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why-do-girls-and-women-drinkThe Washington Post recently featured an article on the normalisation of heavy drinking for women. Citing targeted advertising and multiple media, particularly to girls on social media, the article outlines the dangers in this trend of treating alcohol as a lifestyle rather than a drug. The obvious dangers are that normalising heavy drinking will increase the number of alcohol-exposed pregnancies and have a negative impact on girls’ and women’s health. Advertising exploits the positive connections women seek with each other, making it about drinking together and promoting it on t-shirts, cups, cards and even wine labels.

The liquor industry is attempting to link drinking with gender equality. But there is nothing equal or liberating about the risks women and girls face, or the distain that is heaped upon them for drunkenness. A recent article in the Daily Mail supported public shaming of binge drinking by young women in particular, and featured numerous denigrating photos of them on New Year’s Eve. Many pointed out the hypocrisy of moralising (Suzanne Moore, The Guardian). A different dialogue is needed: one that focuses on facts, health, education, and creates platforms of conversation and support.

It’s science not sexism that reveals the risks and consequences of heavy drinking for women and girls, and ways to reduce harm. We have learned why women may drink, the effectiveness of non-judgmental approaches to reducing harm, and best practices and policies for promoting health. The facts are not as confusing as some suggest and by focusing on them, we can counter normalising and moralising.

  • Women’s bodies process alcohol differently, so woman’s alcohol level will be higher than a man drinking the same amount. Canada’s low-risk drinking guidelines reflect this sex difference.girls-alcohol-pregnancy-picture
  • Men, in general, are riskier drinkers than women as evidenced by rates of alcohol-related injury and mortality, but women have more chronic health risks related to heavy drinking (Wilsnack & Wilsnack, 2013).
  • Beyond the risk of addiction, Jennie Cook’s research found a causal link between drinking and at least 7 forms of cancer for both sexes (Connor, 2017).
  • Claims of protective factors for cardiovascular disease are coming under scrutiny and skepticism even as these claims remain a core industry research topic and argument for drinking (Chikritzhs, Fillmore, & Stockwell, 2009)
  • How and when we present the facts of drinking alcohol to women and their partners makes a difference to the health of women and their families (See 10 Fundamental components of FASD Prevention from a women’s health determinant perspective).
  • Prevention of alcohol harms requires a tiered response in policy, practice, and messaging (See FASD Prevention: Canadian Perspectives)
  • Comprehensive and integrated programs that build relationships work best for supporting women in making healthy choices for themselves and their families (See Mothercraft’s Mother-Child Study)

References

Chikritzhs, T., Fillmore, K., & Stockwell, T. I. M. (2009). A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug and Alcohol Review, 28(4), 441-444. doi:10.1111/j.1465-3362.2009.00052.x

Coalescing on Women and Substance Use. http://coalescing-vc.org/virtualLearning/section2/documents/GirlsAlcoholPregnancyinfographic7.pdf

Connor, J. (2017). Alcohol consumption as a cause of cancer. Addiction, 112(2), 222-228. doi:10.1111/add.13477

Wilsnack, R. W., & Wilsnack, S. C. (2013). Gender and alcohol: consumption and consequences. In P. B. Peter Boyle, Albert B. Lowenfels, Harry Burns, Otis Brawley, Witold Zatonski, Jürgen Rehm (Ed.), Alcohol: Science, policy and public health (pp. 153-160). Oxford, England: Oxford University Press.

 

 

For the last four years, HerWay Home in Victoria, BC, has been providing outreach, medical and social services to pregnant and parenting women with difficult lives in a one-stop supportive environment. On June 23 from 9:00-10:00 a.m. PST, there will be a free webinar to share the results of a first-phase evaluation of HerWay.

Deborah Rutman and Carol Hubberstey of Nota Bene Consulting, and Nancy Poole of BC Centre of Excellence for Women’s Health will discuss lessons learned and promising practices, and lead a discussion on working with pregnant and parenting women affected by substance use, violence and mental health issues. With its child-focused, women-centred and family focused approach, HerWay Home encourages positive parenting and healthy outcomes for children and women.

Click here for more information and register by June 20th at http://fluidsurveys.com/surveys/bccewh/herway-home-evaluation-webinar/

To learn more about HerWay home and similar programs, see these previous postings:

 

NDARC Guide

This new resource from the National Drug & Alcohol Research Centre, University of New South Wales, Australia, is designed for all primary health care professions who see women in a broad range of health care service settings during the course of their practice.

