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2nd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 1

“Evidence for multi-faceted, culturally relevant, community-led approaches” – Dr. James Fitzpatrick, Head, and Kaashifah Bruce, Program Manager of Telethon Kids Institute’s FASD Research; June Councillor, CEO of Wirraka Maya Aboriginal Health Services; Anne Russell, Russell Family Fetal Alcohol Disorders Association

Making FASD History newsletter

The “Make FASD History in the Pilbara” program in Western Australia is the result of community-led and culturally relevant efforts within Indigenous communities dealing with the effects of long-term colonization and FASD. It was developed in collaboration and partnership with communities in the Fitzroy Valley and provides strategies and programs to assess and diagnose FASD, as well as to provide health, educational, and management supports to mothers and children.

James Fitzpatrick described earlier successes that underpin this program – like the Lilliwan prevalence project, the PATCHES program to diagnose FASD, and the Marlu Strategy for prevention and intervention (See Video). Dr. Fitzpatrick was nominated in 2016 for the WA Australian of the Year award for his work on FASD.

June Councillor explained the role of the “’Warajanga Marnti Warrarnja” Project – translation Together We Walk This Country – in the strategy and its long-term approach. She featured a video of the project in her remarks. View the program launch Video here.

Kaashifah Bruce presented evaluation results of using this multi-pronged approach that show an increase in: 1) awareness of FASD and the harms caused by drinking in pregnancy; 2) intentions to NOT drink during future pregnancies; and, 3) intentions to help pregnant women not to drink. The encouraging results suggest that this community-led, multi-strategy approach can serve as a blueprint for success in other Aboriginal communities.

LtoR: June Councillor, Anne Russell, Kaashifah Bruce, and James Kirkpatrick

 

Finally, Anne Russell provided a lived-experience viewpoint with examples of how stigma and stereotyping impede prevention efforts. By describing her own as well as other women’s experiences, she underscored how important it is to avoid stereotypes about women and drinking, and to talk with women and communities about what they need and what is important to them.

For more on FASD prevention in Western Australia, see earlier posts:

Alcohol Think Again Campaign in Western Australia (June 19, 2012)

Films from the Lililwan Project: Tristan and Marulu (May 9, 2012)

FASD Campaign from Kimberley and Pilbara Regions of Western Australia (October 22, 2012)

FASD Prevention in Australia’s Ord Valley (October 13, 2011)

Targeting Health Professionals in Western Australia (February 9, 2011)

Getting Fathers Involved (January 4, 2011)

More Activism from Australia (October 19, 2011)

Yajilarra: the story of the women of Fitzroy Crossing (October 15, 2010)

FASD Initiatives in Western Australia (September 15, 2010)

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

teratogen pop quiz

The Yukon Department of Health and Social Services, working with the Fetal Alcohol Spectrum Society of Yukon (FASSY) and Partners for Children, began an awareness campaign to raise awareness about teratogens, including alcohol on International FASD Awareness Day (September 9, 2014). (A teratogen is a substance, organism or process that may harm a baby during pregnancy. Teratogens can be diseases, medications, drugs, alcohol or environmental exposures.)

The online ads take the form of a pop quiz and a pictographic pronunciation guide to make the point that many substances can cause birth defects, from alcohol to certain viruses such as rubella (German measles).

The press release (September 8, 2014) states that the initiative is intended to “emphasize the community’s role in healthy pregnancies.”

Jeddie Russell, supervisor for education and prevention with Alcohol and Drug Services, commented in an news interview that “the campaign is innovative because it does not only target pregnant women, as FASD campaigns do typically… That target is not wide enough. Fetal alcohol syndrome is not about one woman drinking, it’s not about one couple being irresponsible, it’s about everybody – grandmothers, aunts, uncles, brothers – knowing that alcohol is a teratogen.” (See the news article: Yukoners mark FASD awareness day, September 10, 2014, Yukon News)

An editorial by John Thompson credits the Yukon government for putting resources into addressing FASD, such as a new supportive housing facility for individuals with FASD and a study looking at the prevalence of FASD in individuals in corrections facilities. But he critiques the new campaign:

“Quirky humour has its place, but this seems to fall flat, given the gravity of the problem being addressed.

And, however well-meaning the employees at the Department of Health may be, it would also be hard to imagine a more impenetrable approach to the subject. Perhaps in the next phase, the whole thing could be written in Latin?

And what is being accomplished? Well, the general public will soon be armed with a completely unnecessary piece of jargon, to say what everyone already knows: alcohol damages unborn babies. The better subject would be: what are we going to do to prevent mothers, who already know this, from drinking anyhow?”

