Decolonizing FASD Policy in Canada

Poster, STOP Fetal Alcohol Syndrome/Fetal Alcohol Effects NOW, First Nations and Inuit health, Health Canada, 2002

It makes sense that the way we understand a problem shapes the solutions we develop. Gemma Hunting and Annette Browne have recently published an article in the journal Women’s Health and Urban Life (click here for free full-text) that looks at how issues related to alcohol use, mothering, and Aboriginal women are often understood.

Despite the growing discussion among researchers that Aboriginal communities may be no more affected by FASD than non-Aboriginal communities, Hunting and Browne argue that FASD continues to be perceived as an ‘Aboriginal issue.’ The problem with this is that, rather than paying attention to all women’s alcohol use, negative misperceptions about Aboriginal women, and Aboriginal health and social issues are perpetuated.

They address some key prevailing ideas (incorrect ideas!) such as:

  • Aboriginal people have a genetic vulnerability to the effects of alcohol (despite compelling evidence that this is not true)
  • Aboriginal women are not capable mothers (they connect this to policies that started in the 1960s and continue today in child welfare practices)
  • Increased awareness about the dangers of alcohol use during pregnancy will lead to changes in behaviour (relates to the idea that health education is the primary solution to FASD)

Overall, Hunting and Browne show that the assumptions underlying FASD prevention policies and interventions, while well intentioned, can inadvertently contribute to racializing and stigmatizing Aboriginal people in Canada (and abroad for that matter). It also means that we continue to focus our energies and resources on who we think are “high risk groups” for FASD rather than on all women and on addressing the broad range of factors that influence their drinking.

For more on this topic, see previous posts:

Further Reading

Hunting, G. and Browne, A. (2012). Decolonizing Policy Discourse: Reframing the ‘Problem’ of Fetal Alcohol Spectrum Disorder. Women’s Health and Urban Life, 11(1): 35-53. (Free full-text here).

Salmon, A. (2004). ‘It takes a community’: Constructing Aboriginal mothers and children with FAS/FAE as objects of moral panic in/through a FAS/FAE prevention policy.  Journal of the Association for Research on Mothering, 6(1), 112-123. (Free full-text here).

Tait, C. L. (2009). Disruptions in nature, disruptions in society: Indigenous peoples of Canada and the ‘making’ of Fetal Alcohol Syndrome. In L. J. Kirmayer & G. Valaskaki (Eds.). Healing traditions: The mental health of Aboriginal peoples in Canada (pp. 196-222).Vancouver: University of British Columbia Press.

Wilson, S. A. & Martell, R. (2003, October). The story of Fetal Alcohol Syndrome: A Canadian First Nation’s response. Women & Environments International Magazine, 60/61: 35-36.

STOP Fetal Alcohol Syndrome/Fetal Alcohol Effects NOW, First Nations and Inuit health, Health Canada, 2002 – Inuktitut

Grannies Group in South Australia addressing alcohol misuse

Source: The Council of Aboriginal Elders of SA website, http://www.caesa.org

The National Indigenous Drug & Alcohol Committee (NIDAC) in Australia has a great article on their website on Locally designed and operated Indigenous community models. The article states:

“The benefit of locally designed and operated initiatives is that they can be tailored to community needs and in a cultural context that is owned and supported by the community. This enhances the strengths and builds resilience of a community and combined with the added support of services provides for a more sustainable and long term solution.”

One of the programs profiled in the article is The Grannies Group.

The Grannies Group in South Australia is a peer support network of senior Aboriginal men and women who advocate on behalf of issues affecting their children, grandchildren and their community. Part of their work includes raising awareness of drug and alcohol issues through community education sessions using their own stories and issues.

In a radio interview in May 2012, 75-year-old Grannies Group member Coral Wilson describes the founding of the group:

“We sort of got together and talked about how we can come to terms with the drug abuse that’s in our community and within our families. It wasn’t that we had to set up this group straight away it was a lot of talking between ourselves about, what are we going to do with him? What are we going to do with her? They’re in jail, we’ve got to look after the kids and so on. And that brought about this group coming together, and it was to support, support each other because of the problems we all had with our children on drugs and alcohol. And it’s been going for well over ten years now. “

The Grannies Group is part of the Council of Aboriginal Elders of South Australia and is supported by the Australian Government’s Home and Community Care (HACC) program.

