcohol is marketed to women, nesting the recovery journey within a soup of societal forces that make the journey uphill.
More recent empowering guidance on women’s recovery
There are recent writings from women in recovery which are inspiring in their descriptions of the complexities of the recovery process, their critique of the gendered challenges women face, and their very practical advice on self directed recovery practice for women. One such book is Dawn Nickel’s She Recovers Every Day book of meditations for women. Dawn and her daughter founded the SheRecovers movement “dedicated to redefining recovery, inspiring hope, ending stigma and empowering women in or seeking recovery to increase their recovery capital, heal themselves and help other women to do the same.” This book, while small in size, packs powerful wisdom and critique in short daily readings that conclude with a daily affirmation statement. It is helpful to every woman on a recovery path, and as SheRecovers asserts:
“we are all recovering from something, and you don’t have to recover alone.”
-SheRecovers
Quit Like a Woman!
Another fine example of the new wave of writings on women and stopping drinking is Holly Whitaker’s book entitled Quit Like a Woman. She picks up on Johnston’s thesis about the challenges of not drinking, within a culture obsessed with alcohol. The book is funny, clever, fearless, insightful and candid. See for example “seven things I wish I’d known about relationships before I got sober” – the “act like a log” advice alone, is worth reading the book for. It is a great, readable guide for women who want to take steps to quit drinking, providing solid analysis of what women face in recovery, what her own trial and error process involved, and what might work as other women put together a recovery journey. In the final chapter Whitaker says “If recovery is anything, it’s the first step on the path to radical self awareness.” She sums up by taking up the points of the pioneering women mentioned above, about seeing sexism and other forms of oppression that we need to shed and resist, discovering our power, and finding collective growth in recovery. She ends with the statement:
“Recovery is the resistance. Here is where you start”
In 2009 a group of women gathered in Victoria BC Canada to discuss how we would approach the development of a network on FASD prevention. We were researchers, policy advocates, service providers, community activists and those with Indigenous wisdom – all with a commitment to seeing and acting on how social determinants affect women’s health and substance use, and the ability for them influence the conditions of their lives.
Out of our discussion emerged a consensus on 10 fundamental components or principles for approaching FASD prevention from a women’s health determinants perspective. Now, in 2022, we have updated that consensus statement, so that those interested in FASD prevention are directed to new evidence and resources. The update is a testament to the soundness of the original principles and to the ever-growing expertise of the network participants and international partners. We hope this will empower those working on FASD prevention to continue to use and build upon this principle-based approach.
The principles foundational to approaching FASD prevention are:
Respectful – Grounding prevention initiatives in respectful relationships is vital to reduce stigma and discrimination.
Relational – It can be a transformative experience for women who use substances to experience care that aligns with their needs, views them as a whole person, and offers respect, understanding, and authentic collaboration.
Self-Determining– Health care and other support systems can facilitate self-determined care by supporting women’s autonomy, decision making, control of resources, and including exercise of their reproductive rights.
Women+ Centred– Women+ centered care moves beyond a fetus/child-centered approach, and focuses on fostering safety and empowerment when providing support to women and gender diverse individuals who are pregnant or parenting.
Harm Reduction Oriented– A harm reduction oriented approach focuses on safer substance use but also on reducing broader harms, including retaining or regaining custody of children, access to adequate and stable housing, and the challenges of poverty, food insecurity, and intimate partner violence.
Trauma- and Violence-Informed– Trauma- and violence-informed services integrate awareness of the impacts of trauma on health into all aspects of service delivery including wellness support and prevention of secondary trauma.
Health Promoting – Holistic, health promoting responses to the complex and interconnected influences on women’s health and substance use are vital to FASD prevention.
Culturally Safe – Respect for individuals’ values, worldviews, and preferences in any service encounter is important, as is respect for and accommodation of a woman’s desire for culturally-specific healing.
Supportive of Mothering – FASD prevention efforts must recognize women’s desire to be good mothers and the importance of supporting women’s choices and roles as mothers.
Uses a FASD-informed and Disability Lens – Uses strengths-based responses, makes person-centered accommodations, and ensures equity of access to health and social services.
We hope you will find the Consensus Statement with these principles and supporting sources – journal articles, reports and infographics – an inspiration for action.
