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The World Health Organization’s regional office for Europe has published Prevention of harm caused by alcohol exposure in pregnancy: Rapid review and case studies from Member States.

who-coverIn this report it is stated that Europe has the highest level of alcohol consumption in the world, and that the gender gap in drinking, and in binge drinking, among young people has narrowed.

Looking over the past decade, the report features a review of 29 research studies and details current FASD prevention efforts of Finland, Germany, Lithuania, Luxembourg, Norway, Poland, Slovenia and Sweden. Studies included in the report were based on Recommendation 2 of the WHO Guidelines for the identification and management of substance use and substance use disorder in pregnancy, which calls for prevention of alcohol consumption in the general population of pregnant women through brief interventions. Consequently, the review excluded studies of alcohol-dependent women.

For women who may become pregnant, interventions related to both risky drinking and contraception were reviewed, such as CHOICES, EARLY and BALANCE.

For pregnant women, interventions to abstain from or reduce alcohol use, or to raise awareness were reviewed. Two of the studies with pregnant women included their partners and showed positive results regarding women reducing their drinking and partners supporting non-drinking.

Case studies of prevention efforts from the 8 profiled countries describe national awareness campaigns; screening and specialized treatment in clinical practice guidelines; national strategy/policy planning and implementation; and post-partum support including for those affected by FASD.   The report features a table that illustrates country-specific levels of FASD awareness, which can assist in developing focused strategies.

For more on related topics, see earlier blogs:

DANISH CAMPAIGN SUGGESTS THAT EVERYONE “STICK A CORK IN IT” ON OCTOBER 11TH, October 11, 2012

SPECIALIZED TREATMENT AND CARE FOR PREGNANT WOMEN WITH SUBSTANCE ABUSE PROBLEMS AND THEIR CHILDREN IN HAGA, GOTHENBURG, SWEDEN, November 15, 2012

WORLD HEALTH ORGANIZATION RELEASES THE FIRST EVIDENCE-BASED GLOBAL GUIDELINES TO PREVENT AND TREAT SUBSTANCE USE BY PREGNANT WOMEN, April 28, 2014

GLOBAL STATUS REPORT ON ALCOHOL AND HEALTH 2014 – WORLD HEALTH ORGANIZATION, July 24, 2014

PLANNING AND IMPLEMENTING SCREENING AND BRIEF INTERVENTION FOR RISKY ALCOHOL USE: A STEP-BY-STEP GUIDE FOR PRIMARY CARE PRACTICES FROM THE CDC, August 4, 2014

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016

thunder-bay-report-coverAs part of the work of the Family Health Program, the Thunder Bay District Health Unit has published results from a research project on best practices to preventing alcohol-exposed pregnancy. Alongside reviewing literature, they looked at practices both in their health unit and among local community programs and services, and at provincial public health standards.

Seven over-arching themes were identified for a multi-pronged approach to preventing FASD:

1.  Population Health Surveillance
2. Public Awareness
3. Public Programs
4. Education for Health Care and Social Service Providers
5. Screening and Intervention by Health Care and Social Services Providers
6. Partnerships
7. Policy/Government Directives (1)

The report targets gaps to be addressed within each of these themes. As an example, within “Public Programs” there is a call to expand or develop programming that is culturally based and that includes women’s partners, and within “Education” to replace generalized training and education with approaches that target specific provider needs.

The authors caution readers not to “dilute the alcohol and pregnancy focus” when incorporating recommendations into existing service structures, and stress that additional research and evidence of programming, policy, and partnerships is needed.

Download the full report here to read more about their research methods, findings and recommendations, and to explore linkages with the Ontario Public Health Standards for reproductive health.


REFERENCES
  1. Thunder Bay District Health Unit, Family Health Program. (2016). Effective interventions and strategies to prevent alcohol-exposed pregnancies. Thunder Bay, ON.

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Most interventions and programs to prevent alcohol use during pregnancy focus on encouraging pregnant women to abstain from alcohol use. However, one of the most consistent predictors of alcohol use during pregnancy is women’s drinking patterns before pregnancy. As well, a large majority of women have been drinking alcohol for many years prior to getting pregnant.

A recent journal article published in the Maternal and Child Health Journal (April 2015) looks at data from the National Survey of Family Growth in the United States to estimate the number of women during a one month period who are at risk of having an alcohol-exposed pregnancy. (An “alcohol-exposed pregnancy” means that a woman is drinking alcohol, sexually active and not using contraception).

