In my work as a neonatologist, I've looked after many, many babies. I've seen families of all ages, cultures and circumstances. But I've never seen a mother who wanted to harm her growing baby. Yet too often I still see mothers who use alcohol during pregnancy despite extensive educational campaigns about its harmful effects on the growing fetus.
Alcohol use in pregnancy can result in Fetal Alcohol Spectrum Disorder (FASD). FASD is a lifelong disability, which may include intellectual and learning disorders, facial differences and social and emotional difficulties. Not all babies exposed to alcohol in utero develop FASD, but many do.
It's easy to judge, but the truth is, consistently practicing healthy behaviours is not as simple as it sounds. There are often many barriers that may affect a person's ability to do what they know they should.
Studies show that women who use alcohol in pregnancy often deal with many other problems at the same time -- physical and mental health disorders, an abusive partner, addictions, homelessness and food insecurity, among other possible issues. So designing programs to adequately support women in such situations can be challenging.
This is where InSight comes in. Insight is a Manitoba-based program where mentors work with women at risk of having an infant with FASD. Participants work with a mentor for three years to set and achieve goals for small, positive behavioural changes. The good news -- it works.
In a recent report from the Manitoba Centre for Health Policy, my colleagues and I demonstrate that women involved in the InSight program made many important gains. They accessed prenatal and other health care at greater rates, they reduced their use of alcohol, both in and outside of pregnancy, and they had greater connections to social supports such as housing, income assistance and postnatal family support programs.
Their children were also more likely to be assessed for FASD which likely results in connection to appropriate services, and ultimately, improved outcomes for the child. Importantly, we also found that due to the women's behavioural changes with mentor support, the children born to women during the program were less likely to be taken into the care of Child and Family Services.
But it wasn't all good news. The report also showed some unexpected findings, which identify areas to change or expand the supports offered through InSight.
Our report indicates some of the benefits that were seen during the program did not persist after the women left the program. Some women previously engaged in InSight reported increased social isolation, most likely because they lost previous networks of support after changing their behaviours. Going forward, we must find a way to ensure that before an InSight mentor is removed, appropriate other social supports are in place. Lasting positive change shouldn't be expected to happen overnight.
Also, despite having fewer children taken into foster care overall, more newborns were taken into care during the Insight program than in our (lower risk) control group. This can be prevented. The risk of having their babies taken away is a fear that can stop women from accessing supports to reduce their alcohol use during pregnancy. And separating mothers and their newborns increases the risk for postpartum depression and decreases breastfeeding, among other detrimental effects.
The solution? It's a systems problem. We have an opportunity here for child protection agencies to work directly with the InSight program to reduce the occurrence. Insight participants are already attending prenatal care and receiving other supports. Child protective services should allow time for participants to benefit from the program before assessing the home situation. Insight could help provide whatever is needed to allow participants to take their newborns home wherever possible with appropriate surveillance to ensure the safety of the family.
When faced with complex problems requiring complex solutions many people don't know where to start. Our evaluation suggests that the women in InSight know themselves where to start -- but they need support to get there and stay there.
Addressing poverty, intimate partner violence and mental health issues may take a while, but until we make progress on these pressing issues, expecting there to be quick fixes for reducing alcohol use in pregnancy is unrealistic.
Programs like InSight are critical because they are non-punitive in addressing substance use and addictions and address the underlying determinants of disease. When we encounter families and patients affected by drug and alcohol use, we should ask why they got there and how we can help instead of judging them.
Steps to provide food security, housing and safety from violence go a long way towards solving the problem for mother and baby.
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