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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

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Overall, alcohol and tobacco are the most commonly used drugs during pregnancy in Canada. They are also the two drugs that can be the most harmful to a fetus during pregnancy and in the long-term for babies that are exposed.

New research, using data from the Canadian Community Health Survey (2003-2012), takes a closer look at this relationship. Internationally, research has shown that women who smoke are also more likely to drink and vice versa. (One study by Cannon et al showed that 74% of mothers who had a child with FASD also smoked during their pregnancy).

The researchers looked at a national sample of 22,962 women who had given birth in the previous five years. They found that the overall prevalence of smoking during pregnancy in this group of women was 14.3% (of the women who smoked, 52.5% smoked daily and 47.5% smoked occasionally). The prevalence was the lowest in British Columbia at 9.0% and the highest in the territories (Yukon, Northwest Territories, and Nunavut combined) at 39.9%.

They found that:

  • Women who smoked during pregnancy were more likely to be younger, single, white/non-immigrants, and have a lower income.
  • Women who smoked during pregnancy were more likely to drink while pregnant. Women who were daily or occasional smokers during pregnancy were 2.54 and 2.71, respectively, times more likely to have consumed alcohol during pregnancy as compared to non-smokers.
  • Women who had a lifetime history of smoking, but who did not smoke during pregnancy, were also more likely to have consumed alcohol during pregnancy.
  • Binge drinking was the only factor that had a relationship to whether women used alcohol, smoked or used both during pregnancy.

These findings suggest the importance of public health interventions that address alcohol use and smoking together both before and during pregnancy.

References

Bailey, B.A., McCook, JG., Hodge, A. and McGrady, L. (2012). Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting harder drugs. Matern Child Health J, 16:414–422.

Cannon, M.J., Dominique, Y., O’Leary, L.A., Sniezek, J.E., & Floyd, R.L. (2012). Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome. Neurotoxicology and Teratology, 34: 90–95.

Janisse, J.J., Bailey, B.A., Ager, J., and Sokol, R.J. (2014). Alcohol, Tobacco, Cocaine, and Marijuana Use: Relative Contributions to Preterm Delivery and Fetal Growth Restriction. Substance Abuse, 35(1): 60-67, DOI: 10.1080/08897077.2013.804483

Lange, S., Probst, C., Quere, M., Rehm, J., Popova, S. (2015). Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addictive Behaviors, 50: 102–109.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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