Global Trends in Unintended Pregnancy: Implications for FASD Prevention

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Of the 213 million pregnancies that occurred worldwide in 2012, 40%—about 85 million—were unintended.

A recent study, “Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends,” by Gilda Sedgh et al. of the Guttmacher Institute found that the proportion of pregnancies that are unintended varied considerably by region.

The highest proportions were in Latin America and the Caribbean (56%) and North America (51%), and the lowest were in Africa (35%), Oceania (37%) and Asia (38%); Europe’s proportion was the closest to the global average (45%).

One of the key recommendations of the study is increased support for contraceptive services worldwide.

These findings have important implications for those interested in preventing alcohol-exposed pregnancies. While most FASD prevention efforts focus on preventing alcohol use during pregnancy, preventing pregnancy while using alcohol is an equally important approach.

For more on this issue, including a brief review of evidence, practice suggestions for health care providers, and resources, visit the Alcohol, Contraception, and Preconception section of the Coalescing on Women and Substance Use website.

Also, see earlier posts:

 

 

 

 

Poster Campaign from the Alberta Gaming and Liquor Commission

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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:

Do concerns about alcohol use during pregnancy lead women to consider having an abortion?

Research explores whether alcohol use prior to pregnancy awareness affects women’s decision-making

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Most women are aware that alcohol and other substance use can affect an unborn baby. Current medical advice supports abstaining from consuming alcohol during pregnancy as there is no known safe level of alcohol consumption.  However, we also know that approximately 1/3 to half of pregnancies are unplanned. And, in most Western countries, the majority of women drink alcohol. (According to the 2006 Canadian Maternity Experience Survey, 62% of women consumed alcohol in the three months prior to pregnancy. Other studies suggest that over 50% of women ages 18-24 drink at moderate to high risk levels).

As a result, some people have expressed concern or reported anecdotes about women who might seek an abortion due to fear or stress associated with drinking alcohol prior to becoming aware of their pregnancy and the harm they might have caused their baby.

A study published last year by Roberts et al called “Alcohol, Tobacco and Drug Use as Reasons for Abortion” examines some of these questions for the first time. The research team surveyed 956 women accessing abortion services in the USA to identify whether alcohol, tobacco or other drug use in the month prior to pregnancy awareness contributed to their decision to end their pregnancy. 25 women (2.6%) identified alcohol as a reason for seeking the abortion.

The majority (84%) of women who identified alcohol as a reason for seeking an abortion reported drinking at binge levels (5+ standard drinks per occasion) or having experienced alcohol-related problems such as blackouts. Around half of the women who reported binge drinking as a reason for seeking an abortion were binge drinking more than once a week and the median number of binge drinking sessions was five.

This study can be seen as reassuring in that a small number of women considered their alcohol use as a factor in ending an otherwise wanted pregnancy. It does raise questions about how we talk about FASD and the framing of messages about the potential harms of alcohol use during pregnancy.

Current guidelines by obstetrics and gynecology professional associations in Canada and the USA explicitly state that low levels of alcohol use in early pregnancy is not an indication to end a pregnancy.

For more on related topics, see earlier posts:

References

O’Leary, C. (2012). Alcohol and Pregnancy: Do Abstinence Policies Have Unintended Consequences? Alcohol and Alcoholism, 47(6):638-9. doi: 10.1093/alcalc/ags094

Roberts, S.C.M., Avalos, L.A., Sinkford, D., and Foster, D.G. (2012). Alcohol, Tobacco and Drug Use as Reasons for Abortion. Alcohol and Alcoholism, 47(6): 640–648. doi: 10.1093/alcalc/ags095. Download free full-text here.

Society of Obstetricians and Gynecologists of Canada. (2010). Alcohol Use and Pregnancy: Consensus Clinical Guidelines. Journal of Obstetrics and Gynaecology Canada, 32(8): S1-S32.

Walker, M., Al-Sahab, B., Islam, F., & Tamim, H. (2011). The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES). BMC Pregnancy and Childbirth, 11(1), 52. doi:10.1186/1471-2393-11-52. Download free full-text here.

Unintended Pregnancies and Alcohol Consumption during Pregnancy in the United States

Making the link between unintended pregnancies and FASD prevention

The Centers for Disease Control and Prevention (CDC) in the United States released two reports this month with new data on alcohol consumption during pregnancy and unintended pregnancies. It’s interesting to take a look at these reports side-by-side as they suggest completely different target groups for FASD prevention activities.

The first report looked at alcohol use and binge drinking among women of childbearing age. The researchers found that approximately 7.6% (or 1 in 13) of pregnant women consume alcohol during pregnancy and that 1.4% of pregnant women binge drink. Interestingly, non-pregnant women and pregnant women had similar patterns of binge drinking: about three times per month and approximately six drinks on an occasion.

Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), “white” (8.3%), college graduates (10.0%), or employed (9.6%).

In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use. Currently, the CDC advises: “Because no safe level of alcohol during pregnancy has been established and alcohol is known to cause birth defects, developmental disabilities, and other adverse pregnancy outcomes, women who are pregnant or who might become pregnant should refrain from drinking alcohol.”

It’s the last part of this advisory targeted at “women who might become pregnant” that leads us to the second report.

Generally speaking, it is believed that 1/3 to 1/2 of pregnancies are unintended. This report found that about 37% of births in the United States were unintended at the time of conception. While this statistic hasn’t changed much since the early 1980s, the groups with the highest rates of unintended pregnancies have changed (you can take a closer look at the report for more – see the link below).

Unintended pregnancies include both pregnancies that are unwanted, and those are mistimed, meaning the woman said she wanted to become pregnant at some point, but not at the time she did.

There’s a lot of reasons why a women becomes pregnant unintentionally and contraception use is one of them. The researchers found that 40% of women were using contraception and 60% were not. The researchers asked women who were not using contraception at the time they conceived about their reasons. They found that:

  • 35.9 percent said they did not think they could get pregnant
  • 23.1 percent said they would not mind if they became pregnant
  • 17.3 percent said they had not expected to have sex
  • 14.3 percent said they were worried about the side effects of using birth control

In terms of men, 8% said their male partner did not want to use birth control himself, and 5.3 percent said their male partner did not want them to use birth control.

So, it’s interesting to think about, right?

  • 52% of women of childbearing age consume alcohol
  • 37% of pregnancies are unintended (which means these women were unlikely to change their alcohol consumption)
  • Of women who become pregnant unintentionally, 60% were not using contraception.

These data suggest that we need to be looking at alcohol use, especially risky alcohol use like binge drinking, way before conception. It also suggests that many women need additional support around their fertility and finding contraception that works for them (and that perhaps their male partners might want to get involved in some of these issues??)

References

Marchetta, C.M., Denny, C.H., Floyd, L., Cheal, N.E., Sniezek, J.E., McKnight-Eily, L.R. (2012). Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR), 61(28): 534-538.

Mosher, W.D., Jones, J. and Abma, J.C. (2012). Intended and Unintended Births in the United States: 1982–2010. National Health Statistics Reports, No. 55. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.