Submitted by Lindsay Wolfson and Toni Winterhoff.

Lindsay Wolfson (MPH) is a Research Coordinator at the Centre of Excellence for Women’s Health and a consultant at the Canada FASD Research Network. She holds a Master of Public Health, Social Inequities and Health, from Simon Fraser University. Lindsay is responsible for research and collaboration on projects relating to the operationalization of the Truth and Reconciliation Commission, fetal alcohol spectrum disorder prevention, and the integration of gender-, trauma- and equity-informed approaches into policy and research.

Toni Winterhoff (Ey Cla:ney) resides and works in in traditional Stó:lō territory and is a member of Xa’xtsa, a Stl’atl’Imx community located at the north end of Harrison Lake. Her present title is Stó:lō Service Agency (SSA) FASD Regional Engagement and Traditional Parenting Coordinator. She is the innovator of the indigenized PCAP program: Family Empowerment Team model as well as the Two Worlds Indigenous Parenting Program, and “Indigenous Healthy Sexuality” Program. Toni is proud to have been a partner on and developer of the Fraser Region FASD Toolkit.
Toni is a facilitator on topics including but not limited to: Impacts of Intensive Perinatal Support, Safer Communities, Mentorship, FASD, Frontline Worker Mental Health Support, Healthy Sexuality, Indigenous Cultural Safety, Professional Standards and Practice Guidelines for Regulated Health Workers, Two Worlds Indigenous Parenting, and Relationship Based Frontline Service Provision.

In the last few years, there has been an increased interest in Indigenous approaches to FASD prevention with FASD emerging as a health and social justice priority in Indigenous communities. The relationship between FASD and Indigenous peoples is complex and rooted in colonialism, institutional and systemic racism, and historical trauma and is of such significance that it was highlighted in the Truth and Reconciliation Commission’s Final Report with Call to Action #33 on FASD Prevention.

Modern collaborative Indigenous approaches have the potential to not only to inform but improve FASD prevention outcomes as well as numerous Maternal Child Health and Wellness outcomes. Intergenerational trauma combined with the loss of Indigenous maternal health teachings and skills created a vacuum of maternal health and wellness for many Indigenous women and mothers in Canada over several generations. This vacuum created the foundation for the perceived inertia found in some Indigenous communities and can still be felt in some communities while on their journey for better, more holistic maternal health and wellness.

Central to Indigenous wellness is balance in all things. This balance is delicate, but its strength lies in its malleability and its capacity for modern medicine to be interwoven with traditional knowledge, healing practices, and teachings. Although Indigenous cultures and teachings vary greatly across diverse First Nations, Inuit, and Métis communities in Canada, there are a few universal threads that Indigenous approaches to FASD prevention utilize.

1. Relationships are central to wellness, healing, and health. Work and engagement with each other must focus on building or maintaining the relationships between individuals, families, and communities. In practice, it is important that we continuously share and acknowledge who we are, where we come from, and identify our values, knowledge we carry, and strengths we bring to the wellness journey.
2. Strengths-based approaches should be adopted rather than focusing on perceived weakness or deficiencies. Strengths-based models avoid defining individuals through labels or stigmatizing women through claims that FASD is “100% preventable”. Instead, these models look to build upon individuals’ strengths and skills. Nurturing these strengths through community supports and acknowledges a common core cultural teaching that we each carry strength, but no one carries enough of it alone.
3. Children are the future. Children remain at the center of Indigenous values, priorities, and families. Recognizing children’s role, and the important cultural roles of pregnancy, child birth, and child rearing as a sacred part of the life cycle can disrupt cycles of intergenerational trauma and may help foster close engagement with traditional and western prenatal health practices.

Indigenous approaches to FASD prevention acknowledge individuals’, families’ and communities’ past journeys, their present strength, and their future goals. Working across communities and tailoring interventions to meet the needs of individuals, families, and communities allows for customization and best potential of success for FASD prevention and maternal health outcomes. Often, these initiatives may not be named ‘FASD prevention’ but are important to recognize as they meaningfully address the broad social and structural issues that are associated with alcohol use in pregnancy.