Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps


Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps

Nancy Poole, Rose A. Schmidt, Courtney Green and Natalie Hemsing

British Columbia Centre of Excellence for Women’s Health, Vancouver, BC, Canada. The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada.


Effective prevention of risky alcohol use in pregnancy involves much more than providing information about the risk of potential birth defects and developmental disabilities in children. To categorize the breadth of possible initiatives, Canadian experts have identified a four-part framework for fetal alcohol spectrum disorder (FASD) prevention: Level 1, public awareness and broad health promotion; Level 2, conversations about alcohol with women of childbearing age and their partners; Level 3, specialized support for pregnant women; and Level 4, postpartum support for new mothers.

In order to describe the level of services across Canada, 50 Canadian service providers, civil servants, and researchers working in the area of FASD prevention were involved in an online Delphi survey process to create a snapshot of current FASD prevention efforts, identify gaps, and provide ideas on how to close these gaps to improve FASD prevention. Promising Canadian practices and key areas for future action are described. Overall, Canadian FASD prevention programming reflects evidence-based practices; however, there are many opportunities to improve scope and availability of these initiatives.

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  1. Reduction in the incidence of fasd only occurs when prevention and awareness programs are associated with a diagnostic process.
    This paper makes no mention of diagnosis. All efforts to prevent PAE and FASD will fail unless they are associated with diagnostic clinics.
    Barry Stanley

  2. Prevention continues to be pursued at the expense of diagnosis.

    FASD and the 2017 Ontario Provincial Budget.

    The provisions for FASD in the recent budget fall far short of the FASD Provincial Roundtable Report, submitted to the Ontario Government in 2015. The Report assessed the number of individuals in Ontario with FASD at over 130,000.

    The Budget provides, quote “ funding for 56 FASD workers to support approximately 2,500 Ontarians with FASD”, leaving 127,500 in limbo.

    Funding for diagnosis is excluded: this when the diagnostic capacity for FASD has been decreased. St Michael’s FASD Diagnostic Clinic now only accepts referrals from the Toronto area and Sick Kids no longer accepted referrals at all, in keeping with CAMH and McMaster which have never had diagnostic processes for FASD.

    The official Canadian incidence of fasd is one per 100 births. Over the last five years a conservative estimate of children born with FASD in Ontario would be 7201. Not include are all those children and adults born before 2011, many of whom are suffering from mental illnesses, are in prison or are homeless: secondary problems that we know are mitigated by an early diagnosis, which is not provided for in this Ontario Budget.
    Ontario births 2011/16 140,999 142,367 144,051 145,513 147,244

    Barry Stanley

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