The best practices guide builds on the evidence for providing coordinated, supportive and comprehensive care to pregnant women who use substances by providing a model for reducing the harm from alcohol and substance for women and their babies. See page 12 of this guide for a clearly charted overview of how physicians and other health care practitioners can support withdrawal, do psycho-social and nutritional interventions, and address barriers to care for pregnant women.

The model acknowledges the interconnections that impact a woman’s use of substances during pregnancy – including domestic violence, mental health, smoking, and stigma – and provides a guide for identifying risk and next steps for further assessment, support and/or treatment. See page 9 for a view of how identification differs for women who are pregnant, planning a pregnancy, or not planning a pregnancy.

It also moves beyond normal referral and coordination practices by using a holistic assessment process and designating a case coordinator or clinical lead to ensure “assertive follow-up.” Assertive follow-up consists of: making sure women are supported during pregnancy and birth; keeping mothers and their babies in the hospital so that post-birth assessments for mother and child can be done and plans for support and services are in place; providing breastfeeding, safe sleeping, parenting skills and contraception support; as well as, interfacing with partners, family members, and community agencies in support of the woman and her child.  See page 16 for more discussion on assertive follow-up and pages 19-20 for “Addressing barriers to care”.

Although the extensive resources that are included in this guide are geared for practitioners in Australia, many of them provide topic-specific information that practitioners everywhere may find helpful. See pages 24-27 for website links.

For more on screening in primary care settings, see previous posts:

For more on FASD prevention in Australia, see previous posts:

 

 

 

 

Edmonton inner-city program - Aboriginal - CBC'

The Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta uses professional staff and peer support workers to reach at-risk pregnant and parenting women in inner city Edmonton. The program, developed by Streetworks, supports street-involved women to access healthcare services before and throughout their pregnancy and address issues such as addiction, poverty and family violence.

CBC News featured the H.E.R. Pregnancy Program last week in the article “Pregnant aboriginal women find ‘world of difference’ in Edmonton inner-city program” (July 27, 2015). Nikki Wiart interviewed staff and clients of the program and learned about the importance of outreach, peer support, and the impact of early engagement with services on pregnancy and parenting outcomes.

90% of the program’s clients are Aboriginal while 50% of the staff is Aboriginal. Morgan Chalifoux, a pregnancy support worker, with the program describes how her personal experiences as a teen mother and living on the streets can make a difference: “”Honestly, if I wasn’t aboriginal, if I didn’t have the experience, if I didn’t use when I was on the street, if I didn’t understand what it was like to have my son threatened to be taken away from me … I wouldn’t be able to have the success that I have now with the clients.”

The program uses a harm reduction approach to addressing alcohol and other substance use during pregnancy. An evaluation of the program found that:

  • 76% of 139 pregnant women who connected with the program reported substance use, typically alcohol (32%), marijuana, and other drugs
  • While connected with the program, women reported elimination of use (40%), safer use (37%), and reduction of substance use (26%) at least once during their pregnancy with the program

The Alberta government has committed to funding the program for another three years as well as developing similar programs in Red Deer and Calgary.

For more on the H.E.R. Pregnancy Program, see earlier posts:

cbc mothering project

Manito Ikwe Kagiikwe (The Mothering Project), located at Mount Carmel Clinic in Winnipeg’s North End, provides prenatal care, parenting and child development support, group programming, advocacy, and addiction support for vulnerable pregnant women and new mothers.

CBC News interviewed Stephanie Wesley and Margaret Bryans about the program earlier this week. Bryans, a nurse and program manager at Manito Ikwe Kagiikwe, discusses the successes of the program since it first opened two years ago. The article focuses on the importance of supportive relationships and the value of a ‘focus on kindness’: “Women who are pregnant, who are using drugs and alcohol are one of the most stigmatized groups in our community.” (The Mothering Project aims to break cycle of addiction, CBC News, April 28, 2015).

MC_WebBanner_Mom

The program is a wonderful example of a integrated and holistic pregnancy program for women with addiction and related concerns. The program is based on principles of harm reduction. (Learn more about harm reduction and similar programs in this booklet, Harm Reduction and Pregnancy: Community-based Approaches to Prenatal Substance Use in Western Canada).

