The Mothering Project/Manito Ikwe Kagiikwe in Winnipeg, Manitoba

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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).

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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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Save the Date for the Herway Home Community Conference – September 29, 2014

Final HWH conference date saver

HerWay Home in Victoria, BC is organizing a community conference and networking event for September 29, 2014.

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.

When: Monday September 29, 2014

Where:  DaVinci Centre, 195 Bay Street, Victoria

Time:  09:00 – 4:00

Cost: Free to those attendees from Vancouver Island. A minimal charge of $50 to attendees from off the island.

Who should attend: HWH works with women who are pregnant or early parenting and also affected by substance use, mental health issues, violence, and trauma. This conference will be of interest to those working with women or in settings that are more focused on working with the baby (such as the NICU, foster care etc.),  along with those working on the social determinants of health such as housing, poverty, food security.

Registration information will be available in August. For more information or if you have any questions please contact HerWay Home at  Herwayhome@viha.ca

For more information about HerWay Home, see earlier posts:

World Health Organization releases the first evidence-based global guidelines to prevent and treat substance use by pregnant women

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The World Health Organization recently released Guidelines for identification and management of substance use and substance use disorders in pregnancy.

These guidelines were primarily written for health-care providers managing women from conception to birth, and during the postnatal period, and their infants.

The guidelines focus on six areas:

  1. Screening and brief intervention
  2. Psychosocial interventions
  3. Detoxification
  4. Dependence management
  5. Infant feeding
  6. Management of infant withdrawal

Download the Guidelines from the WHO website.

Women’s health and FASD prevention in a special issue of the International Journal of Circumpolar Health

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The International Journal of Circumpolar Health is a multidisciplinary journal that specializes in Arctic and Antarctic health issues, with a particular interest in the health of indigenous peoples.

The journal has just published a special supplement (Supplement 1, 2013) which includes 100 full length papers, 90 extended abstracts and nearly 100 short abstracts from the 15th International Congress on Circumpolar Health held in August 2012.

This issue has a number of full length and brief papers related to FASD, women’s addictions, and indigenous health. Here are some of the papers you might be interested in taking a look at:

Perceptions of needs regarding FASD across the province of British Columbia, Canada – Anne George, Cindy Hardy, Erica Clark (p. 91)

This study describes the perceived needs for services for people affected by FASD in rural and urban British Columbia.

Prenatal alcohol exposure among Alaska Native/American Indian infants – Burhan A. Khan, Renee F. Robinson, Julia J. Smith, Denise A. Dillard (p. 147)

A survey which found that rates of prenatal alcohol use are primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters.

An examination of the social determinants of health as factors related to health, healing and prevention of foetal alcohol spectrum disorder in a northern context – the Brightening Our Home Fires Project, Northwest Territories, Canada – Dorothy Badry, Aileen Wight Felske (p. 169)

An exploratory study of the issue of the prevention of FASD from a women’s health perspective in the Northwest Territories of Canada.

Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women – Caroline L. Tait (p. 200)

Drawing from a project documenting 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults, this paper explores the influence of government policies and programs in Canada on recovery and healing.

Coordinating foetal alcohol syndrome interventions in Alaska – Kris Broom, Wendy Getchell, Chantelle Hardy, Garrett Hartley and Jessica Olson (p. 241)

A review of current Alaska FAS policies and interventions.

The healing constellation: a framework for understanding and treating trauma in Alaska Native women – Wendy H. Arundale (p. 243)

Connecting theory, research, and treatment approaches, a look at indigenous women’s substance use in relation to mental health, intergenerational trauma and other factors.

Community-driven alcohol policy and foetal alcohol spectrum disorder prevention: implications for Canada’s North? – Nancy Poole, Tasnim Nathoo and Arlene Hache (p. 250)

An exploration of the potentially important role of alcohol policy in northern communities in influencing alcohol use in pregnancy and risk of FASD.

The full publication is freely available for download here.

For more on FASD prevention in northern regions, see earlier posts:

Trauma Matters: Guidelines for trauma‐informed practices in women’s substance use services

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Over the past several years, the impacts of trauma and the interrelationships between trauma and women’s substance use have been well-identified by both research and clinical practice.

Recently, the Ontario Drug Treatment Funding Program Trauma and Substance Use project team released guidelines to support organizations that provide substance use treatment services for women. The guidelines are intended to help service providers understand the interconnections of trauma and substance use and to provide improved care for substance-involved women who have experienced trauma.

The guidelines identify six core principles for trauma‐informed practice: acknowledgment, safety, trustworthiness, choice and control, relational/collaborative approaches, and strengths-based empowerment.

