FASD prevention work is complex; it involves much more than providing information about the risks of alcohol use in pregnancy. Preventing risky alcohol use by pregnant women (and mothers before and after pregnancy) does not take place at only one point in time, nor does it occur through a single interaction with one care provider.

In a publication (2008) Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives – Multiple Approaches to FASD Prevention, produced by the Public Health Agency of Canada, Canadian prevention specialists identified four mutually reinforcing prevention approaches as effective in delivering FASD prevention.

The four levels of prevention span general and specific practices that assist women to improve their health and the health of their babies, with support from family, support networks, services and community. They include:

1. The first level of prevention is about raising public awareness through campaigns and other broad strategies. Closely linked to public awareness/social marketing, campaigns can be public policy and health promotion activities that are supportive of girls’ and women’s health. The engagement and involvement of a broad range of people at the community level is key to advancing social support and social change.
2. The second level of prevention is about girls and women of childbearing years having the opportunity for safe discussion of pregnancy, alcohol use, and related issues, with their support networks and healthcare providers.
3. The third level of prevention is even more specific. It is about the provision of recovery and support services that are specialized, culturally specific and accessible for women with alcohol problems and related mental health concerns. These services are needed not only for pregnant women, but also before pregnancy and throughout the childbearing years.
4. Finally, the fourth level of FASD prevention is about supporting new mothers to maintain healthy changes they have been able to make during pregnancy. Postpartum support for mothers who were not able to make significant changes in their substance use during pregnancy is also vital. This will assist them to continue to improve their health and social support, as well as the health of their children. Early interventions for children who potentially have FASD are also important at this stage.

I am not a medical professional, so I can only provide quotes from and links to articles I have found on the topics I am posting about. What I can say is there should be no stigma, shame or blame. Women should feel safe expressing their concerns. And women should not feel that because they consumed an alcoholic drink they should “abort the child” – as some recent articles are suggesting women are being frightened by the no alcohol message and its possible implications. I am even surprised at some of the shaming that goes on in support groups. It needs to stop. Women will not disclose if they feel stigma or fear persecution. If you want to reduce FASD then let’s support women and make liquor companies and legislators more accountable.

The following speaks to current practices and was published on VOX:

In a study published in the May 2019 journal PLOS One, Meenakshi S. Subbaraman, a biostatistician at the Public Health Institute, and Sarah C.M. Roberts, an associate professor of obstetrics and gynecology in UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) research group, looked at state policies designed to stop pregnant women from drinking. They found that several of these policies, including posting warning signs in bars and restaurants and defining drinking while pregnant as child abuse or neglect, are actually associated with worse health outcomes for babies, specifically low birth weight and premature birth. One reason, the researchers say, is that the policies can actually discourage women from seeking prenatal care.

“Usually, when we talk about harms from substance use during pregnancy, we talk about the harms from the use itself,” Roberts told Vox. But in the study, she and Subbaraman also found “harms from the policies that we adopt in response.”

The results have implications for how doctors treat pregnant women and how state governments approach maternal health.

In studying the barriers keeping some of these women from getting prenatal care, she found “that they were really scared of being reported to Child Protective Services and having their children removed.” Some of the women she worked with were also “really worried that they had already irreversibly damaged their babies, and that if they went to prenatal care, that they would get some confirmation of that” — and perhaps be judged by a doctor or have their use publicized in some way.

Many of them, she said, believed that by drinking during pregnancy, they had already done irreversible harm to the fetus. In addition to keeping women from visiting an obstetrician, this fear might even keep them from trying to quit drinking. Women may think “that they’ve already used earlier in their pregnancy, and so it doesn’t matter what they do now,” even though stopping drinking later in pregnancy could still benefit the fetus, Roberts said.

In her earlier work, meanwhile, Roberts has found that policies that aim to reduce alcohol consumption among the general population, like restricting where alcohol can be sold, are associated with reductions in low birth weight babies and premature births.

The study published Wednesday, she said, suggests that when it comes to state alcohol policies, “a pause is in order” while policymakers figure out what really works. “What we need is to step back and start again and center the voices of people who are using during pregnancy and the people who take care of them,” she said.

Various FASD organizations continue to update and implement best practice prevention models to support women. In Canada, CanFASD and the Centre of Excellence for Women’s Health updated the above-noted 4 Part FASD Prevention Model. More information on this model can be found on the CanFASD site.

Not every woman who drinks alcohol will have a child with FASD. Not every child born with FASD will have the same outcomes. There are many factors. And even if a child is born with FASD, early intervention and support for the child and family will result in better outcomes. It is never too late to provide support. There are many adults with FASD who are living their best lives because of the support they received. The issue (I think) has been a mix of the lack of awareness, understanding, interventions and support provided. This is what we need to work on.

We know alcohol has an effect. But we need to provide information to women without frightening them, or fearing they will lose their child/ren. We want women to make well-informed choices. If you haven’t seen this, take 5 minutes to watch this video by Myles Himmelreich, an advocate, mentor, speaker and adult with FASD.

There will be more on how to support women later in our journey. For now, come back tomorrow for another FASD tip, quote, fact or piece of information on the 99 Days to 9/9 journey!