About FASD Prevention

Canadian prevention specialists have identified four mutually reinforcing prevention approaches as effective in delivering FASD prevention, linked to overall policy strategies. The four levels span general and specific practices that assist women to improve their health and the health of their children, with support from family, support networks, services and community.

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.

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.

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 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.

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.

Supportive child welfare policy – It is also important that maternal/child health and substance use policy is in alignment with 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.

Two Key documents on FASD prevention

Over the past decade, prevention experts working with CanFASD have collaboratively created the following key documents to guide FASD prevention work in Canada.

Consensus Statement on 10 Fundamental Components of FASD Prevention from a Women’s Health Determinants Perspective – Ten fundamental components of FASD prevention emerged from a working session of the Network Action Team on FASD prevention. is session was held in Victoria, B.C., in March 2009, and was funded by the Canadian Institutes for Health Research. is consensus document weaves together a range of sources—women’s experiences, peer-reviewed research, published articles, as well as expert evidence—to create a clear message regarding the importance of FASD prevention from a women’s health determinants perspective.

Prevention of Fetal Alcohol Spectrum Disorder (FASD) – A multi-level model – This issue paper summarizes what has been learned about the prevention of FASD in the course of implementation of prevention initiatives across Canada and describes the four levels of FASD prevention.

Annual Annotated Bibliographies

Each year the pNAT researchers identify articles from the academic literature published in English on FASD prevention. We then organize the articles according to our 4 level prevention model.

Journal Articles

Journal articles describing overall FASD prevention efforts authored by Prevention Network Action Team members include:

Poole, N., Schmidt, R., Green, C., & Hemsing, N. (2016). Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps Substance Abuse Research and Treatment, 10(S1). doi:10.4137/SART.S34545. eCollection 2016

Pei, J., Tremblay, M., McNeil, A., Poole, N., McFarlane, A. (2016). Neuropsychological Aspects of Prevention and Intervention for FASD in Canada. Journal of Pediatric Neuropsychology. doi:10.1007/s40817-016-0020-1

What do we mean by Level 1 Prevention?

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.

Four Part Prevention Model

Journal articles

Journal articles describing Level 1 FASD prevention efforts authored by Prevention Network Action Team members include:

Fetal Alcohol Spectrum Disorder: What does Public Awareness Tell Us about Prevention Programming? – International Journal of Environmental Research and Public Health. Peter Choate, Dorothy Badry, Bruce MacLaurin, Kehinde Ariyo and Dorsa Sobhani (2019). This paper reports on a secondary data analysis of public awareness in one Canadian province looking at possible creative pathways to consider for future prevention efforts.

“No Alcohol Is Recommended, But . . .”: Health Care Students’ Attitudes About Alcohol Consumption During Pregnancy. Global Qualitative Nursing Research. Kelly D. Coons, Shelley L. Watson, Nicole M. Yantzi, Nancy E. Lightfoot, Sylvie Larocque (2017). doi:10.1177/2333393617707663

Awareness Materials

As well as academic publications, NAT members and others across Canada prepare resources to guide improvements in practice and policy, to support the prevention of FASD. Here are some examples related to Level 1 prevention.

FASD Awareness Day infographic – What we know about pregnancy and alcohol, and what women have found helpful when making decisions to stop drinking in pregnancy.

What Men Can Do to Help – Preventing FASD is about more than telling women not to drink alcohol during pregnancy – in fact, this approach can often lead to more harm than good. Researchers and service providers who are part of the Canada FASD Research Network have some suggestions for men who want to make a difference.

Thumbnail for What Men Can Do to Help infographic

Substance Use and Pregnancy Infographics

Issue papers

Issue papers related to this level of prevention include:

The Efficacy of Warning Labels on Alcohol Containers for Fetal Alcohol Spectrum Disorder Prevention – This issue paper explores the effectiveness of alcohol warning labels as an FASD prevention strategy and offers ideas to increase the potential use and impact of warning labels.

The effectiveness of alcohol warning labels for reducing drinking in pregnancy: A brief review – Fetal Alcohol Spectrum Disorder (FASD) is prevalent in many countries around the world. One approach to FASD prevention is the use of alcohol warning labels (AWLs) to provide information about the risks associated with alcohol consumption during pregnancy. Although AWLs are a policy option commonly supported by the general public, their effectiveness for changing behaviour among high-risk maternal drinkers has not been documented in the research and their use remains controversial.