The guidelines also take a look at trauma and its connection to mothering and family relationships. The authors comment:

“Substance-involved women who have experienced trauma may also be mothers, or be pregnant. Many have needs related to their mothering role when they seek help with their substance use concerns. For
these women, concerns about their children and their role as mothers can play a critical part in their recovery and be a powerful catalyst for change.

Hard data on substance use, mothering, and pregnancy are somewhat limited because many mothers fear negative or punitive consequences if they disclose their substance use concerns; however, research
indicates that up to 70% of women who attend substance use programs have children.

Although there are sensitive and caring mother-centered programs in Canada, “there are vast gaps in the availability and accessibility of these services, depending on the required level of care, parenting status,
and the severity of health and social problems.” “(p. 87)

Trauma Matters: Guidelines for trauma‐informed practices in women’s substance use services can be downloaded here as well as from the Jean Tweed Centre, the Evidence Exchange Network, and the Ontario Federation of Community Mental Health and Addiction Programs.

For more on women’s substance use and trauma, see Trauma-informed care for women in Canada (July 11, 2011).

“Drunkorexia” and Weight-conscious Alcohol Marketing

Making links between substance use and eating disorders

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The Atlantic published an interesting article last week called “Road to ‘Drunkorexia’ – The downsides of the weight-conscious alcohol boom.” (March 27, 2013, Jacoba Urist).

I’ve blogged in the past about the phenomenon of dieting or overexercising to ‘save’ calories for drinking later on. (See earlier posts Drunkorexia: Binge drinking and disordered eating on college campuses (October 27, 2010) and “Drunkorexia”: an update on binge drinking and disordered eating from The Fix (November 1, 2011)).

The article in The Atlantic provides an update on drunkorexia and comments on a trend in alcohol marketing focusing on calories and weight concerns.

Shape magazine (www.shape.com) lists Bud Select 55 as one of 15 bikini-friendly beers.
Shape magazine (www.shape.com) lists Bud Select 55 as one of 15 ‘bikini-friendly’ beers.

Sarah Beller at The Fix in ” ‘Drunkorexia’ is Double Trouble” (April 1, 2013) comments on the relatively common co-occurence of disordered eating and substance abuse. She interviews Dr. Harris Stratyner, Vice President of Caron Treatment Centers, who comments:

“The thing that worries me…is the combination of the two. Alcohol robs you of very important vitamins—such as Vitamin A, B12, and folate. And anorexia, bulimia, and over-exercising rob you of some of the same vitamins at an additional volume. We’re seeing girls and women destroying their reproductive systems, getting calcium deficiencies. It’s frightening to me as a doctor.”

This link between alcohol misuse and malnutrition is an important one for those of us working in FASD prevention. We know that nutrients such as zinc, vitamin A, folate, and choline can help protect a developing fetus from the harms of alcohol.

For more on weight-conscious alcohol marketing to women, see earlier posts:

Illuminating Invisibilities: Working with Women whose Lives have been Impacted by Homelessness, Violence, Mental Health Issues and Substance Use

International Women’s Day Event – March 8, 2013

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The Health Equity Office and Human Resources at the Centre for Addiction and Mental Health in Toronto is hosting a 90 minute International Women’s Day educational event: Illuminating Invisibilities: Working with Women whose Lives have been Impacted by Homelessness, Violence, Mental Health Issues and Substance Use.

The forum will bring together addiction and mental health service providers, allied professionals, community members and women with lived experience to:

  • Identify populations of women that are invisible and have been impacted by homelessness, violence, trauma, mental health issues and substance use including newcomers and women from diverse communities
  • Highlight barriers to access to the mental health, addictions and social service system for women that have been impacted by homelessness, violence, mental health issues and substance use
  • Identify strategies for creating connection with all of these communities of women that are not accessing services

Presenters include:

  • Rani Srivastava, Chief of Nursing and Professional Practice at CAMH – Opening Remarks
  • Eva Scott, Community Outreach Worker, Peer Support Program, Sistering
  • Sheryl Lindsay, Executive Director – Sistering 
  • Mirna Paz, Interpreter, Barbra Schlifer Clinic
  • Amanda Dale, Executive Director, Barbra Schlifer Clinic
  • Ann Pottinger, Discipline Chief, Nursing with Professional Practice and Acting Director of Teaching Excellence and Innovation – Moderator

Eva Scott and Sheryl Lindsay are from Sistering, a women’s agency serving homeless, marginalized and low-income women in Toronto. Mirna Paz and Amanda Dale are from the Barbara Schlifer Clinic in Toronto which offers legal help, counselling and language interpretation to women who have experienced violence.