See the editorial: This FASD campaign is a flop, September 12, 2014, Yukon News.

 

CBC News screenshot

A new campaign from the territorial government of Nunavut is getting some media attention. (See the coverage in the Huffington Post here and CBC here).

The posters, in English and in Inuktitut, read “Baby or the bottle? Pregnant women should never drink alcohol.”

The campaign was designed by Iqaluit-based graphic design company Atiigo Media Inc. According to the Huffington Post article, the image was inspired by a poster campaign from Russia (which I blogged about here in 2012.)

The media coverage discusses how responses to the campaign have been mixed with opinions ranging from “effective” to “offensive.” This follows discussions last week about a campaign in Ontario by the Liquor Control Board of Ontario (LCBO) that spurred one mother to make a formal complaint.

The LCBO campaign was critiqued for suggesting that mothers who drink during pregnancy are irresponsible and uncaring. Rather than promoting love, it was suggested that the campaign promoted shame and guilt.

The Nunavut campaign takes a different approach with the use of a shocking image and threatening message (“Pregnant women should never drink alcohol”), but still raises similar questions about the target audience and what is actually being communicated.

o-NUNAVUT-FASD-ADS-570

While public health authorities clearly state that there is “no safe time, no safe amount, and no safe kind” of alcohol use during pregnancy, this type of campaign can lead to mixed effects or even have unintended consequences.

While most women stop drinking after learning they are pregnant, some women continue to drink due to addiction or other related concerns. For these women, the use of shocking images or the suggestion that women who love themselves and their baby bump won’t drink can lead to feelings of shame and embarrassment – which makes it hard for women to reach out for care and support from family, friends, and health care providers.

This type of approach may also have negative consequences for women who drank (lightly or otherwise) before knowing they were pregnant. It may cause unwarranted anxiety about possible effects or lead some women to consider an abortion. (See a previous post: Do concerns about alcohol use during pregnancy lead women to consider having an abortion? February 1, 2013)

For more on FASD prevention in Nunavut, see earlier posts:

For more discussion on best practices and controversies related to messaging, see earlier posts:

 

 

 

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This awareness campaign in Ontario has been getting a fair amount of attention in the past few weeks. (See the CBC coverage: LCBO joins campaign against Fetal Alcohol Syndrome, August 25, 2014)

The campaign was developed by FASWorld in Toronto, a non-profit organization co-founded by adoptive parents, Brian Philcox and Bonnie Buxton. Earlier this year, posters from the campaign could be seen around Toronto.

This September, FASWorld teamed up with the Liquor Control Board of Ontario (LCBO) to spread the campaign across all 640 LCBO outlets in Ontario.

While many people find the images to be positive, others have critiqued the campaign as it suggests that women who do not stop drinking during pregnancy are uncaring and irresponsible. Others have found the focus on the fetus/pregnant belly and the use of naked women to promote awareness as problematic.

Global News reports on mother, Laura Jamer, who lodged a complaint with the LCBO.  Jamer critiques the campaign in light of inconclusive research on “light” drinking.

Jamer is quoted as saying that the campaign is unlikely to be effective for women with serious alcohol misuse concerns and may make other women feel guilty or scrutinized: “This marketing campaign is probably not going to target people with the propensity to drink heavily while they’re pregnant. Those people have bigger issues going on in their lives where a light guilt-ridden campaign is not going to make a difference to their drinking.” (See the coverage: LCBO ad urging pregnant women to avoid alcohol spurs formal complaint, September 16, 2014)

Tom Megginson on the Osocio blog also takes a closer look at the campaign. He comments:

“This campaign sounds positive, but there’s a second read here: “If you love your body, and love your baby, you won’t drink any alcohol while pregnant.” Or worse: “IF you drink ANY alcohol while pregnant, you obviously don’t love your body or your baby, and if the baby has problems it’s your fault!”

ENG_Whisky

The Too Young To Drink campaign was launched last week on September 9, 2014 (International FASD Awareness Day).

The launch of the campaign involved individuals and organizations displaying a banner of the campaign in a busy area of their home towns at 9:09am on September 9, 2014. Groups all over the world took pictures and made videos of themselves with the banners and shared them via social media, including Facebook, Twitter, and Instagram.

global images

Campaign materials are available in English, French, Spanish, Russian, Portugeuse, Japanese, Italian, Slovenia, and Polish. All the images feature a fetus immersed in a bottle of alcohol, but the bottle reflects the traditional drinks of various countries and regions: brandy from the Balkans, the French champagne, Italian wine, the English and Irish whiskey, and vodka of Eastern Europe.