In our work on FASD prevention, reaching women on the topic of the effects of alcohol use before they are pregnant is a much needed component. Yet when offering a continuum of perinatal and reproductive care, our health care systems usually do not make preconception health a priority. It is indeed a challenge to promote critical thinking about alcohol use in pregnancy when women a) are not yet actively planning a pregnancy, b) are unaware, misinformed or unconcerned about of the effects of alcohol, or c) are acutely aware of the stigma associated with drinking alcohol in pregnancy and resistant to hearing the message.
In a recent article for the UK journal, International Journal of Birth and Parent Education, we described what is known about empowering and effective preconception health interventions, to catalyse and support the work of health care practitioners working with women of childbearing years.
We entitled the article “Beyond Screening” as it is important to enter discussions about alcohol use in pregnancy as conversations that reduce stigma and support critical thinking about alcohol use before, during, and after pregnancy.
In a section of the article entitled “Issues and Actions Needed” we offered 8 key considerations when offering preconception education and support on substance use issues:
moving beyond screening – Asking about what women know about effects of substance use in pregnancy and what their plans are, may be more engaging and helpful to open conversations, rather than starting with formal screening questions
reducing stigma – By naming how stigma and fears of judgement may be a barrier, health care providers can build an open relationship with women that facilitates safety and empowerment
involving women – In the context of substance use by women overall, and in pregnancy, where judgement, bias, discrimination, misinformation and stigma are rampant, it is particularly important to involve women respectfully and collaboratively in defining what works for them
involving men/partners– Involving partners in preconception and prenatal care, messaging, and support can be an important strategy for reducing the weight of pregnancy planning for women, and for improving overall health.
using technology – Web-based support on substance use issues is increasingly available to extend the reach and engagement by the public in early and accessible assistance. Sharing where such information is available, supports the seeking of assistance in an anonymous and self determining way
building on practitioner wisdom and relationships – Motivational Interviewing and other evidence informed practices are already being used by many practitioners for guiding conversations on substance use that are trauma informed, harm reduction oriented and strengths based. These approaches are highly relevant in conversations about substance use before, during and following pregnancy, and can be best ‘heard’ in conversations with trusted providers.
multi-tasking – The benefits and reach of dual focus preconception interventions (that involve discussion of substance use with other health issues) are important. Integrating discussion of how alcohol may be a factor linked with nutrition, mental wellness, prevention of intimate partner violence and/or housing can be helpful, and respectful of women’s interests.
embedding preconception conversations in multiple systems of care – It is vital that preconception care be well integrated in health, social, and community care, with many types of practitioners all playing a role.
We are appreciative of being asked to revisit what we know about preconception interventions, and see it as important for everyone to ask of their communities and countries:
Who is doing preconception interventions on alcohol and other substance use?
In what additional contexts can preconception health and substance use issues be raised?
How can we promote gender and other forms of equity as we are doing preconception interventions on substance use?
What does each practitioner need to support action on this level of FASD prevention?
Preventing Fetal Alcohol Spectrum Disorder (FASD) requires a range of efforts from general awareness to targeted prevention and treatment services. In the Canadian Four-Part FASD Prevention Model, Level 3 and 4 programs provide low barrier holistic services for pregnant or parenting women who face substance use and a range of other health and social burdens and challenges.
Over a four-year period, the Co-Creating Evidence (CCE) evaluation study has involved eight different community-based Level 3 & 4 programs that support women through the provision of holistic, wraparound services, and in doing so, see FASD prevention as part of their mandate. These programs are guided by theoretical approaches such as being trauma-informed, relationship-based, women-centred, culturally grounded and harm reducing. The evaluation team has been led by the Nota Bene Consulting Group and has involved researchers from the Centre of Excellence for Women’s Health and representatives of the eight programs.
This CCE evaluative study (2017-2020) has had three main research questions:
What are the common elements of the diverse Level 3 programs across Canada?
What program components are helpful from women’s perspectives?
What are best measures to evidence outcomes and what outcomes are being achieved?
The answers to these questions are now available via:
In all these documents, service providers, researchers, policy makers and women with lived/living experience will see promising approaches and outcomes that these programs provide and the women who access these programs are realizing, together with their community partners. This study makes a significant contribution to our understanding of this level of FASD prevention. It hopefully will be an inspiration to all those committed to this important work.
