In 2008 the Public Health Agency of Canada developed four levels of prevention to guide our efforts in the prevention of FASD. The four levels are:
Level 1 – Raising Awareness
These strategies involve broad awareness building health promotion efforts. This level of prevention is the most common strategy used for prevention. It is important to continue to raise awareness with the entire population and also higher risk populations. However, it is important to remember that this level of prevention is one part of a prevention strategy and it will be more effective if it is used in combination with Levels 2, 3, and 4.
Level 2 – Brief Counselling with Girls and Women of Childbearing Age
These strategies involve discussion of alcohol use and the related risks with all women of childbearing years and their support networks. This level of prevention has shown great promise but it is the hardest to implement. A universal approach to screen all women of childbearing years and their support networks for alcohol use is likely to be a very important strategy in preventing alcohol exposed pregnancies and FASD.
The FASD ONE Prevention Work Group has just developed a poster that can be used across the province to promote the practice of screening for alcohol and birth control use with all women of childbearing years. The resource is targeted to health and social service providers to encourage them to make this a universal practice with all women of childbearing age. The research is strong to support this practice – studies done by the Centre for Disease Control found that the risk of FASD can be decreased by 50% or more by talking to women about alcohol and birth control use before pregnancy.
Information for Health and Social Service Providers to Help Prevent FASD
- Asking About Alcohol and Birth Control Use Together Can Decrease the Risk of FASD
- Why do girls and women drink alcohol during pregnancy?
- Sensibiliser la population en ce qui a trait à la consommation d’alcool et à
l’utilisation de méthodes contraceptives peut réduire les risques de l’ETCAF
- Pourquoi certaines filles et femmes boivent-elles de l’alcool durant la grossesse?
Information for the Public
Best Start http://www.
Level 3 – Specialized Prenatal Support
These strategies involve 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. In Ontario, access to programs that provide specialized addiction services for pregnant women is not equitable in each area of the province. To improve this level of prevention focussing on creating evidence informed addiction programs for pregnant women and women of childbearing age across the province would help to prevent and decrease the impact of FASD.
Level 4 – Postpartum Support
These strategies provide postpartum support for new mothers assisting them to maintain/initiate changes in their health and social networks and to support the development of their children.
Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives Multiple Approaches to FASD Prevention3
Supportive Alcohol Policy at the Core of the Four Levels of Prevention
Supportive alcohol policy is at the centre of the four levels of prevention. Evidence-based alcohol policies, when widely implemented, have considerable potential to reduce the health and social harms from alcohol, including influencing rates of FASD through each level. Alcohol policies are critical because they determine the availability of alcohol and other aspects of the environment in which decisions about drinking are made.
Alcohol promotion and marketing has increased exponentially in the last 20 years and this has affected the amount women are drinking, the frequency with which women are drinking and the number of women binge drinking.
To understand how drinking has become normalized see this article and video from the Washington Post:
Focus on Women of Childbearing Age and Discuss Alcohol and Contraception Together
Approximately 50% of all pregnancies are not planned and almost one half of those occur in women using birth control. The 2009 Canadian Maternity Experiences Survey found that 62.4 % of women drank during the 3 months before pregnancy and binge drinking was reported by 11% of women before they knew they were pregnant. When women were aware of their pregnancy the rate of alcohol consumption in pregnancy decreased to 10.5%.4
Keeping in mind these statistics some programs in Canada and the United States are combining a discussion about birth control and alcohol consumption and using motivational interviewing to reduce the risk of alcohol exposed pregnancies. Studies find that women use birth control more reliably, assess their drinking habits and some women reduce their risky drinking habits as well.
Discussing alcohol with women of childbearing age before they are pregnant is important as many women do not change their alcohol use until they know they are pregnant, which increases the risk of alcohol exposure during the first two months of fetal development.
Centre For Disease Control – Preventing Alcohol Use in Pregnancy – Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES)
The Canada FASD Research Network
This research network has one research team that focusses on prevention of FASD. It has a lot of good information for professionals, policy makers and researchers.
B.C. Centre of Excellence For Women’s Health
This centre does research on and evaluates the effectiveness of programs addressing women’s health. One of their priority areas is Women, Gender, Addictions and Mental Health. The public, professionals, policy makers and researchers will find useful information on this site.
What Strategies Are More Effective When Providing Care To Pregnant Women Using Alcohol?
- Universal alcohol screening for all pregnant women
- Key message regarding alcohol use in pregnancy provided by a health care provider and help with linking to services if needed
- Motivational Interviewing
- Non-judgemental respectful approach
- Women centred approach
- Accepting of a harm reduction approach if the client chooses this path
- Support with Social Determinants of Health
- Recognition of the interconnectedness of addiction, trauma and mental health and support for trauma and mental health issues
- Collaboration between services
- Immediate support for alcohol use and addiction
- Addiction services specific for pregnant and parenting women
- Behaviour changes/care need to be led by the client
- FASD informed approach
B.C. Centre of Excellence for Women’s Health
Supporting Pregnant and Parenting Women Who Use Substances What Programs Are Doing to Help?
Canada FASD Research Network
Consensus Statement on 10 Fundamental Components of FASD Prevention from a Women’s Health Determinants Perspective
Substance Abuse Treatment and Care for Women – Case Studies and Lessons Learned
United Nations Office on Drugs and Crime, 2004