See the press release Elders take a stand against alcohol abuse (September 12, 2012). You can also take a look at the NIDAC report Addressing fetal alcohol spectrum disorder in Australia (2012).

Cultural Safety and FASD Prevention

The term “cultural safety” is popping up in all sorts of fields these days, ranging from law to education to social policy. It’s also a term connected with a growing number of FASD support programs, such as the Alberta Parent-Child Assistance Program (PCAP) and the FASD Key Worker and Parent Support Program in British Columbia, which include cultural safety as part of the program framework.

So, what is cultural safety? Cultural safety is still a relatively new term in the Canadian context, but it first evolved out of nursing practice in New Zealand with regards to health care for Maori people. It was suggested that in order to provide quality care for people from different ethnicities and cultures that nurses needed to provide care within the cultural values and norms of the patient.

In Canada, the concept is often used to describe an approach to healthcare that recognizes the conditions that Aboriginal people experience today as a result of a history of colonization, residential schools, and other practices of cultural and social assimilation. This has resulted in a lack of trust and understanding between health care providers and patients and power imbalances that affect care and treatment. Culturally unsafe practices can be considered “any actions that diminish, demean, or disempower the cultural identity and well-being of an individual.”

Cultural safety can be a tool for understanding relationships between health care providers and patients, for analyzing organizational practices, and developing policies that support healing and self-determination.

When cultural safety does not exist, we see issues like the reluctance of individuals to visit mainstream health facilities even when services are needed (and a subsequent discussion by programmers about the “low utilization” of available services by Aboriginal people), inappropriate discussions about the “non-compliance” of individuals with referrals and recommendations, and feelings of fear, disrespect and alienation.

When we apply cultural safety to FASD prevention, we start to recognize things like how:

  • FASD is a medical diagnostic label based on a Western bio-medical model; FASD prevention interventions are based on this same bio-medical model of care
  • FASD continues to be described in mainstream media as a problem primarily in Aboriginal communities
  • Discussions of FASD often build on the historical ‘deficit’ view of Aboriginal people and, in particular, of Aboriginal women as ‘deficit’ mothers
  • The solutions to preventing FASD still continue to focus on addressing alcohol use during pregnancy and do not recognize the historical relationships between colonization, trauma, and alcohol use
  • FASD prevention frequently views alcohol use in pregnancy as an act by an individual women that must be targeted with various interventions (e.g., awareness campaigns and screening by health care providers) and ignores strategies that focus on families and communities (e.g., policies to redress residential schools or addictions programs that include a cultural component on intergenerational trauma)

There’s a growing number of resources on cultural safety available on-line. You can take a look at the resources below as well as the National Aboriginal Health Organization website and the National Native Addictions Partnership Foundation website.

 

References

Brascoupe, S. (2009). Cultural Safety:  Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness.  The Journal of Aboriginal Health.  Ottawa: National Aboriginal Health Organization. Download free full-text here.

FASD Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective. (2010). 10 Fundamental components of FASD prevention from a women’s health determinants perspective.

Gerlach, Alison J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3): 151-158.

Indigenous Physicians Association of Canada and The Association of Faculties of Medicine of Canada.  (2009). First Nations, Inuit, Metis Health Core Competencies: A Curriculum Framework for Undergraduate Medical Education.

National Aboriginal Health Organization. (2008).  Cultural Competency and Safety: A Guide for Health Care Administrators, Providers and Educators. Ottawa, ON.

Tait, Caroline L. (2008) Ethical Programming Towards a Community-Centered Approach to Mental Health and Addiction Programming in Aboriginal communities. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 6(1), 29-60. Download free full-text from here.

FACE, FASDLive, and a Public Forum: A Few Upcoming Events

Not only is it International FASD Awareness Day on September 9th, there also seems to be a lot of other events happening in September. Several of them touch on the issue of FASD prevention.

2012 FACE Research Roundtable

This annual scientific research conference will be held on September 11, 2012 in Saskatoon, Saskatchewan.

Be sure to check out Caroline Tait‘s presentation on Transformative change: can a community-based ethical framework improve FASD prevention and interventions in indigenous health? Dr. Tait will be introducing an indigenous community-based ethical toolkit.

