Do you know what your message is going to be?

Since 2013, I have participated in the Red Shoes Rock campaign. From September 1-9, I wear red sneakers, and share a messages on my personal social media, as well as on social media connected to Our Sacred Breath. The red shoes are a great conversation starter. Each year I increased my participation, with 2017 and the introduction of 99 Days which has been shared around the world and in 2018 was translated into Italian, Spanish, Afrikaans and Polish!

2018 Update: Although infographics contain information from reliable sources, as my knowledge grew, and as language has evolved, I noticed “old” language. Where I could (if it wasn’t a direct quote) I updated the language. However, even in the last year new suggestions have been made for updating language and I found this article (about language) could be updated. Which I will do.

It can be confusing to wade through all the messages and pick ones that get the message out there, but also respects all those connected to FASD. Different audiences may require different messages. Today I’m highlighting information from a research study by Wendy Burgoyne from Best Start: Ontario’s Maternal Newborn and Early Child Development Resource Centre (2005) called What We Have Learned: Key Canadian FASD Awareness Campaigns.

The purpose of this post is not to detail how to run an awareness campaign (but if you want to run one this is a great resource to use) – my goal is simply to get people to think about the messages and words we all use to talk about FASD. My own vocabulary evolves as I learn more.

What is an Awareness Campaign?

Awareness campaigns are defined as goal-oriented attempts to positively influence a specific audience, through an organized set of activities that take place in a specific time period. They may focus on use of the media, personal contact (e.g. displays or presentations), events (e.g. launch events or FASday activities) or a combination of these three strategies.

Target Markets for FASD Awareness

Although some campaigns in this review focused on one population of interest, others had several. The most common populations of interest for the campaigns reviewed in this project included the community (38%), youth (30%), the general public (28%), women of childbearing age (21%), service providers (19%), partners and family members of pregnant women (15%), the Aboriginal community (13%) and pregnant women (11%). Additional populations of interest included families affected by FASD (6%), friends (4%), high-risk families (4%), working adults (2%), multicultural community (2%), male partners (2%), sex trade workers (2%), licensed establishments (2%) and women before pregnancy (2%).

FASD, Alcohol Use and Pregnancy

FASD is a complex problem, with profound underlying causal factors and serious, long-term consequences. Healthy birth outcomes are influenced by multiple factors, including substance use, environmental contaminants, violence and nutrition.

Alcohol use in pregnancy is one of many prenatal concerns. A women’s ability to create an environment conducive to a healthy pregnancy is dependent upon her access to resources such as information, health care, support, counselling and healthy food.

Alcohol use can be influenced by social factors and the broader determinants of health, including social norms and expectations, poverty and violence (Roberts and Nanson, 2000).

The actions of partners and family members also influence a woman’s ability to make healthy choices in pregnancy (Environics, 2002). Partners and family members have a role to play in supporting and encouraging a pregnant woman to stop drinking.

Not known at the time of this study, but paternal drinking is now thought to have an effect. See Day 9 of 99 Days to FASDay

There are misconceptions and myths around women and alcohol use, which are compounded when alcohol use occurs within the context of pregnancy and motherhood. These misunderstandings can be translated into discriminatory practices and attitudes when dealing with women around substance use issues.

Alcohol use is stigmatizing, as society places judgments on people who are unable to address their alcohol use. Pregnant women who use alcohol may find it difficult to access the services they need, due to judgmental attitudes of service providers, feelings of shame, depression, low self-esteem and fear of losing their children (Poole and Isaac, 2001). Family and friends may also discourage a pregnant woman from talking about her alcohol use, due to concerns about reprisal (Poole and Isaac, 2001).

Awareness campaigns need to emphasize that alcohol use during pregnancy can cause serious harm, while being careful not to inadvertently reinforce judgmental attitudes about pregnant women who are struggling to address their alcohol use.

Stigma and Judgemental Attitudes

Society can place similar fears, judgments and consequences on individuals with FASD. FASD is an invisible disability. Individuals with FASD may be harshly judged by those who do not understand that their actions are a consequence of brain damage, not wilful misconduct.

Although FASD has been linked to increased mental health concerns and contact with the legal system, early diagnosis, care and services can reduce these risks (Streissguth et al., 1996).

Awareness campaigns need to reinforce the potential serious long-term consequences of prenatal alcohol exposure, without creating negative and inappropriate perceptions of individuals with FASD.

See Day 26 of 99 Days to FASDay a post about stigma.

Targetting Your Message

Health promotion research indicates more than half of all respondents (66%) wanted to get information to a broad group, such as the community or the general public, in order to be inclusive and to encourage support.

Groups gave the following reasons for their focus on the general public or community:

• FASD is not the sole responsibility of individual pregnant women or parents of individuals with FASD.
• A woman’s ability to change her alcohol use is influenced by available supports and services, and underlying factors such as poverty and violence.
• Individuals and families affected by FASD can benefit from community support.
• The community needs to understand the issue to be supportive.
• Community awareness is the first step to community buy-in and support and can lead to more targeted initiatives later on.

Controversial Messages

Survey respondents discussed messages that were controversial:

FASD is 100% preventable.

FASD is not entirely preventable. Alcohol use often happens before a woman recognizes that she is pregnant and is related to unintended pregnancies, poverty, violence, addictions and mental health issues.

If you are pregnant, drink less or not at all.

Including harm reduction messages is necessary for some sub-populations. With the general public, it can confuse the issue. Harm reduction approaches may be most appropriate in the context of individual counselling sessions with a health professional, instead of an awareness campaign.

Simply don’t drink alcohol for nine months.

For some women, stopping drinking is not simple. It can be a struggle. Depicting this as simple is misleading and can alienate the population of interest.

Choose not to drink alcohol during pregnancy.

For some women alcohol use is not about choice, it is about addiction.

It takes only one drink.

Many women have a small amount of alcohol before they know they are pregnant. While we want to be clear that there is no known safe limit, we also do not want to instil undue fear about the risks of unknowingly drinking a very small amount of alcohol in pregnancy.

Pregnant women never drink alone.

This can be seen as use of shame and blame, making it more difficult for women to disclose alcohol use, and to access appropriate services.

What do you think about these phrases? Do you agree they are controversial? See Day 21 of 99 Days to FASDay to Day 24 which had information about suggestions around other language used to talk about FASD, alcohol and pregnancy.

Call to Action

When planning campaigns that included print resources, most respondents (87%) included a specific call to action or a simple first step for the population of interest.

The calls to action included: calling a specific phone number (66%), visiting a specific Web site (19%) or talking to a health care provider (8%). The calls to action included contact information for local, provincial or national services. Some campaigns provided more than one call to action (e.g. a phone number and a Web site). A few respondents (13%) did not include a call to action in their campaigns; however, most of these indicated that this was an oversight.

See Day 50 of 99 Days to FASDay for information about other awareness campaigns and resources.

Come back tomorrow for some thoughts on images used to raise awareness of FASD.