Fetal alcohol spectrum disorder (FASD) prevention is about more than alcohol use during pregnancy. It is about creating the conditions that support healthy pregnancies, improve health and wellbeing, and help people access the support they need.
Canadian prevention specialists have identified four mutually reinforcing levels of FASD prevention. Together, these approaches recognise that preventing alcohol use in pregnancy requires support from individuals, families, healthcare providers, services, communities, and policymakers. September is FASD Month and this year’s theme is Everyone Plays a Part: It Takes a Community. The four levels of prevention provide a useful framework for understanding what this can look like in practice. From raising awareness and encouraging supportive conversations to providing specialised services and continuing support after pregnancy, each level has an important role to play.
What is FASD prevention?
FASD is a lifelong disability associated with prenatal alcohol exposure. Alcohol use during pregnancy is complex, and there are many reasons why it may occur. Prevention is not simply about telling someone to stop drinking. This approach does not recognise the realities of people’s lives and can contribute to stigma rather than meaningful support.
Factors such as poverty, housing, nutrition, access to prenatal care, violence, trauma, grief, stress, and isolation can influence health and alcohol use. Addressing these interconnected factors is an important part of preventing alcohol use in pregnancy. The four levels of prevention provide a framework for responding to these realities through awareness, conversation, specialised services, and ongoing support.
It is important to note that using terminology such as “FASD prevention” or “prevention of FASD” may be seen in some spaces as being stigmatizing. This language may cause individuals with FASD to feel as though they, as people, should be prevented. When talking about prevention, we need to recognize and emphasize that this work is not about preventing people with FASD from existing, but rather about supporting women and gender diverse people to avoid or reduce their alcohol use during pregnancy.
Level 1: Raising awareness and promoting health
The first level of prevention is about raising public awareness through campaigns and other broad strategies. Public policy initiatives and health promotion activities supportive of girls’ and women’s health are also key to this level of prevention. The inclusion of a broad range of people at the community level is important to advancing social support and change.
At this level, everyone has a role to play. Families, friends, schools, workplaces, healthcare organisations, community groups, cultural communities, and professionals can all contribute to creating supportive environments!
Level 2: Encouraging safe and respectful conversations
The second level of prevention is about girls and women of childbearing years having the opportunity for safe discussion about reproductive health, contraception, pregnancy, alcohol use, and related issues, with their support networks and healthcare providers.
Doorways to Conversations: Brief Intervention on Substance Use with Girls and Women provides guidance on brief interventions and opportunities for supportive conversations in different practice settings. The accompanying 50 Ideas for Dialogue, Skill Building, and Empowerment offers practical ideas for discussing substance use while also focusing on women’s overall health and wellbeing.
Level 3: Providing specialised and accessible support
The third level of prevention concerns the provision of supportive services that are specialized, culturally safe and accessible for women with alcohol problems, histories of violence and trauma and related health concerns. These trauma-informed, harm-reduction-oriented recovery services are needed not only for pregnant women, but also before pregnancy and throughout the childbearing years.
The Digital Handbook on Wraparound Programs provides guidance for developing and sustaining wraparound programs for people who are pregnant or parenting while experiencing substance use and other concerns.
Level 4: Continuing support after pregnancy
The fourth level of 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 to assist them to continue to improve their health and social support, as well as the health of their children.
This info sheet describes how Level 4 prevention involves continued support after childbirth, wrapping care around the mother-child unit.
Supportive policies are central to prevention
Supportive alcohol policy is at the centre of the four mutually reinforcing 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.
It is also important that maternal/child health and substance use policy is in alignment with supportive child welfare policy to ensure that care is wrapped around the mother child unit, and women are not afraid to access prenatal care out of fear of losing custody.
Everyone plays a part
The four levels of prevention show that no single person, service, or organisation can do this work alone. Each of us can learn more about FASD, challenge stigma, create space for supportive conversations, connect people with services, and advocate for policies that promote health and wellbeing.