The campaign visuals were developed by Fabrica, the organization that developed the Italian “Mummy Drinks, Baby Drinks” campaign (which I’ve blogged about in the past here and here). Fabrica is a communications research centre financed by Benetton.

Creative Director Erik Ravelo talks about the campaign in this “behind the scenes” video.

Visit the campaign website here. If you are interested in learning more about or joining the network, visit the Network website here. Also, read more about the background to the campaign in an article published in the International Journal of Alcohol and Drug Research earlier this year (Open Access).

RUS_Wodka

network

 

photo

Yesterday, the Alberta government announced that liquor stores, restaurants and bars are required to display signs about FASD prevention to help raise awareness of FASD.

While increasing awareness about FASD and the harms of alcohol use during pregnancy is very important, it’s very interesting that this announcement (as well as other awareness initiatives) rarely discuss whether FASD signage is helpful or effective.

Several jurisdictions, including the United States, France, Russia, South Africa, and the Yukon and Northwest Territories in Canada, have regulations requiring warning labels related to drinking during pregnancy and/or other risks.

A recent review on the effectiveness of alcohol warning labels in FASD prevention found that:

While alcohol warning labels are popular with the public, their effectiveness for changing drinking behavior is limited. Available research suggests that for maximum effect, alcohol warning labels should speak clearly about the consequences of alcohol consumption and should also be coordinated and integrated with other, broader social messaging campaigns. Use of alcohol warning labels related to alcohol and pregnancy must be carefully considered; their messaging has the most influence on low-risk drinkers, and to date they have not been shown to change the drinking behavior of those who drink heavily or binge during pregnancy. However, alcohol warning labels have been shown to stimulate conversations about alcohol consumption and may play a role in shifting social norms to reduce risks.

There are so many types of signange these days –  from posters to videos to coasters to pregnancy test dispensers – that it’s hard to evaluate each approach effectively. But it does seem clear that these types of efforts may increase knowledge about the risks of drinking during pregnancy but have little impact on women’s behaviours.

So, it’s always a little worrisome when awareness campaigns are accompanied by discussions of bystander interventions. Manmeet S. Bhullar, Alberta Minister of Human Services is quoted in the Alberta press release as saying:

“FASD is 100 per cent preventable, and like drinking and driving, we all have a role to play to make drinking while pregnant a social taboo. The effects of FASD on children are devastating, but through common sense initiatives like this, we will bring instances of FASD down by raising needed awareness and encouraging people to step up and say ‘no’ when they see someone drink alcohol while pregnant.”

FASD is arguably NOT 100% preventable – addiction is common in our society, alcohol use often happens before a woman recognizes that she is pregnant, and is linked to issues such as  poverty and gender-based violence. But, more importantly, fear of stigma and judgement is a major reason for many pregnant women to avoid seeking help if they are having a difficult time stopping drinking. For women who are at the highest risk of having a child with FASD (and who research shows are least likely to be influenced by awareness campaigns), bystander interventions where people step up and say ‘stop drinking’ will likely make things worse.

See the media release from the Alberta Gaming and Liquor Commission here.

For helpful information about alcohol and pregnancy, including FASD prevention, see the Alberta government’s Healthy Pregnancies website here.

For more on FASD prevention in Alberta, see earlier posts:

 

fasd_poster_vertical_highres

References

Thomas, G., Gonneau, G., Poole, N., & Cook, J. (2014). The effectiveness of alcohol warning labels in the prevention of Fetal Alcohol Spectrum Disorder: A brief review. The International Journal Of Alcohol And Drug Research, X(Y), N-M. doi:10.7895/ijadr.vXiY.126 (Open access)

 

 

 

flower

An article published by Kathryn E. France and colleagues in the journal Substance Use & Misuse looks at the development and testing of advertising concepts for a campaign to promote abstinence from alcohol during pregnancy in Western Australia.

France and colleagues conducted a series of nine focus groups with women on beliefs and attitudes on alcohol use during pregnancy and motivations for behavior change and gathered feedback on four television concepts that used different types of messaging.