Genetic and Epigenetic Perspectives on the Role of Fathers in Fetal Alcohol Spectrum Disorder – The purpose of this issue paper is to summarize the current research on the genetic and epigenetic perspectives of the potential contribution of fathers to FASD.

The Role of Partners in Fetal Alcohol Spectrum Disorder Prevention – This issue paper highlights the role of partners in influencing maternal alcohol consumption and offers suggestions to further integrate partners into FASD prevention efforts. Although most research to date has focused largely on the role of fathers in contributing to women’s substance use, we acknowledge that partners can be men, women, or gender-diverse people, and that some women may have multiple partners or may be single by choice or circumstance.

What do we mean by Level 2 Prevention?

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.

Four Part Prevention Model

Journal articles

Journal articles describing Level 2 FASD prevention efforts authored by Prevention Network Action Team members include:

Nathoo, T., Wolfson, L. Gelb, K., Poole, N. (2019). New approaches to brief intervention on substance use. Canadian Journal of Midwifery Research and Practice. 18(1), 10-21.

Poole, N., Schmidt, R. A., Bocking, A., Bergeron, J., & Fortier, I. (2019). The potential for FASD prevention of a harmonized approach to data collection about alcohol use in pregnancy. International Journal of Environmental Research and Public Health, 16(11). doi:10.3390/ijerph16112019

Health Care Students’ Attitudes About Alcohol Consumption During Pregnancy: Responses to Narrative Vignettes. Global Qualitative Nursing Research. Kelly D. Coons, Shelley L. Watson, Nicole M. Yantzi, Nancy E. Lightfoot, Sylvie Larocque (2017). DOI: 10.1177/2333393617740463

Preconception health care interventions: A scoping review. Sexual and Reproductive Healthcare, 14C, 24-32. Hemsing, N., Greaves, L., & Poole, N. (2017). doi:10.1016/j.srhc.2017.08.004

“No Alcohol Is Recommended, But . . .”: Health Care Students’ Attitudes About Alcohol Consumption During Pregnancy. Global Qualitative Nursing Research. Kelly D. Coons, Shelley L. Watson, Nicole M. Yantzi, Nancy E. Lightfoot, Sylvie Larocque (2017). doi:10.1177/2333393617707663

Robertson-Boersma, D., Butt, P., Dell, C. (2015). Reflections on how a university binge drinking prevention Initiative supports alcohol screening, brief intervention, and referral for student alcohol use. Yale Journal of Biology and Medicine 88(3): 339-346

Reports

As well as academic publications, NAT members and others across Canada prepare resources to guide improvements in practice and policy, to support the prevention of FASD. Here are some examples related to Level 2 prevention.

Doorways to Conversations: Brief Intervention on Substance Use with Girls and Women – Brief interventions are collaborative conversations between an individual and a health care or social service provider about a health issue such as substance use, mental wellness, contraception, or experiences of violence and trauma. Brief interventions may be formal or informal, structured or unstructured, short or long, a one-time event, or a series of conversations over a period of time. Because substance use has wide-ranging effects on many different aspects of life, service providers across a range of health care and social service settings can have an important role in addressing the potential harms of substance use and improving overall health. This resource focuses on brief intervention with girls and women in the preconception and perinatal period.

Brief Intervention on Substance Use with Girls and Women: 50 Ideas for Dialogue, Skill Building, and Empowerment – Brief interventions are collaborative conversations about a health issue such as alcohol and pregnancy. This resource focuses on brief intervention on alcohol and other substance use with girls and women, on conversations that involve the potential harms related to substance use and also on improving girls’ and women’s overall health.

Small steps matter poster – This poster is designed for use by services involved in prevention of alcohol, tobacco and other substance use in pregnancy. On the front it is a poster, and on the back is information for service providers on supporting women, families and communities from a harm reduction stance. This resource was developed with the support of the Education and Training Council, Alberta FASD Cross Ministry Committee and was reviewed by members of the CanFASD Research Network with prevention expertise.

