FASD and Stigma… Consequences of admission of alcohol consumption

Fetal Alcohol Spectrum Disorders (FASD) is a range of complex conditions caused by alcohol consumption by mothers during their pregnancy. Exposure to alcohol can cause severe harm to the unborn fetus that ultimately leads to the major characteristics of FASD: growth retardation, unique craniofacial abnormalities and damage to the central nervous system [reviewed in (Liyanage et al., 2017)]. Alcohol consumption and its consequences on individuals, families and the society have lead it to be considered as a public health issue and social concern, in fact into a ‘moral panic’ in the 1980s (Armstrong et al., 2000).

Is it necessary to confirm the mother’s alcohol consumption?

Mothers’ admission of alcohol consumption during pregnancy is required for FASD diagnosis. However, no every pregnant woman is forthcoming about their drinking behaviors. I believe that the healthcare professionals should play a role in sensitively and empathically inquiring about the alcohol consumption by mothers, because guilt, blame or stigma associated with the situation may result in mothers not to disclose their alcohol consumption. Which in turn may have negative consequences and challenges in diagnosing the affected child’s condition as FASD. “Stigma can act as a barrier to acceptance, social interaction, health care or adoption,” says Eric Racine (Langelier, September 10, 2015) who published an article on the impact of stigma against FASD and mothers (Bell et al., 2016).

Why mothers are stigmatized for their admission of drinking?

Women who drink during pregnancy, as well as the mothers of children with FASD, are stigmatized (P. W. Corrigan et al., 2018). The nature of stigma described in association with the admission of alcohol consumption by biological mothers during pregnancy included taking personal responsibility for their child’s condition, shame, and guilt by their past behaviors. Media can also play a role in creating or facilitating this stigma for either sympathetically towards children with FASD or shaming the mothers. Some media programs showed sympathy towards the mothers of children with FASD (Eguiagaray et al., 2016). Nevertheless, the stigma comes with the endorsement of prevention of drinking during pregnancy or increasing public awareness and showing support for the families of children with FASD (P. W. Corrigan et al., 2018).

It is unfortunate that most biological mothers are often be blamed for admitting that they consumed alcohol, even though some women are not aware of their pregnancy status while they drank (Healthy Child Manitoba; Muggli et al., 2016). For example, a report by the Health Child Manitoba mentions that “In Manitoba, 14% of women report drinking alcohol before knowing they were pregnant” (Healthy Child Manitoba). In fact, many of the pregnant women stop drinking after they are aware of their pregnancy (Muggli et al., 2016). Unfortunately, the gestation time of alcohol exposure is a significant factor in FASD, that the exposure during the first trimester (most women are unaware of their pregnancy during this period) may cause severe damage to the fetus (Muggli et al., 2016).

What can we do to reduce stigma?

FASD is preventable by avoiding alcohol consumption, but if knowing or unknowingly a mother consumes alcohol, subjecting that person to stigma, blame and shame do not help the situation. Therefore, families, healthcare professionals, and the community should be educated to reduce the stigma around this issue. One article published in 2017 in the USA, suggested that mothers who admitted alcohol consumption while pregnant are highly stigmatized and discriminated in the society for their previous behavior (Patrick W. Corrigan et al., 2017). They suggest contact‐based stigma reduction and prevention strategies, over education‐based strategies. Healthcare professionals and society should encourage mothers to rise over the challenges of stigma for their actions, and practice openness (Eguiagaray et al., 2016).

Many FASD-associated organizations implement campaigns and programs to reduce and prevent stigma of the mothers and families of children with FASD. Examples are

(https://fasdlearningwithhope.wordpress.com/2016/04/04/stigma/ )

As human beings, we should be more responsible before blaming or shaming someone for their actions. Living with a child with FASD is difficult by its own. While public awareness of the drinking while pregnant and FASD is highly necessary, it should be carried out without stigmatizing women who drink, mothers and families of children with FASD and adult/youth with FASD.

Note: The ideas expressed in this blog are my own.

References

Armstrong, E. M., Abel, E. L. J. A., & alcoholism. (2000). Fetal alcohol syndrome: The origins of a moral panic. 35(3), 276-282.

Bell, E., Andrew, G., Di Pietro, N., Chudley, A. E., N. Reynolds, J., & Racine, E. (2016). It’s a shame! Stigma against fetal alcohol spectrum disorder: Examining the ethical implications for public health practices and policies. Public Health Ethics, 9(1), 65-77. doi:10.1093/phe/phv012

Corrigan, P. W., Lara, J. L., Shah, B. B., Mitchell, K. T., Simmes, D., & Jones, K. L. (2017). The public stigma of birth mothers of children with fetal alcohol spectrum disorders. Alcoholism Clinical & Experimental Research, 41(6), 1166-1173. doi:10.1111/acer.13381

Corrigan, P. W., Shah, B. B., Lara, J. L., Mitchell, K. T., Simmes, D., & Jones, K. L. (2018). Addressing the public health concerns of fetal alcohol spectrum disorder: Impact of stigma and health literacy. Drug & Alcohol Dependence, 185, 266-270. doi:10.1016/j.drugalcdep.2017.12.027

Eguiagaray, I., Scholz, B., & Giorgi, C. (2016). Sympathy, shame, and few solutions: News media portrayals of fetal alcohol spectrum disorders. Midwifery, 40, 49-54. doi:10.1016/j.midw.2016.06.002

Healthy Child Manitoba. Why do girls and women drink alcohol during pregnancy? Retrieved from Manitoba, Canada: https://www.gov.mb.ca/healthychild/fasd/whywomenandgirlsdrink.pdf

Langelier, J. (September 10, 2015). Stigma against fetal alcohol spectrum disorder. Retrieved from https://medicalxpress.com/news/2015-09-stigma-fetal-alcohol-spectrum-disorder.html

Liyanage, V. R., Curtis, K., Zachariah, R. M., Chudley, A. E., & Rastegar, M. (2017). Overview of the genetic basis and epigenetic mechanisms that contribute to fasd pathobiology. Current Topics in Medicinal Chemistry, 17(7), 808-828. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27086780

Muggli, E., O’Leary, C., Donath, S., Orsini, F., Forster, D., Anderson, P. J., Lewis, S., Nagle, C., Craig, J. M., Elliott, E., & Halliday, J. (2016). “Did you ever drink more?” a detailed description of pregnant women’s drinking patterns. BMC Public Health, 16, 683. doi:10.1186/s12889-016-3354-9

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