Some of the key findings from the study include:

  • Women’s motivations for stopping alcohol use during pregnancy included, but were much broader than, a desire to protect their baby from harm
  • Messages could either aim to emphasize that the negative outcomes, experiences, or feelings could be reduced or avoided and/or that positive outcomes, experiences, or feelings could be obtained or maintained if women abstained from alcohol during pregnancy (e.g., wanting to minimize a generalized fear that something could go wrong or wanting to believe they were in control and doing the best that they could to support the health of the pregnancy and the baby)
  • In this particular study, the most effective message/tested ad concept was one that appealed to negative emotions, suggesting that fear appeals can be more effective than positive messages
  • It might be useful for campaigns to also include positive messages (e.g., a display of social support and acceptance for a pregnant women) abstaining from alcohol in conjunction with a threat-based message
  • Study participants also appreciated specific strategies for avoiding alcohol during social situations.

This study supports previous research showing that fear-based messaging can be effective if the behaviour that is being promoted is achievable by the viewer, i.e., women who drink alcohol in general. Fear or threat-based messaging promoting abstinence is not helpful for women with alcohol problems.

The authors also comment on the importance of being honest and factual about the limits of research on alcohol during pregnancy. Most women believed the public health guidelines that alcohol should be avoided during pregnancy, but questioned whether light drinking was a major concern.

“Credibility of the message was enhanced by acknowledging uncertainty about the risk to the fetus with low to moderate alcohol exposure. Rather than undermine an abstinence-based message, this information served as a clear rationale for the recommendation. An honest and scientific framing of the message and delivery by an expert source were also shown to minimize counterargument and strengthen the message’s persuasiveness.” (p. 8)

For more on this topic, see earlier posts:

Reference

France, K. (2011). Creating Persuasive Messages to Promote Abstinence from Alcohol During Pregnancy. Theses: Doctorates and Masters. Paper 413. http://ro.ecu.edu.au/theses/413

France, K., Donovan, R.J., Henley, N., Bower, C., Elliott, E.J. et al. (2013). Promoting Abstinence From Alcohol During Pregnancy: Implications From Formative Research. Substance Use & Misuse, Early Online:1–13.  DOI: 10.3109/10826084.2013.800118

FASDposterLtr72

The Alberta Gaming and Liquor Commission (AGLC) has a new FASD poster campaign. The AGLC  website reports that the poster will be distributed through liquor stores, healthcare delivery sites, and key provincial stakeholders and describes the poster like this:

“The poster is bold and impactful as it was created to be eye-catching and to grab consumer attention. The message does not place blame nor create an unsupportive environment, but is a visual representation of the fact that choices related to alcohol and pregnancy do matter and can have severe consequences.”

While the poster is not intended to be unsupportive, it is reminiscent of smoking in pregnancy campaigns of the early 1980s. (For more on this issue, see earlier posts here and here). What do you think? Who is the intended audience and what is the poster trying to accomplish?

The Alberta Gaming and Liquor Commission is a member of the FASD Cross Ministry Committee. The FASD-CMC works in co-operation with provincial and community organizations and regional groups to provide a comprehensive and co-ordinated provincial response to FASD.

Denise Milne, Senior Manager in Alberta Health Services and lead of the Provincial FASD Initiative, recently gave an update on FASD prevention activities in Alberta which you can view here.

Denise mentions the development of an FASD Awareness and Prevention Council through the FASD Cross Ministry Committee. She also reports on evaluation findings from Alberta’s 24 mentoring programs (7 are First Nations) based on the Parent–Child Assistance Program (PCAP) (learn more about the PCAP model here). These programs work with about 250 women who are at-risk of having a child with FASD. Evaluation findings show that the program is effective in decreasing rates of welfare use and increasing employment and use of birth control.

For more on FASD prevention in Alberta, see earlier posts:

New poster and brochure from Healthy Child Manitoba

Poster_art_lr

It is important for women to receive clear and supportive information about staying as healthy as possible during pregnancy. This includes receiving appropriate culturally sensitive information about the potential impact of alcohol on pregnancy and ways of preventing FASD.

Women accessing the North Point Douglas Women’s Centre in Winnipeg, Manitoba wanted to get this message out to their community. Working with nursing students on practicum, and with help from the Aboriginal Health and Wellness Centre and Mount Carmel Clinic, they designed the message they wanted women to hear and know: “You are not Alone. Support is available.” Download the poster as a PDF here.

Healthy Child Manitoba worked with the North Point Douglas Women’s Centre at the final design and production stages providing: (1) helpful suggestions about design qualities including the final placement of visuals on the posters and brochures, (2) accurate message and content information for the posters and brochures, and (3) the financial resources for the production of the posters, brochures and promotional items.

Learn more about other FASD prevention initiatives in Manitoba, including Project Choices and the InSight Mentoring Program, on the Healthy Child Manitoba website.

For more on alcohol and pregnancy awareness initiatives in indigenous communities, see earlier posts:

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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