The event will be held on March 8, 2013 – 11 am to 12:30 pm in Toronto, Ontario. View the flyer here.

For more on homelessness and FASD prevention, see earlier posts:

For more on violence against women and FASD prevention, see recent post:

Handbook for Aboriginal Alcohol and Drug Work from Australia

Handbook Cover

“The Handbook for Aboriginal Alcohol and Drug Work is a practical tool written for Aboriginal drug and alcohol workers, mental health workers and others working in this field. It offers a detailed look at alcohol and drug work from clinical, through to prevention, early intervention and harm reduction. This handbook is also likely to help people working to improve policy and those advocating for change.

The idea for it came from workers all over Australia. They told us that they needed an easy to use handbook that can help them respond to the range of alcohol and drug issues they face every day. They also told us that such a book needs to take into account the complex challenges facing workers when helping clients, their families and, sometimes, whole communities.”

This plain language, evidence-based guide was created in partnership between the University of Sydney and Aboriginal and non-Aboriginal agencies and health professionals. Four of the six editors are Aboriginal.

It covers alcohol and drug use as well as a whole range of other issues, including child protection notifications, legal issues, working with clients without housing, mental health and polydrug use, and community-wide approaches.

Chapter 2 focuses on alcohol and Chapter 16 focuses on Special situations, settings, and groups, including pregnancy, breastfeeding and early childhood. It discusses the use of brief intervention and counselling approaches in the context of alcohol and pregnancy. It also has sections covering Neonatal Abstinence Syndrome, Alcohol use in pregnancy and Foetal Alcohol Spectrum Disorders.

The handbook was first distributed to alcohol and drug professionals from around Australia at the National Indigenous Drug and Alcohol Conference in Western Australia in June 2012.

The project started in 2010 with a grant from the Foundation for Alcohol Research and Education (FARE) and continued with the support of the NSW Ministry of Health.

The handbook is available online.

Testing pregnant low-income moms for drugs in New York creates outrage and controversy

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A few days ago, Pix11 (part of the CW Television Network) published an article called Outrage as hospitals test pregnant moms for drugs near low-income neighborhoods (Stephanie Tsoflias, December 27, 2012).

The article looks at how pregnant moms across New York are being tested for drug use, specifically marijuana.  Many health care providers are administering the test without women’s consent. In some places, all women are asked to agree to testing; if women refuse, then babies are tested.

The article explores how this practice is not as supportive as one might think. In low-income neighborhoods, all mothers are being tested while in high-income neighborhoods, only women who are clearly under the influence of alcohol and/or drugs are being tested.

More worrisome is how the test results are being used – results are being sent to child protection services, with the implication that the results are an indicator of whether a woman is fit to parent.

While this article is taking a look at marijuana testing, it is directly relevant to those involved with FASD prevention or who are concerned about reducing alcohol use during pregnancy. I’ve blogged in the past about meconium testing which examines a baby’s first stools for evidence of whether a mother consumed alcohol during pregnancy. In Canada, meconium testing has been proposed as part of a comprehensive approach to addressing FASD.

While supporters of universal meconium testing believe that this will help with early identification of FASD in children, there are a lot of unresolved murky ethical issues and, at present, the practice would likely lead to more harm than good. As this article shows, while women in all socio-economic brackets use substances, certain groups of women are unfairly targeted and subject to more invasion of their privacy and are likely to experience adverse outcomes from testing.

See earlier posts on meconium screening:

The 16 Days of Activism against Gender Violence Campaign in Carnavon, South Africa

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Thousands of organizations across the world are participating in the 2012 16 Days of Activism Against Gender Violence Campaign. The campaign, now in its 22nd year, is organized by the Center for Women’s Global Leadership at Rutgers University. The campaign began on International Day for the Elimination of Violence Against Women (November 25) and ends on International Human Rights Day (December 10).

While there are a huge number of events and activities being held across South Africa, I was interested to see that the Province of the Northern Cape was hosting an event related to FASD awareness in the community of Carnavon on one of the 16 days.

According to the government press release:

“The preliminary finds of the Balelapa survey indicates that of the 2,045 persons interviewed in Carnavon , 1,523 indicated that they are unemployed and 1,075 indicated that they have no income. Unemployment and poverty are of the contributing factors for substance abuse and the situational analysis indicates that Carnavon is a high risk area for substance abuse.”

I think it’s still exceedingly rare for individuals and governments to make the connections between violence, poverty, substance misuse, and FASD.

Check out this series of stories by Leonie Marinovich on All Africa called South Africa: 16 Stories for 16 Days of Activism.

For more on FASD in South Africa, see earlier posts:

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