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A few of our Prevention Network (pNAT) members recently spotted an online article entitled “Demonising smoking and drinking in pregnancy may lead women to do it in private, says study.” Read the online article about the study here.

This study from the University of Cardiff in Wales has confirmed what most women’s health advocates know – that judging pregnant women for behaviours that may negatively affect fetal and child health, did not cause them to stop, but instead caused them avoid public and professional scrutiny, and to use in private. Women felt judged by healthcare professionals for their smoking and poverty, which made interactions with health care providers awkward. (See journal article on the study here.)

In the research 10 low-income, pregnant women in Wales were asked to “tell their stories” including how pregnancy affects their everyday life. Although smoking was discussed extensively by the women, interviewers did not raise the topic during the interviews. As part of their stories, women described their smoking behaviours, and reactions from the public, family, friends, and health care providers.

  

Liberation: Helping Women Quit Smoking

  

Doorways to Conversation

This study underscores what we know about substance use prevention in general – shame and stigma are not solutions to helping people change use, and specifically that the judgement of health professionals is tied to not accessing the support that is needed and deserved. In that way, the professionals become part of the problem instead of the solution. Evidence has established that using non-judgmental approaches are key to supporting behaviour change. These approaches emphasise harm reduction and employ collaborative and empathic conversations that respect individuals’ self determination and understand the underlying issues of substance use problems. Further to collaborative conversations, it is critical to understand substance use, and challenges to change substance use, as related to the burdens of violence and poverty faced by women – this forces us to move beyond a focus on individual behaviour and instead to action for social justice on these conditions of women’s lives.

Collaborative Approaches for Health Care Professionals

Indigenous Approaches to FASD Prevention

Mothercraft Study: “A Focus on Relationships”

The pNAT has written extensively about the importance of non-judgmental Level 2 discussions with women and their partners about alcohol, other substance use and the determinants of health that affect use. Included here are some resources that can help practitioners to engage in those discussions with women in a way that builds connection and relationship and supports movement toward positive change in alcohol and tobacco use, and related health and social concerns. As well, practitioners can connect to local pregnancy and addictions support programs to learn what community action to address stigma and promote social justice is underway.

References

Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D., & Goodwin, R. D. (2017). Cigarette Smoking is Associated with Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. The Journal of clinical psychiatry, 78(2), e152-e160.

See earlier posts

LINKING CANNABIS USE WITH ALCOHOL AND TOBACCO November 13, 2018
NEW RESOURCES FOR COLLABORATIVE CONVERSATIONS ON SUBSTANCE USE WITH GIRLS AND WOMEN June 18, 2018
REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017
TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017
ADVERSE CHILDHOOD EXPERIENCES AND ALCOHOL USE DURING PREGNANCY August 18, 2015
BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013
LET’S START A CONVERSATION ABOUT HEALTH . . . AND NOT TALK ABOUT HEALTH CARE AT ALL June 23, 2011

CBC News screenshot

A new campaign from the territorial government of Nunavut is getting some media attention. (See the coverage in the Huffington Post here and CBC here).

The posters, in English and in Inuktitut, read “Baby or the bottle? Pregnant women should never drink alcohol.”

The campaign was designed by Iqaluit-based graphic design company Atiigo Media Inc. According to the Huffington Post article, the image was inspired by a poster campaign from Russia (which I blogged about here in 2012.)

The media coverage discusses how responses to the campaign have been mixed with opinions ranging from “effective” to “offensive.” This follows discussions last week about a campaign in Ontario by the Liquor Control Board of Ontario (LCBO) that spurred one mother to make a formal complaint.

The LCBO campaign was critiqued for suggesting that mothers who drink during pregnancy are irresponsible and uncaring. Rather than promoting love, it was suggested that the campaign promoted shame and guilt.

The Nunavut campaign takes a different approach with the use of a shocking image and threatening message (“Pregnant women should never drink alcohol”), but still raises similar questions about the target audience and what is actually being communicated.

o-NUNAVUT-FASD-ADS-570

While public health authorities clearly state that there is “no safe time, no safe amount, and no safe kind” of alcohol use during pregnancy, this type of campaign can lead to mixed effects or even have unintended consequences.

While most women stop drinking after learning they are pregnant, some women continue to drink due to addiction or other related concerns. For these women, the use of shocking images or the suggestion that women who love themselves and their baby bump won’t drink can lead to feelings of shame and embarrassment – which makes it hard for women to reach out for care and support from family, friends, and health care providers.

This type of approach may also have negative consequences for women who drank (lightly or otherwise) before knowing they were pregnant. It may cause unwarranted anxiety about possible effects or lead some women to consider an abortion. (See a previous post: Do concerns about alcohol use during pregnancy lead women to consider having an abortion? February 1, 2013)

For more on FASD prevention in Nunavut, see earlier posts:

For more discussion on best practices and controversies related to messaging, see earlier posts:

 

 

 

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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