Funding for this project has been received from the Public Health Agency of Canada, Fetal Alcohol Spectrum Disorder (FASD) National Strategic Project Fund. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Harm reduction and health promotion for women and their partners before conception are key to FASD prevention [1]. Providing health information and supports during the preconception period provides an opportunity for men and women to actively plan for a healthy pregnancy and learn strategies such as healthy nutrition, supplementation, and reducing alcohol and other substance use [2]. Such education and support can contribute greatly to optimizing health and preventing FASD [3].
Around the world, there are examples of unique approaches to preventing alcohol exposed pregnancies. Some interventions are geared towards women and men separately, and others are gender synchronized, creating complimentary programs for men, women, boys, and girls. Interventions may also include both members of a couple and include training for healthcare professionals.
Credit: Pretestie Bestie campaign.
Websites, such as Healthy Families BC and the Society of Obstetricians and Gynaecologists of Canada have pages offer information about alcohol use during pregnancy and clear and concise steps to consider before becoming pregnant. The recent ThinkFASD website sponsored by the CanFASD Research Network offers advice both for couples who are consciously planning a pregnancy, and those who are drinking and having unprotected sex. Other websites are interactive, such as Alberta Health Services’ Ready or Not, which allows a woman to click through different resources and prompts based on whether or not she feels ready to become pregnant. Don’t Know? Don’t Drink is a creative campaign in New Zealand, which posts fun, engaging graphics and videos to their social media platforms with messages about using contraception and supporting friends to not drink if there’s a chance they might be pregnant. The campaign caters to younger girls and encourages finding a “Pretestie Bestie”, a friend who supports you and your decision making before getting a pregnancy test, as a strategy of FASD prevention.
Interventions in the preconception period are not limited to women. Paternal drinking can impact men’s safety, sperm health, fetal/infant health, and women’s ability to reduce their alcohol use [4]. Various programs have been geared towards men’s education about contraception options, reproductive health, and how to support partners in their efforts to reduce drinking before and during pregnancy. Project Alpha is an American collaboration aimed at educating boys age 12 to 15 about fatherhood, contraception, healthy relationships, and sexuality.
MenCare+ empowers men to be active and positive participants in their own health as well as the health of their partners and children. It has been implemented in Brazil, Indonesia, Rwanda, and South Africa and has been shown to reduce intimate partner violence in its participants, which is an important contributing factor to women’s substance use during pregnancy [5]. In addition to programming for men, MenCare also offers workshops and training for healthcare professionals on engaging men in maternal and child health.
The internet has been a preferred source of information when it comes to preconception [6] and for couples who know they want to have children, web-based interventions are helpful tools. The UK’s Smarter Pregnancy program helps couples build a profile through an online health assessment and then offers evidence-based recommendations based on their profile. A similar approach is taken by HealthyMoms and HealthyDads complimentary websites, which were created after asking expectant moms and dads what information and supports they need to prepare for parenthood.
Culturally safe and non-judgemental interventions have been shown to be effective in reducing the risk of alcohol exposed pregnancies [7]. In the US, CHOICES and Amor Y Salud are interventions geared towards Indigenous and Latinx communities. CHOICES educates non-pregnant at-risk women about contraceptive options and uses motivational interviewing to support women to reduce drinking. Amor Y Salud, available through the Oregon Health Authority Website, offers a radionovela that follows a young couple as they learn how to optimize their health and prepare for future children. In Canada, Best Start’s website has a page for Indigenous prenatal health with information and resources that integrates Indigenous knowledge with Western health information. They also provide resources, such as Planning for Change, to support healthcare providers in educating their patients about FASD and supporting them in making meaningful changes.
The variety of preconception education and support approaches illustrates opportunities for incorporating these initiatives across the various levels of reproductive health. Childbearing years span four decades for women and are longer for men, and interventions have and can continue to focus on those that are planning or not yet planning a pregnancy, as well as for those in the period before a pregnancy is confirmed. When such preconception and early pregnancy supports are well incorporated throughout the healthcare system, this key component of FASD prevention can be realized.
1. Network Action Team on FASD Prevention. (2010). Consensus on 10 fundamental components of FASD prevention from a women’s health determinants perspective. Canada Northwest FASD Research Network.
3. Webb, Shelby, and Diane Foley. “An Introduction to the Optimal Health Model for Family Planning Clinicians.” National Clinical Training Center for Family Planning, 17 Feb. 2020, http://www.ctcfp.org/optimal-health-podcast/.
4. McBride, N. and S. Johnson, Fathers’ role in alcohol-exposed pregnancies: Systematic review of human studies. American Journal of Preventive Medicine, 2016
5. Alhusen JL, Ray E, Sharps P, Bullock L. Intimate partner violence during pregnancy: maternal and neonatal outcomes. J Womens Health (Larchmt). 2015 Jan;24(1):100-6. doi: 10.1089/jwh.2014.4872. Epub 2014 Sep 29. PMID: 25265285; PMCID: PMC4361157.
6. Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ. 2015;24(4):213-24. doi: 10.1891/1058-1243.24.4.213. PMID: 26834443; PMCID: PMC4718007.
7. Hanson, J., & Pourier, S. (2015). The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. International Journal of Environmental Research and Public Health, 13(1), 1. doi:10.3390/ijerph13010001
Twenty years ago, Astley, Bailey, Talbot, and Clarren (2000) [1] published a study that revealed how common intimate partner violence (IPV) was amongst mothers of children with FASD. The study showed the importance of thinking broadly about the risk factors and influences of FASD and demonstrated that preventing violence against women is also a preventative measure for FASD. Research efforts since Astley et al.’s study in 2000 have continued to show that IPV is an important factor to consider when supporting pregnant women who use alcohol and other substances [2].
This year, researchers at the Centre of Excellence for Women’s Health (CEWH) have been conducting a rapid review to understand the complex, multi-directional relationship between IPV and substance use during the COVID-19 pandemic and provide available and accessible research evidence to frontline providers [3]. Since the implementation of stay at home orders and social distancing recommendations, use of substances and experiences of IPV have increased. Canadians have reported an 18% increase in alcohol consumption[5] due to the stress, boredom, and lack of a regular schedule brought on by the COVID-19 pandemic[6]. One in 10 Canadian women are concerned for their safety[4] and calls to the Battered Women’s Support Services in Vancouver have tripled, demonstrating an increase in help seeking by women. These findings highlight the importance of understanding how public health policies and recommendations that help curb the spread of COVID-19 can be used by partners who cause harm in coercive and controlling ways.
In our efforts to prevent and reduce substance use during pregnancy, collaboration among service providers in substance use and IPV services is essential. Understanding the interconnectedness of these issues and how they are affected by pandemics and disasters can help us address them collectively. As examples, the Learning Network at the Centre for Research & Education on Violence Against Women & Children [7] and Calgary Women’s Emergency Shelter [8] have developed educational materials to help us understand how to support women who are experiencing IPV during the ongoing pandemic. As we deepen our understanding of the risk factors for FASD to include psychosocial factors such as IPV, materials like these can help us incorporate holistic support into service provisions and better support women who are experiencing violence and aggression during the COVID-19 pandemic.
Astley, S. J., Bailey, D., Talbot, C., & Clarren, S. K. (2000). Fetal alcohol syndrome (FAS) primary prevention through fas diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and alcoholism (Oxford, Oxfordshire), 35(5), 509–519. https://doi.org/10.1093/alcalc/35.5.509
FASD Awareness Day started on September 9, 1999 to bring global awareness to Fetal Alcohol Spectrum Disorder (FASD).
This year, Canada FASD Research Network (CanFASD) is launching FASD Awareness Month for all of September. The goal is to bring awareness to what FASD is and challenge the stigma and misinformation surrounding the disability. In preparation, they have released a toolkit with information about FASD, speech-writing tips, and images that are strengths-based, non-judgemental, and person-centered as to reduce the stigma around FASD, alcohol, and pregnancy.
CanFASD’s campaign explores how FASD is many things; including a women’s health issue. Preventing FASD requires supporting women in addressing the issues that contribute to their substance use and experience of trauma. When women receive non-judgemental support that is tangible and offers practical help, women are able to reduce or abstain from substance use, improve their health, and be empowered mothers.
Positioning FASD as a woman’s health issue recognizes:
Communities’ roles in healthy pregnancies;
Service providers’ role in delivering services that women need (i.e. housing, employment, nutrition, anti-violence, substance use) in an accessible and non-judgemental way;
Governmental roles in creating evidence based alcohol policy, and addictions & child welfare policies that prioritize wrapping support around the mother-child unit; and,
Society’s role in learning more about alcohol use in pregnancy and FASD.
This year, Canada FASD Research Network (CanFASD) is launching 
Girls, Women, Alcohol, and Pregnancy 