Currently there are no ethical reviews completed by government policy makers and program funders before they introduce “best practice” programming for FASD prevention and interventions into Indigenous communities and this toolkit will help to protect vulnerable individuals from experiencing undue harm resulting from the design, implementation, or termination of a health care initiative.

FACE also has an annual research poster competition – keep an eye out for the poster on our Network Action Team.

Learn more about Caroline Tait on the University of Saskatchewan website.

Learn more about the FACE Roundtable here.

FASDlive 2012 Conference: Expanding our Vision

Following on the heels of the FACE Roundtable is FASDlive on September 12-14th. Dr. Tait will also be a keynote speaker here and will present on Linking FASD Prevention to Child Welfare Reform. Several Canada FASD Research Network members will also be presenting, including:

  • Sterling K. Clarren, CEO and Scientific Director will be delivering a keynote address on CanFASD Research Network and Comprehensive Approaches to FASD Prevention. Time to Get Serious
  • Linda Burnside will co-facilitate a session on Hearing Their Voices: The Experiences of Women Who Have Completed a Mentoring Program to Prevent FASD
  • Nancy Poole will present on Reflecting on Developments in FASD Prevention and  The Power of Networking – Highlights of the Work of the Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective
  • Deb Rutman and Nancy Poole will present on Evaluation Approaches for FASD Prevention and Support Programs: Strategies for Community Programs and Organizations

There’s lots more on FASD prevention happening so check out the program here.

Fetal Alcohol Spectrum Disorder (FASD) Public Forum

This forum will be held on September 22, 2012 in Toronto, Ontario.

Part I is on Neuroethics and FASD: An interdisciplinary examination of the ethical and social challenges associated with the development and implementation of biomarkers for prenatal alcohol exposure with James Reynolds (Queen’s University); Gideon Koren (University of Toronto); Anna Zadunayski (University of Calgary); Nina DiPietro (University of British Columbia).

Part II is on How Much Is Too Much? Understanding Prenatal Alcohol Exposure And Its Impact On Individuals, Families And Society and panelists include Dr. Sterling Clarren, Director of the Canada FASD Research Network (CanFASD) Sharron Richards, Chair of FASD Ontario Network of Expertise (FASD ONE) Steve Catney, Operator of Alliance Youth Services Kamille Shulman, a teenager with FASD and her family.

Learn more here.

And, of course, as I mentioned, September 9th is FASD Awareness Day. Check out previous posts to see how you can participate or create an event to honor the day:

The Sacred Journey – new resource for service providers who work with First Nations families

New resource explores the journey from preconception to parenting

The Best Start Resource Centre  in Toronto, Ontario has released a resource for service providers who work with First Nations families called The Sacred Journey from Preconception to Parenting for First Nations Families in Ontario.

Alcohol use and FASD is covered in the sections on preconception and pregnancy, but alcohol use is also discussed from a historical and cultural perspective:

“The impact of intergenerational trauma from disease, forced relocation, religious indoctrination, the residential school system and racism have left a “soul wound” in the heart of First Nations communities (Duran, Duran, 1995)…. When addressing substance use, keep in mind that information and advice may not be enough. Understanding and addressing underlying factors such as poverty, stress, abuse, mental health concerns etc., may be particularly important in setting the stage to address substance use.”

The resource brings together up-to-date statistics on use, practice tips and resources for service providers.

I especially like that the resource challenges service providers to view alcohol use as an issue that is integrated throughout the lifespan and isn’t just something to get concerned about when a woman gets pregnant. Historically, FASD prevention efforts have been very “fetus-centric” and have missed seeing a woman within a greater context (e.g., partner, family, community) as the route for action and awareness.

Jessica Yee (Mohawk), Founder and Executive Director of the Native Youth Sexual Health Network, comments in the resource:

“I am quite concerned about the isolation of the rest of sexual and reproductive health to pregnancy and birthing. It’s almost as if pregnancy and birthing gets treated like it’s a separate issue—disconnected from other issues like sexual self-esteem and pleasure, and it is typically approached with a very heteronormative, monogamous lens (as in it’s an identified “woman” who is pregnant with an identified “man” and they have a monogamous relationship). This does not allow any resources, support, or dialogue for Two Spirit, transgender, or gender non-conforming persons, alternative families, surrogacy, or single mothers to be.”

This resource can be downloaded for free from the Best Start Resource Centre.

For more on similar resources in Aboriginal/indigenous communities, see previous posts: