Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
6.Prevention Of FASD
Carol Bower, Lorian Hayes and Agnes Bankier
Fetal Alcohol Spectrum Disorders (FASD) are the end point of a complex interaction between genetic, social, political and environmental risks (Elliott and Bower 2004). The causal pathway to FASD is complex and prevention requires consideration and modification, where possible, to the antecedent risk factors. Prevention of FASD is not a problem for health alone but for a range of government portfolios including education, housing, justice and community services. Nevertheless, most strategies to prevent FASD will depend on both health professionals and women of childbearing age being knowledgeable about the effects of alcohol use in pregnancy including FASD and a willingness and ability of women to avoid alcohol in pregnancy.
Prevention of alcohol use in pregnancy and FASD requires a comprehensive and multifaceted approach that includes a range of prevention initiatives undertaken at three levels: primary, secondary and tertiary. As alcohol use in pregnancy is higher in some subgroups, prevention initiatives at each level should incorporate contextual information, including an understanding of cultural and sociological frameworks. Targeted strategies will be strengthened significantly by ongoing measures to address broader community attitudes towards and behaviours around alcohol consumption.
Consuming alcohol at risky levels is associated with a higher incidence of FASD. As there is evidence to suggest that per capita alcohol consumption is an indicator of heavy drinking in a community, population based strategies to reduce overall consumption may reduce arms
(Rose 1992). Therefore reducing the prevalence of risky drinking at the population level should reduce alcohol-related harms including the incidence of FASD.
Primary prevention requires an integrated approach that combines evidence-based social marketing initiatives with policy practices that influence the way alcohol is portrayed and is made available. This approach requires coordinated action nationally, jurisdictionally and locally for optimal impact. Primary prevention includes universal education messages to reduce acceptance of risky drinking and to inform both health professionals and the public, particularly young people, about the dangers of drinking during pregnancy. Messages may be
communicated through a range of media, employment, educational and recreational outlets as well as through activities such as warning labels on the containers of alcoholic beverages, and provision of written information at a range of locations such as health care centres.
These education messages must be supported by policy initiatives and legislation that are effective and sustained. They include, but are not limited to, supply and demand strategies such as alcohol pricing (taxation), labelling, availability and the way that alcohol is advertised and promoted in the community. Legislative restrictions on outlets, the alcohol content of beverage, take-away availability and dry communities through community agreement (with legislation) may be beneficial (Australian Human Rights Commission 2011).
Secondary prevention involves actions targeting persons at risk. In this situation this refers to women who drink alcohol and are in the reproductive age range and/or who are pregnant. A range of strategies should be developed for this group including screening and early intervention programs and services. The importance of partners in supporting women not to drink has also been identified (Centers for Disease and Control 2006). To reduce prenatal alcohol exposure, prevention efforts should include contraceptive advice to women who are
having unprotected sex. A USA study by Floyd et al. reported a positive effect from a brief intervention (including motivational interviewing to reduce drinking and increase contraception use) on reducing the risk of an alcohol affected pregnancy (Floyd et al. 2007).
Women who are drinking at risky levels during pregnancy and those who have previously given birth to a baby with a FASD should be targeted in tertiary prevention programs. These initiatives will need to incorporate broad interventions that recognise the complexity of the
problems faced by these women often including poverty, disadvantage, lack of support and poor mental and physical health.