The study found that during a one-month period, nearly 2 million women in the United States were at risk of an alcohol-exposed pregnancy, including 600,000 who were binge drinking. This translates to 3.4%, or 1 in 30, non-pregnant women being at risk of an alcohol-exposed pregnancy.

Interestingly, being at risk for an alcohol-exposed pregnancy was not clearly associated with most demographic and behavioral characteristics (e.g., income level, tobacco use, ethnicity, education level, etc).

That said, women in this study who were planning to get pregnant were the ones who were at highest risk of an alcohol-exposed pregnancy – because they often continue to drink until they find our they are pregnant (and thus exposing the fetus to alcohol for several weeks or even months).

As a recent report on alcohol use in OECD countries describes how rates of alcohol use (including binge drinking) continue to rise in young women in many parts of the world. This suggests the importance of strategies to improve women’s overall health in relation to alcohol (e.g., emphasizing a culture of moderation with low risk drinking guidelines) and FASD prevention activities that target alcohol and contraception use prior to pregnancy and in the preconception period.

 Reference

Cannon, M.J., Guo, J., Denny, C.H., Green, P.P., Miracle, H., Sniezek, J.E., Floyd, R.L. (2015). Prevalence and Characteristics of Women at Risk for an Alcohol-Exposed Pregnancy (AEP) in the United States: Estimates from the National Survey of Family Growth. Maternal and Child Health Journal, 19:776–782. DOI 10.1007/s10995-014-1563-3.

Forsaken-ES cover

The Missing Women Commission of Inquiry was established in September 2010 to inquire into the “(BC Missing Women) Investigation and events leading up to the arrest and conviction of Robert W. Pickton and a broader examination of the manner in which cases involving missing women are investigated.”

The final report, including 63 recommendations, by Commissioner Wally Oppal was released in mid-December.

Oppal begins his report by looking at the context of the lives of the women. He states:

Each missing and murdered woman had a unique life and story. At the same time, this group of women shares the experience of one or more disadvantaging social and economic factors: violence, poverty, addiction, racism, mental health issues, intergenerational impact of residential schools and so on. While not every woman experienced each of these conditions, most had experienced several of them. (p. 12)

While the story of the missing and murdered women might seem unrelated to FASD prevention, health and social service providers who work with women who have experienced (and continue to experience) these interlinking factors – violence, poverty, addiction, racism, mental health issues, intergenerational impact of residential schools – would argue differently. Many women who are at risk for having an alcohol-exposed pregnancy are facing one or more of these issues.

For example, Susan Astley and her colleagues conducted a seminal piece of research in Washington State, in which they followed up with 160 women who had children diagnosed with fetal alcohol syndrome. Forty of the women could not be contacted due to confidentiality issues, another 40 had died or disappeared; of the 80 women they interviewed, they found:

  • 100% had been seriously sexually, physically, or emotionally abused;
  • 80% had a major mental illness, with the most prevalent (77%) being Post-Traumatic Stress Disorder (PTSD);
  • 80% still lived with men who did not want them to stop drinking; and
  • 46% were still at risk of having an alcohol-exposed pregnancy.

As another example – some of you may be familiar with the InSight Mentoring Program in Manitoba, an outreach program that provides intensive support to women who are pregnant or have recently had a baby and have substance use problems. Of the first 60 women to enroll in the program, 100% reported experiencing abuse or violence at some point in their lives (Umlah & Grant, 2003).

These research findings illustrate the importance of  recognizing and understanding the role violence and other related factors  plays in the lives of pregnant women struggling with their use of drugs or alcohol. Reports like the one from the Missing Women Commission of Inquiry serve as a reminder that these issues are not isolated events or confined to pregnancy and require broader systemic changes.

You can download the full report from http://www.missingwomeninquiry.ca. For recent media coverage, see:

References:

Astley SJ, Bailey D, Talbot T, Clarren SK (2000). Fetal alcohol syndrome (FAS) primary prevention through FAS Diangosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol & Alcoholism, (35) 5:509-519.

Oppal, Wally T. (2012). Forsaken: the Report of the Missing Women Commission of Inquiry: Executive Summary. Available from: http://www.missingwomeninquiry.ca/

Umlah, C. & T. Grant (2003). Intervening to prevent prenatal alcohol and drug exposure: the Manitoba experience in replicating a paraprofessional model. Envision: The Manitoba Journal of Child Welfare, 2(1): 1-12.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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