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.

FASD Prevention Model

Level 1

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.

Level 2

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.

Level 3

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.

Level 4

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 Policies

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.

Key FASD Prevention Resources

10 fundamental components of FASD prevention from a women's health determinants perspective
10 Fundamental Components of FASD Prevention

CEWH & CanFASD, 2022
This consensus statement, created in 2009 and updated in 2022, highlights the importance of looking at FASD prevention from a women’s health perspective.

FASD Prevention Model
Prevention of FASD: A Multi-Level Model

CEWH & CanFASD, 2022
This paper explains to four levels of FASD prevention and summarizes what has been learned about FASD prevention.

Developing an Indigenous Approach to FASD

CEWH, Thunderbird Partnership Foundation & CanFASD, 2019
This consensus statement outlines eight tenants for enacting the Truth and Reconciliation Commission’s Call to Action #33.

Girls, Women, Alcohol, and Pregnancy Blog

This monthly blog provides inside into new and upcoming resources and initiatives around girls, women, alcohol, and pregnancy.

ThinkFASD.ca

Created as part of a national alcohol and pregnancy awareness campaign, this site gives you the information you need whether you’re pregnant, thinking about pregnancy, or at risk for an unplanned pregnancy.

A Digital Handbook on Wraparound Programs

Part of the Co-Creating Evidence project, this digital handbook supports the creation, development, ongoing operation, and sustainability of wraparound programs for those who are pregnant and/or parenting with substance use and other concerns (en français).

The Prevention Network Action Team (pNAT)

The Prevention Network Action Team (pNAT) is a pan-Canadian 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 from Whitehorse to Iqaluit, from St John’s to Victoria. The group meets virtually every month. We share highlights of resources and initiatives discussed in our meetings on the pNAT blog, Girls, Women, Alcohol, and Pregnancy. 

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. The 2022 annotated bibliography explores a list of 113 research articles related to FASD prevention.

Review our past annotated bibliographies below. 

Key Journal Articles

These key journal articles authored by pNAT members describe overall FASD prevention efforts:

Supportive Alcohol Policy as a Key Element of Fetal Alcohol Spectrum Disorder Prevention

Wolfson, L. & Poole, N.,
Women’s Health, 2023

At a Juncture: Exploring Patterns and Trends in FASD Prevention Research from 2015 – 2021 Using the Four-Part Model of Prevention

Wolfson, L., Poole, N., Harding, K.D., & Stinson, J.
JFASD, 2022

“The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

Lyall, V., Wolfson, L., Reid, N., Poole, N., Moritz, K.M., Egert, S., Browne, A. J., & Askew, D.A.
International Journal of Environmental Research & Public Health, 2021

Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33

Wolfson, L., Poole, N., Morton Ninomiya, M., Rutman, D., Letendre, S., Winterhoff, T.,… Rowan, T.
International Journal of Environmental Research & Public Health, 2019

Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps

Poole, N., Schmidt, R., Green, C., & Hemsing, N.
Substance Abuse Research and Treatment, 2016

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.

FASD Prevention Model

Resources

As well as academic publications, pNAT 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.

Thinking about Pregnancy: A Booklet to Reflect on Alcohol Use Before You Are Pregnant (2022)

This booklet includes information about why thinking about alcohol use during the preconception period is important as well as activities for reflection.

Title page of booklet Thinking About Pregnancy? A booklet to reflect on alcohol use before you are pregnant

What We Know About Alcohol and Pregnancy (2022)

This inforgraphic summarizes what we know about pregnancy and alcohol, and what women have found helpful when making decisions to stop drinking in pregnancy.

What we know about alcohol and pregnancy infographic

Guidelines for Pregnancy Application (‘App’) Developers (2020)

These guidelines were created to support pregnancy app and online content developers in integrating alcohol- and FASD-related content that is clear, up-to-date, and non-judgmental in order for women, pregnant individuals, and families to learn more about alcohol/substance use during pregnancy and FASD to get the support they may need to have a healthy pregnancy.

Indigenous Approaches to FASD Prevention (2019)

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.

ThinkFASD (2020)

Created as part of a national alcohol and pregnancy awareness campaign, this site gives you the information you need whether you’re pregnant, thinking about pregnancy, or at risk for an unplanned pregnancy.

A couple sits on a rock. The woman is visibly pregnant. Her partner hugs her from behind, cradling her stomach. The text says "drinking and baby-making don't mix. ThinkFASD"

What Men Can Do to Help (2014)

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

Issue Papers

Some of the CanFASD Issue papers address prevention issues and approaches

The Efficacy of Warning Labels on Alcohol Containers for Fetal Alcohol Spectrum Disorder Prevention (2019)

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 Role of Partners in Fetal Alcohol Spectrum Disorder Prevention (2019)

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.

Journal Articles

These key journal articles authored by pNAT members describe Level 1 prevention efforts:

“You Don’t Want to Drink? What are you, Pregnant?!” Portrayals of Alcohol and Substance Use During Pregnancy on Television

Harding, K., Dionne, A., & Harding, E.
JFASD, 2022

Fetal Alcohol Spectrum Disorder: What does Public Awareness Tell Us about Prevention Programming

Choate, P., Badry, D., MacLaurin, B., Ariyo, K., & Sobhani, D.
International Journal of Environmental Research and Public Health, 2019

Are Rural and Urban Ontario Health Care Professionals Aware of Fetal Alcohol Spectrum Disorder? A Secondary Data Analysis of the Fetal Alcohol Syndrome Survey for Health Professionals

Coons, K.D., Clement, A.L., Watson, S.L.
Journal of Developmental Disabilities, 2017

“No Alcohol Is Recommended, But . . .”: Health Care Students’ Attitudes About Alcohol Consumption During Pregnancy

Coons, K.D., Watson, S.L., Yantzi, N.M., Lightfoot, N.E., Larocque, S.
Global Qualitative Nursing Research, 2017

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.

Journal articles

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

Graves, L., Carson, G., Poole, N., Patel, T., Bigalky, J., Green, C., Cook, J. (2020). Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy. SOGC Clinical Practice Guideline, Volume 42, Issue 9, P1158-1173.E1

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

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 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:

Co-Creating Evidence (CCE) evaluation study and Executive summary – This report offers the findings of the Co-Creating Evidence (CCE) evaluation study, that has involved eight community-based, Level 3 and 4 programs that work towards prevention of FASD, that are situated in provinces across Canada. These programs support pregnant and parenting women who use substances and face a range of other health and social issues, through the provision of holistic, wrap-around services. The report describes the common elements these programs offer and the outcomes being achieved from the perspectives of the women who access these programs, the program providers and their community partners.  A set of 12 two-pager info sheets that highlight key findings and promising practices from the CCE study are also available for download.

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.

Alcohol and Breastfeeding – New mothers and health care providers need accurate information about the effects of alcohol intake while breastfeeding. This issue paper summarizes what is known about the effects of alcohol use on lactation, as well as the impact of alcohol use while breastfeeding on infant and child health.

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:

International FASD Prevention Seminar Series

Research about preventing FASD is advancing across the globe. In 2022, CanFASD sponsored a five-part seminar series that brought together 14 researchers from around the world to share what is known about preventing alcohol use in pregnancy and supporting women’s health. View the full five-part series below:

Destigmatizing Considerations

Frameworks for FASD Prevention

Level 1 – Raising Awareness and Community Development Work

Level 2 – Brief Intervention and Support

Levels 3 and 4 – Holistic Support during Pregnancy and Postpartum