Since the program opened two years ago, 49 women have participated. Early evaluation findings show that, at the beginning of the program, 100% of women were actively using substances, 97% had never completed a substance use treatment program and 56% did not have a prenatal health care provider. Over the course of the program, 36% stopped using alcohol and drugs, 47% reduced their use, 39% attended an addiction treatment facility and 100% accessed prenatal care. Over half of mothers have been able to take their babies home with them from the hospital. Check out the infographic below for more.

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Pages from HR and Preg Booklet_web

This 16-page booklet provides a short introduction to harm reduction approaches during pregnancy.

Harm Reduction refers to policies, programs and practices that aim to reduce the negative health, social and economic consequences that may ensue from the use of legal and illegal psychoactive drugs, without necessarily reducing drug use.

Harm reduction  can be an important approach to FASD prevention for women who struggle with addiction and related concerns and who are often at highest risk for having a child with FASD.

The booklet gives an overview of evidence-based harm reduction approaches during pregnancy and provides concrete examples from integrated maternity programs in Western Canada that work with women with substance use concerns.

Programs profiled include: Sheway in Vancouver, Maxxine Wright Place in Surrey, HerWay Home in Victoria, H.E.R. Pregnancy Program in Edmonton and Manito Ikwe Kagiikwe (The Mothering Project) in Winnipeg.

Other topics discussed include the role of housing, peer support, rooming-in, methadone and buprenorphine use during pregnancy, and outreach.

Download Harm Reduction and Pregnancy: Community-based Approaches to Prenatal Substance Use in Western Canada from the BC Centre of Excellence for Women’s Health website.

FASDInformedPracticeFinalVersionSeptember9-2013_pdf

FASD informed practice can include:

  • An awareness that FASD (diagnosed and undiagnosed) is a reality for many individuals involved with a variety of community-based programs
  • A strong theoretical and practical understanding of the traits, characteristics, barriers, and needs of those affected by FASD
  • A willingness on the part of program staff, including administration, reception, and frontline workers, to participate in ongoing FASD education and training initiatives
  • Agency policies that accommodate the unique needs of individuals living with FASD in order to create a program that works for all participants
  • A respectful and individualized approach to service delivery that recognizes individual strengths

This guide from the College of New Caledonia is designed to assist programs in providing FASD-informed services and supports. The approaches discussed were developed from evidence-based research and from the practical experience of individuals working with women and their families who may be living with FASD.

The guide includes sections on promoting dialogue about alcohol and drug use during pregnancy, contraception, trauma-informed practice, effective group facilitation, strategies for individual support, and examples of exercises that can be used in group programming.

FASD Informed Practice for Community Based Programs can be downloaded from the College of New Caledonia website here.

For more about FASD-informed work at the College of New Caledonia, see an earlier posts:

 

 

'Terrace Standard - Program works to reduce FASD'

Check out this news article “Program Works to Reduce FASD” in the Terrace Standard (May 21, 2013) which interviews NAT member, Lisa Lawley, about her work with the Circle of Life Mentorship Program.

In the article, Lisa describes the Circle of Life Mentorship program which runs out of the Kermode Friendship Society. The program has been running for three years and supports women who struggle with drug or alcohol misuse and who are in their child bearing years.

The program works from a harm reduction perspective and supports women with not only addressing their substance misuse but also parenting, family planning, budgeting, time management, mediation and referral to community services, or anything else they identify as important to reaching their goals. Lisa also describes her experiences as a mother of three children with FASD.

Lisa was a speaker at the 5th International Conference on Fetal Alcohol Spectrum Disorder in Vancouver, BC in February 2013. Check out the video clip here.

New program addresses maternal alcohol and drug use with a range of services under one roof

After six years of planning and research by a volunteer committee of 30 experts, community organizations, advocates and educators, the HerWay Home program began working with women and children on January 7, 2013.

Located in the James Bay Community Project, HerWay Home is a child-focused, women-centred, family-oriented drop-in and outreach program for pregnant women and new moms with substance use challenges and their children.

Women do not need a referral to access the program. The program expects to work with about 70 women in the first year and 100 to 150 in the second year. Currently, there are four staff members who support women accessing a range of services to meet their individual needs. Services include meals during drop-in hours, grocery store food vouchers, health care during and after pregnancy, alcohol, drug and mental-health support, and parenting support.

