Kirsten Morrison, Lindsay Wolfson, Dr. Kelly Harding and Dr. Nancy Poole have produced an issue paper for the Canada FASD Research Network (CanFASD) on Mothers’ Experiences of Stigma: Multi-Level Ideas for Action.

In the paper, the authors argue, “Women who drink alcohol in pregnancy or who have children with FASD experience stigma from the media, health and social service providers, and their friends and family, which can limit women’s access to necessary health and social services. FASD-informed, trauma-informed, and harm reduction oriented health messaging and health education should be adopted to better support women in accessing these needed services. By reducing the stigma and discrimination that women who use alcohol and other substances face while pregnant or mothering, we will improve women’s access to necessary support and prevent FASD going forth.”

Women who experience social inequities, including women of colour and women from lower socioeconomic brackets, may feel unsafe disclosing their alcohol use for fear of judgement from health and social service providers and fear of child protection involvement. In addition, if providers “hold a belief that only certain ‘types’ of women can have a child with FASD, women from other groups who may need help to reduce their drinking may be deterred from asking for it, or may be incorrectly reassured that their drinking is not problematic.”

Responding to research that demonstrates “lack of understanding from health and social service providers and the public, as to the contributing factors to substance use such as trauma, interpersonal violence, stress, poverty, and isolation, can reinforce the belief that women deserve the stigma and discrimination that they receive”, the issue paper identifies opportunities and resources to mitigate stigmatization and better support women who are accessing support services.

“The attitudes of health and social service providers, as well as media representations of mothers who use substances, can influence mothers’ self-efficacy and perceptions of themselves.” A mother may internalize these beliefs, lowering self-esteem and confidence in being a mother to her child, and limiting her capacity to seek supports and services.

“Stigma is considered one of the biggest barriers to women accessing, and practitioners providing, care for pregnant women who use substances…Women may avoid accessing preconception and prenatal care out of fear of being judged by their health providers, or out of fear of child apprehension or criminalization.”

The authors note that organizational policies that require women to be abstinent from substances can limit women’s access to necessary prenatal care, substance use, mental health and harm reduction services, and anti-violence and housing programs. Lack of training in substance use counselling for health practitioners limits understanding of underlying causes and can result in punitive approaches and concern about child removal, which can exacerbate stress-induced responses, e.g. additional drinking to copy, triggering trauma histories, and avoiding access to services.

They welcome recent changes to child protection policies in some Canadian provinces that prioritize keeping families together, commenting, “This shift in practice may bring about promising changes whereby women feel safer to access financial and other supports available from child welfare agencies both when pregnant and parenting.”

The paper makes four recommendations:

·       Women need to feel comfortable seeking support and treatment. Health messaging needs to be compassionate, strengths-based, trauma-informed, and harm-reduction oriented to encourage women to seek supports and services.

·       There is a need for increased training and competence for health care and social service providers in harm-reduction oriented, FASD-informed, and trauma-informed approaches in providing appropriate supports for women with substance-use concerns.

·       There is a need for cross-sector collaboration to expand the use of evidence-base policy and practice approaches which “wrap care around mothers and children” to keep families together and support attachment, resilience and recovery.

·       Evidence-based government-funded health messaging and media campaigns are required to challenge stereotypes and work to address discrimination, making use of language guides, such as Language Matters: Talking about Alcohol and Pregnancy

The issue paper includes links to a group of resources that can be referred to in supporting women and girls who have substance use concerns.