We need to move from stigma to support
Reprinted from "Alcohol" issue of Visions Journal, 2006, 2 (9), p. 16-17
Women who use substances during pregnancy have been subjected to much negative social and legal attention over the years.1 From a health perspective, however, increased evidence about the effects of drinking alcohol during pregnancy has increasingly focused attention—through the lens of risk for fetal alcohol spectrum disorder (FASD)—on women who drink while pregnant.2 National, provincial and regional frameworks related to prevention of FASD have been developed.3,4 A FASD policy partnership and research network has been developed, inclusive of the four western provinces and three territories. The BC government is currently promoting action by service providers who serve pregnant women through its ActNow Healthy Choices in Pregnancy initiative, and FASD prevention plans are being developed by each health authority in the province.
Stigma creates barriers
The issue of alcohol use during pregnancy has shifted from a topic of marginal interest, to a more mainstream children’s and women’s health issue.5 There is, however, an ongoing struggle to balance a heightened interest from professionals and policy makers with efforts to reduce the social and legal stigma applied to pregnant women who drink. Stigmatization is unjust. It also creates barriers for women who might seek treatment. These barriers contribute to poorer health for both women and their infants.
Understanding alcohol use during pregnancy
Estimates of women’s drinking during pregnancy vary. In the 2001 Canadian Community Health Survey, 15.9% of pregnant women in BC indicated alcohol use in the past week.6 Also in this survey, 12.4% of BC mothers reported alcohol use during their last pregnancy.
Most women are able to reduce or stop their use of alcohol during pregnancy. But for some women this is difficult. Women whose alcohol use has progressed to dependency, and those facing other stressors and health problems such as intimate partner violence, inadequate housing or nutrition, mental health problems, lack of support from partners and families, and problem use of other substances may be unable to stop on their own, even if they want to.
Prevention messages have tended to oversimplify this reality, contributing to the stigma and perception that women who drink while pregnant are evil or bad, and are deliberately harming their fetuses. Prevention messages often focus only on the alcohol use and imply that it is a simple matter for all women to “just say no” to alcohol during pregnancy. These messages ignore the dynamics of addiction and the burden of other health and social problems that many women face.
Prevention—a three-level strategy
Level 1 Building public awareness and community action is central. The aim is to shift attitudes from negative to compassionate toward women who have substance use problems, promote understanding of determinants of health, reduce systemic barriers to care, and bring people together to work on community-level solutions. This level forms the groundwork for the other levels of prevention.
In developing effective public awareness campaigns about alcohol use during pregnancy, it is a challenge to create awareness of the risks using messages that are not overly threatening, that speak to women in diverse circumstances, and that promote positive, informed action by women, their partners and their communities.
Pregnancy Outreach Programs To locate a Pregnancy Outreach Program in your community go to www.bcapop.ca
Maxxine Wright Place Project for High Risk Pregnant and Early Parenting Women 13729 92nd Avenue, Surrey, BC V3V 1H9 Phone: 604-587-3835; Fax: 604-581-3908 E-mail: [email protected]
Vancouver Native Health Society - Sheway 533 East Hastings Street, Vancouver, BC V6A 1P9 Phone: 604-216-1699; Fax: 604-216-1698 E-mail: [email protected]
Fetal Alcohol spectrum disorder
Fetal alcohol spectrum disorder (FASD) refers to the range of birth defects and development disabilities associated with prenatal alcohol exposure, including facial abnormalities, growth deficiencies and central nervous system impairment (such as impaired motor skills, visual problems, learning difficulties, poor impulse control, and problems in memory, reasoning and judgement).
Level 2 There needs to be open and nonjudgmental discussion of alcohol use with all women of childbearing years, including pregnant women. These women need to be informed about the risks of substance use during pregnancy and about help that is available to assist them in reducing or stopping their alcohol use. Physicians have long been recognized as important providers of this information, yet many other service providers who come into contact with women are also in a position to provide this information and support.
When this level of prevention is in place, all women will be informed of the risks of drinking in pregnancy, women who are using alcohol in risky ways will be helped to reduce or stop their alcohol use during pregnancy, and women with substantial alcohol and other health problems will be linked to comprehensive care
Level 3 There need to be comprehensive services designed for women at the highest level of risk—that is, pregnant women and mothers who have serious substance use problems and other health and social problems. Fundamental to this work is a holistic, nonjudgmental, harm reduction service orientation. Services that operate from this perspective support improvement in women’s health by providing choice about the health support women receive, by recognizing and accepting the pace of change women are able to make, and by meeting women “where they are at.”
Pregnancy Outreach Programs have been a cornerstone of support for pregnant women in rural and urban communities throughout British Columbia. The multi-faceted Sheway program in Vancouver and the Maxxine Wright Place Project in Surrey are examples of how perinatal services can work with other community services to solve problems of access to care and to support women’s health by providing services “wrapped around” women and their babies. These programs work in partnership with innovative providers of withdrawal management services such as those at BC Women’s Hospital, as well as with child welfare services and many other community-based providers of housing, children’s, Aboriginal, violence, nursing and other services.
Many smaller communities are creating smaller scale perinatal support networks that are based on a compassionate and comprehensive service orientation.
Each of these levels of prevention is important in itself, and optimally, they reinforce each other. As each level of prevention builds, the stigma associated with substance use in pregnancy is reduced and we move forward with effective support of women’s health that truly makes prevention of FASD possible.
About the Authors
Nancy and Cristine work with BC Women’s Hospital, the British Columbia Centre of Excellence for Women’s Health and the British Columbia Reproductive Care Program, supporting the implementation of the ActNow Healthy Choices in Pregnancy initiative
Greaves, L. & Poole, N. (2005). Victimized or validated? Responses to substance-using pregnant women. Canadian Women’s Studies Journal, 24(1), 87-92.
Stratton, K.R., Howe, C.J. & Battaglia, F.C. (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention and treatment. Washington, DC: Institute of Medicine, National Academy Press.
Health Canada. (2003). Fetal alcohol spectrum disorder (FASD): A framework for Action. Retrieved from www.phacaspc.gc.ca/publicat/fasdfw-etcaf-ca/index.html.
Government of British Columbia. (2003). Fetal alcohol spectrum disorder: A strategic plan for British Columbia. Retrieved from www.mcf. gov.bc.ca/fasd/pdf/fasd_ strategic_plan-final.pdf.
Poole, N., Horne, T., Greaves, L. et al. (2004). Windows of opportunity: A statistical profile of substance use among women in their child bearing years in Alberta. Edmonton, AB: Alberta Alcohol and Drug Abuse Commission.