Read the press release (February 8, 2013) from the Children’s Health Foundation of Vancouver Island here. Check out the news coverage New Victoria program helps new moms with addictions (Cindy E. Harnett, Feb 7, 2013).

For more on HerWay Home, see earlier post: Herway Home ‘one-stop access’ program in Victoria set to open (May 20, 2012).

Learn more about the development of HerWay Home and similar programs across Canada in Supporting Pregnant and Parenting Women Who Use Substances: What Communities Are Doing to Help by members of the Canada FASD Research Network.

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ottawa parliament

As approximately 4% of all deaths worldwide can be attributed to alcohol consumption, governments around the world are looking for policy approaches that can reduce the harms of alcohol use and misuse at a population level.

One policy approach that governments are increasingly looking at is minimum alcohol pricing. Minimum alcohol prices help to avoid situations where very low prices entice individuals into purchasing and consuming more alcohol than they otherwise might. Minimum price policies can also help set prices in relation to the percentage of alcohol content that a product has — higher prices for higher alcohol content.

There is strong and growing evidence that:

  • reduced alcohol consumption lowers rates of alcohol-related illnesses, injuries and social problems;
  • high-strength products are associated with risky patterns of alcohol consumption;
  • younger and heavier drinkers tend to choose cheaper alcohol.

So, what does minimum pricing have to do with FASD prevention? Quite a lot actually. An individual woman’s pattern of alcohol consumption is deeply connected to the context in which she lives. A woman’s drinking patterns can be affected by the drinking patterns of her friends and partner, the typical drinking practices in the part of the country where she lives, the packaging size of alcoholic beverages, alcohol advertising legislation, and the geographic density of outlets that sell alcoholic beverages – just to name a few things. Many of these factors can be greatly influenced by policy.

Looking at alcohol policy as a solution to FASD prevention also allows us to shift from focusing on individual women (which often results in a lot of blaming, guilt, and pressure on pregnant women) and to find broader solutions that affect communities and populations and have many positive outcomes, not just a reduction in FASD.

Nootka Sound

A research study published this week in the journal Addiction provides more evidence to support minimum alcohol prices. Researchers from the Centre for Addictions Research of BC at the University of Victoria found that between 2002 and 2009, the percentage of deaths caused by alcohol in British Columbia dropped more than expected when the minimum alcohol price was increased. A 10% increase in the average minimum price for all alcoholic beverages was associated with a 32% reduction in wholly alcohol attributable deaths (this includes things such as alcohol abuse, poisonings due to alcohol, excess alcohol blood level). You can take a look at the press release (Feb 7 2013) for the study here.

This latest study shows that even the heaviest of drinkers reduce their alcohol consumption when minimum alcohol prices increase – an important finding for those concerned with FASD prevention. You could think of it as a different form of harm reduction.

The study is also interesting as it gives some insight into debates about how alcohol is sold. Over the time period for this study, policies changed to allow for the partial privatization of alcohol retail sales resulting in a substantial expansion of private liquor stores. (Previously in British Columbia, alcohol could only be sold directly to the public in government-owned stores, unlike in Europe or the USA where it is often widely available in supermarkets, gas stations, etc.). The researchers found that a 10% increase in private liquor stores was associated with a 2% increase in acute, chronic, and total alcohol attributable deaths mortality rates.

For more on alcohol policy and FASD prevention, see earlier posts:

References

Stockwell T, Auld MC, Zhao JH, Martin G. (2012). Does minimum pricing reduce alcohol consumption? The experience of a Canadian province. Addiction, 107(5):912- 920.

Stockwell T, Zhao J, Giesbrecht N, Macdonald S, Thomas G, Wettlaufer A (2012). The raising of minimum alcohol prices in Saskatchewan, Canada: Impacts on consumption and implications for public health. American Journal of Public Health, 102(12): e103-10. doi: 10.2105/AJPH.2012.301094. Epub 2012 Oct 18. See the press release for this study here.

Zhao J, Stockwell T, Martin G, Macdonald S, Vallance K, Treno A, Ponicki W, Tu A, and Buxton J. (2013) The relationship between changes to minimum alcohol prices, outlet densities and alcohol attributable deaths in British Columbia in 2002-2009. Addiction, 108: doi:  10.1111/add.12139

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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