Issue Papers

Issue papers related to this level of prevention include:

Cannabis Use During Pregnancy – In 2018, the Canadian government introduced legislation that would allow adults to legally possess and use cannabis. This issue paper explores what is known about the effects of cannabis use during pregnancy.

Information Sheets

These information sheets may be helpful to service providers who discuss substance use with pregnant women and new mothers.

What do we mean by Level 3 and 4 Prevention?

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 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.

Four Part Prevention Model

Journal articles

Journal articles describing Level 3 and 4 FASD prevention efforts authored by Prevention Network Action Team members include:

Hubberstey, C., Rutman, D., Schmidt, R., van Bibber, M., & Poole, N. (2019).Multi-service programs for pregnant and parenting women with substance use concerns: Women’s perspectives on why they seek help and their significant changes. International Journal of Environmental Research and Public Health, 16(8 ), 3299. doi:10.3390/ijerph16183299

Hubberstey, C., Rutman, D., Poole, N., Hume, S., & Van Bibber, M. (2015). Toward an evaluation framework for community-based FASD prevention programs. Canadian Journal of Program Evaluation. 30(1), 79-89

Marcellus, L., MacKinnon, K., Benoit, C., Phillips, R., Stengel, C. (2015). Reenvisioning Success for Programs Supporting Pregnant Women With Problematic Substance use. Qualitative Health Research, 25(4), 500-512

Reports and other Resources

As well as academic publications, NAT members and others across Canada prepare resources to guide improvements in practice and policy, to support the prevention of FASD. Here are some examples related to Level 3 and 4 prevention:

Harm Reduction and Pregnancy – Community-based approaches to Prenatal Substance Use in Western Canada. Since the 1990s, services for pregnant women and mothers using harm reduction approaches have emerged in many areas of Canada. Harm reduction is an approach that helps to reduce the negative e ects of alcohol and drug use at the same time as helping women to meet their immediate health, social and safety needs.

Supporting Pregnant and Parenting Women Who use Substances: What Communities are Doing to Help – Communities across Canada are becoming increasingly aware of issues related to pregnancy, alcohol and substance use, Fetal Alcohol Spectrum Disorder, and child health and development. In many communities, the needs of pregnant women with substance use issues are of particular concern as they often intersect with issues such as poverty, unsafe or inadequate housing, violence and abuse, food insecurity, and other health and social issues. This document profiles the development of single-access programs in four different communities and talks about why this type of program works.

Substance Use During Pregnancy: An Overview of Key Canadian Policy and Practice Areas – This backgrounder provides a brief overview of several important areas of policy-making and discusses how policy can contribute to developing supportive health and social services to effectively address substance use during pregnancy.

Parent-Child Assistance Program in Alberta First Nation Communities Evaluation Report — The evaluation was undertaken to provide key information about how the Parent–Child Assistance Program (PCAP) was being implemented in order to identify areas for improvement, and to provide outcome information to stakeholders to inform decision-making regarding ongoing implementation of PCAP in First Nation communities.

Environmental Scan of Prenatal Services for Marginalized Women in Alberta: Specialized Services — The Marginalized Women Working Group was formed by the Maternal Newborn Child and Youth Strategic Clinical Network to examine the availability and access to prenatal care services for marginalized women in Alberta. This environmental scan has been conducted to determine what prenatal services currently exist for marginalized women in Alberta and identify any gaps or opportunities that may be present.

Understanding mothers experiencing homelessness: A gendered approach to finding solutions for family homelessness — This report examines social experiences for mothers and children who are experiencing homelessness in two shelters and one housing program in Calgary, Alberta. Currently, much of the research on homelessness and what works for supporting individuals into sustainable housing comes from research on the single, adult, male population. This study provides evidence to better understand how families become homeless, and the experiences of mothers and children as they move within various public systems while dealing with a history of violence, trauma, and poverty. We conclude with several recommendations, from an asset- or strength- based approach, to reduce structural barriers, bridge gaps between public systems, increase access and availability of supports and ensure cultural supports and trauma-informed care is at the root of interventions for vulnerable women and children.

Supporting Families at Sheway and Beyond Self, Recovery, Family, Home. This longitudinal study led by Dr Lenora Marcellus identified housing issues for new mothers and their families, and makes recommendations for programming and funding policy to reduce the burden on these mothers and children.

