In Canada, the Four-Part Model of FASD Prevention is used to describe the continuum of multi-sectoral prevention efforts, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic wraparound support services for pregnant and postpartum women with alcohol and other health and social concerns. Supportive alcohol policy is at the centre of these four mutually reinforcing levels of prevention, yet there has been little attention paid to the role of alcohol policy in FASD prevention and in promoting women’s and fetal health.
Alcohol policies are important because they determine the availability of alcohol and aspects of the environment in which decisions about drinking are made, such as the geographic density of alcohol serving establishments, health and safety messaging, and alcohol use guidelines (including Canada’s new Guidance on Alcohol and Health).
In 2023, researchers from the Centre of Excellence for Women’s Health wrote a review describing the state of the literature on alcohol and pregnancy policies and their impact across the four-part model of prevention. The findings primarily centered around alcohol warning labels, pregnancy guidelines and their national and regional uptake.
Alcohol Warning Labels
The findings emphasized that while the efficacy of alcohol warning labels as a single strategy is unclear, they are an important part of a comprehensive FASD prevention strategy. Further, in Canada, researchers have found that alcohol warning labels can contribute to a reduction of alcohol sales.
While there was an emphasis on the knowledge and uptake of guidelines on alcohol use in pregnancy and lower-risk drinking, the research findings demonstrated wide variability internationally, including inconsistent messaging around alcohol use. Despite this, knowledge of the risks of alcohol use during pregnancy and a belief that women are motivated to reduce their alcohol use if pregnant or planning a pregnancy were identified as facilitators to guideline adherence.
In the research, there was an increasing focus on alcohol and pregnancy legislative policy, particularly in the US. These ranged from punitive approaches that reported women’s behaviour and prompted child removal to supportive policies that improve women’s health and support the provision of early intervention and treatment services. In examining the evolution of such policies, US researchers found that the number of alcohol policies have increased and in an increasingly punitive policy environment, are often associated with restricting women’s reproductive autonomy.
Supporting FASD Prevention, Women’s Health, and Cross-System Collaboration
Shifting policies to be more supportive of FASD prevention requires the development of evidence-based policies that attend to, and proactively promote, women’s health. Moving forward, it is particularly important that alcohol policies – and supportive alcohol policies at that – are linked to child welfare policies that support mothering. They are depicted together and central in the four part model diagram. This cross-system collaboration can help create a higher standard of care and address the barriers that prohibit women from seeking care in the first place. Through this collaboration, women will be supported to have healthy pregnancies, linked to treatment and diagnosis as necessary, and have access to services that prioritize their needs and goals.