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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

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)

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.

wine-690299_640

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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