Issue papers

Issue papers related to this level of prevention include:

Taking a relational approach: the importance of timely and supportive connections for women – This issue paper has been prepared for decision makers, health system planners and service providers interested in improving care for women at risk of having a child a ected by Fetal Alcohol Spectrum Disorder. It has been prepared by members of the CanNorthwest FASD Research Network’s Action Team on FASD Prevention from a Women’s Health Determinants Perspective. is sheet describes the rationale for multi-faceted relational approaches, and extended timeframes for engagement and support, and finishes with ten recommendations for improved care that have implications for policy, system planning and practice.

Journal articles

Journal articles describing Indigenous approaches to FASD prevention, authored by Prevention Network Action Team members include:

Wolfson, L., Poole, N., Ninomiya, M. M., Rutman, D., Letendre, S., Winterhoff, T., . . . Rowan, T. (2019). Collaborative action on fetal alcohol spectrum disorder prevention: Principles for enacting the Truth and Reconciliation Commission Call to Action #33. International Journal of Environmental Research and Public Health. 16(9). doi:10.3390/ijerph16091589

Reports and other Resources

As well as academic publications, NAT members and others across Canada prepare resources to guide improvements in practice and policy, to support the prevention of FASD. Here are some examples:

Indigenous Approaches to FASD Prevention: Revitalizing Culture and Healing – The seven programs highlighted in this booklet exemplify how Indigenous communities across Canada are working to integrate culture and healing into their efforts to improve the health of women, children, and their families. Each program has thoughtfully drawn upon traditional notions of wellness, whereby culture and language, coordinating basic needs, and addressing complex challenges become a part of community-based strategies. These go beyond how we have previously created FASD prevention programs to promote healing through language, ceremony, protocols, traditional knowledge, Elders, and (re)building cultural identity for individuals and communities.

Developing an Indigenous approach to FASD – Eight Tenets for Enacting the Truth and Reconciliation Commission’s Call to Action #33

Indigenous Approaches to FASD Prevention – These 5 booklets highlight how FASD prevention is understood and practiced in Indigenous traditional culture, recognize the historical, social, political, economic and cultural dimensions of alcohol use during pregnancy, and promote Indigenous women’s health and wellness overall. The series is a collaboration of The Centre of Excellence for Women’s Health, the Thunderbird Partnership Foundation, and the Canada FASD Research Network.

Reframing Fetal Alcohol Spectrum Disorder: Studying Culture to Identify Communication Challenges and Opportunities — Implicit cultural understandings challenge those working to increase public awareness and support for programs to prevent and address FASD. Understanding these cultural beliefs reveals key challenges that communicators face; it also helps identify opportunities to foster public engagement and build support for policies and programs that are important for reducing the prevalence of FASD as a public health issue. Through a series of interviews with members of the public in Manitoba, Canada, the cultural models that members of the Manitoban public draw on to make sense of this issue are identified.

Media Releases

June 1, 2017:

New Consensus on FASD Strategies: English | français

Attached consensus statement: English | français

Issue papers

Issue papers related to this level of prevention include:

The pNAT Team

In the fall of 2006, the Canada FASD Research Network began funding a Prevention Network Action Team (pNAT). Since that time, the pNAT has been building a network of researchers, service providers, health planners, and community partners working on FASD prevention issues, as well as mothers of children with FASD.

Our pNAT has over 70 active members from across the country. We work with a broad spectrum of organizations and institutions, located all across Canada’s vast geography: from Whitehorse to Iqaluit, from St John’s to Victoria.

pNAT team photo
The pNAT team meeting in 2009 in Victoria where we created the first consensus document

Our pNAT has over 70 active members from across the country. We work with a broad spectrum of organizations and institutions, located all across Canada: from Whitehorse to Iqaluit, from St John’s to Victoria.

The pNAT meets monthly in a virtual learning community. In the meeting we update each other on our regional and local work and discuss research, policy and practice developments related to FASD prevention.  All researchers, service providers, policy analysts working on FASD prevention issues as well as women with lived experience are welcome to join the pNAT meetings.

We also have face to face meetings, usually once a year, often in conjunction with a conference on FASD related issues.

Reports

This report illustrates some highlights of the work of the pNAT

The Power of Networking — Highlights of the work of the Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective