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Federal, provincial, and territorial ministers met in Halifax, Nova Scotia, on October 14-5 to discuss issues of justice and public safety in Canada including the impact of FASD. Co-chairs of the meeting were Minister of Justice and Attorney General, Jody Wilson-Raybold, Minister of Public Safety and Emergency Preparedness, Ralph Goodale, and the Minister of Justice and Atto2016-09-life-of-pix-free-stock-leaves-red-sky-leeroyrney General of Nova Scotia, Diana Whalen. Five national indigenous groups participated in the meeting: the Native Women’s Association of Canada, the Assembly of First Nations, the Métis National Council, Inuit Tapiriit Kanatami, and the Congress of Aboriginal Peoples.

Vice-Chief Kim Beaudin from the Congress of Aboriginal Peoples outlined the groups’ priorities to the ministers. Stating that “the most significant issue is violence against women and girls” Beaudin further stressed related issues of FASD, Indigenous girls’ health and safety, violence against Indigenous women, and family justice reforms for Indigenous women.

During the meeting, Ministers discussed the Truth and Reconciliation Commission of Canada: Calls to Action. It underscores the need to address FASD in action numbers 33 and 34, in particular. Ministers agreed to collaborate on addressing solutions for the economic and social impacts of alcohol abuse and to release their final report on FASD and Access to Justice.

FASD prevention efforts in Canada call for multiple approaches that are holistic and move beyond just advising women not to drink during pregnancy (See: Four-part Model of Prevention). The impact of violence and trauma in all its forms on the mental and physical health and safety of women and their families and communities informs and shapes these efforts.

For more on related topics, see earlier blog posts:

ACEs_Original

Adverse childhood experiences (ACEs) is a term that describes potentially traumatic events that can have lasting negative effects on health and well-being. Research has shown a clear connection between ACEs on alcohol use and misuse in adults.

An emerging area of research also suggests that a history of childhood stressors, such as physical, sexual, and emotional abuse, may influence alcohol use among pregnant women.

In a recent study, researchers used data from the 2010 Nevada Behavioral Risk Factor Surveillance System to learn more about this relationship. They found a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for pre-pregnancy drinking and other known factors that influence drinking during pregnancy.

This study contributes to a growing body of research demonstrating that factors affecting alcohol use during pregnancy begin long before pregnancy.

It also suggests the importance of initiatives and movements such as ‘trauma-informed’ practice and their application to FASD prevention. Learn more about trauma-informed practice, alcohol, and pregnancy use on the Coalescing on Women and Substance use website.

For more on this topic, see earlier blog posts:

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References

Astley, S.J., et al. (2000). Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism,  35(5): p. 509-519. [Free full text]

Choi, K.W., Abler, L.A., Watt, M.H., Eaton, L.A., Kalichman, S.C., Skinner, D., Pieterse, D., and Sikkema, K.J. (2014) Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy and Childbirth, 14: 97. [Free full text]

Chung, E. K., Nurmohamed, L., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2010). Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics, 10(4): 245–251. [Free full text]

Frankenberger, D.J., Clements-Nolle, K., Yang, W. (2015). The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues (epub ahead of print). [Abstract]

Nelson, D. B., Uscher-Pines, L., Staples, S. R., & Ann Grisso, J. (2010). Childhood violence and behavioral effects among urban pregnant women. Journal of Women’s Health, 19(6): 1177–1183. [Abstract]

Skagerstrom, J., Chang, G., & Nilsen, P. (2011). Predictors of drinking during pregnancy: A systematic review. Journal of Women’s Health, 20(6):901–913. [Free full text]

Forsaken-ES cover

The Missing Women Commission of Inquiry was established in September 2010 to inquire into the “(BC Missing Women) Investigation and events leading up to the arrest and conviction of Robert W. Pickton and a broader examination of the manner in which cases involving missing women are investigated.”

The final report, including 63 recommendations, by Commissioner Wally Oppal was released in mid-December.

Oppal begins his report by looking at the context of the lives of the women. He states:

Each missing and murdered woman had a unique life and story. At the same time, this group of women shares the experience of one or more disadvantaging social and economic factors: violence, poverty, addiction, racism, mental health issues, intergenerational impact of residential schools and so on. While not every woman experienced each of these conditions, most had experienced several of them. (p. 12)

While the story of the missing and murdered women might seem unrelated to FASD prevention, health and social service providers who work with women who have experienced (and continue to experience) these interlinking factors – violence, poverty, addiction, racism, mental health issues, intergenerational impact of residential schools – would argue differently. Many women who are at risk for having an alcohol-exposed pregnancy are facing one or more of these issues.

For example, Susan Astley and her colleagues conducted a seminal piece of research in Washington State, in which they followed up with 160 women who had children diagnosed with fetal alcohol syndrome. Forty of the women could not be contacted due to confidentiality issues, another 40 had died or disappeared; of the 80 women they interviewed, they found:

  • 100% had been seriously sexually, physically, or emotionally abused;
  • 80% had a major mental illness, with the most prevalent (77%) being Post-Traumatic Stress Disorder (PTSD);
  • 80% still lived with men who did not want them to stop drinking; and
  • 46% were still at risk of having an alcohol-exposed pregnancy.

As another example – some of you may be familiar with the InSight Mentoring Program in Manitoba, an outreach program that provides intensive support to women who are pregnant or have recently had a baby and have substance use problems. Of the first 60 women to enroll in the program, 100% reported experiencing abuse or violence at some point in their lives (Umlah & Grant, 2003).

These research findings illustrate the importance of  recognizing and understanding the role violence and other related factors  plays in the lives of pregnant women struggling with their use of drugs or alcohol. Reports like the one from the Missing Women Commission of Inquiry serve as a reminder that these issues are not isolated events or confined to pregnancy and require broader systemic changes.

You can download the full report from http://www.missingwomeninquiry.ca. For recent media coverage, see:

References:

Astley SJ, Bailey D, Talbot T, Clarren SK (2000). Fetal alcohol syndrome (FAS) primary prevention through FAS Diangosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol & Alcoholism, (35) 5:509-519.

Oppal, Wally T. (2012). Forsaken: the Report of the Missing Women Commission of Inquiry: Executive Summary. Available from: http://www.missingwomeninquiry.ca/

Umlah, C. & T. Grant (2003). Intervening to prevent prenatal alcohol and drug exposure: the Manitoba experience in replicating a paraprofessional model. Envision: The Manitoba Journal of Child Welfare, 2(1): 1-12.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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