Monthly Archives: May 2018

In The News: CBC, IUD most effective birth control method, Canadian pediatricians declare

Intrauterine contraception is easily the most effective method of contraception, the Canadian Paediatric Society says. (Jay Directo/AFP/Getty)


Teen girls who are sexually active should be offered long-acting birth control such as an intrauterine device (IUD) as a first line of defence, the Canadian Paediatric Society says in a new position statement.

Pediatricians reviewed the benefits and risks of each method of birth control, which they will continue to do with patients.

“We’re saying that intrauterine contraception is easily the most effective method of contraception and so you should be talking about it,” said Dr. Giosi Di Meglio, an author of the statement and a member of the society’s adolescent health committee.

An IUD is a small, often T-shaped device placed inside the uterus by a doctor, nurse practitioner or nurse to prevent pregnancy. An intrauterine system (IUS) also has a hormone component. Both work continuously over years and can be removed at any time by a health-care provider.

In the late 1970s, concerns arose because it was thought that the IUD’s string, which comes out through cervix, could help bacteria get into the uterus and increase the risk of an infection.

A copper IUD costs about $60 to $100. (Craig Chivers/CBC)


“However, when they went back and analyzed the data again, they realized in fact that the string was not acting that way at all,” Di Meglio said an interview from Quebec City. “You’re just as likely to get a pelvic infection if you’re not using any form of birth control than if you’re using the IUD.”

A small risk of tissue perforation exists during insertion and there can be intense cramps immediately after the procedure and up to a few days after.

Putting the IUD or IUS front and centre in the list of effectiveness is an important change in practice, the society said. Members will continue to tell young people about the pros and cons of birth control options as part of the collaboration with patients.

The devices themselves cost the Quebec government’s prescription plan about $325 for the hormone-releasing system that lasts five years. People can buy copper-based IUDs for about $60 to $100.

An intrauterine system (IUS), which contains a hormone, lasts about five years and costs about $325. (Craig Chivers/CBC)


Many young women who are sexually active use birth control pills. Di Meglio said the pill works fairly well in studies with ideal conditions, but in real life, the number of failures is much higher.

About nine in 100 women who use contraceptive pills, a skin patch or intravaginal ring will have an unintended pregnancy, which Di Meglio called a lot for teens and their parents. Using a condom reduces the failure rate to two in 100.

Condoms are still the best protection against sexually transmitted infections and all youth are encouraged to always use them for that purpose.

For parents, the society suggests talking about sex and the emotional side of sexuality early and in small steps to encourage youth to ask questions.

Retrieved from

In The News: We’re separating babies from their teenage mothers in care, perpetuating a never-ending cycle


Elizabeth Wall-Wieler – for CBC News

There is a well-known connection between teen pregnancy and child protection services. Girls who spend time in the care of child protection services have higher rates of teenage pregnancy, and teenage mothers are more likely to have their child taken into care.

Teenage mothers who give birth when they are in out-of-home care (e.g. foster care, kinship care) are also more likely to have their children taken into care.

Until recently, we didn’t know how often this happens. It turns out, it is all too common.

In a recently published study in Pediatrics, my colleagues and I followed the children of 5,942 teenage mothers in Manitoba up to their second birthday to see how many were placed into care. We found that among teenage mothers who were themselves in care when they gave birth, 49 per cent of their children were placed into care before their second birthday, with 25 per cent being placed in care in their first week of life.

For teenage mothers who were not in care when they gave birth, 10 per cent of their children were placed in care before age two (2.5 per cent were placed in their first week of life).

This means that teenage mothers who were in care when they gave birth were more than 11 times more likely to have their child placed in care in their first week of life, and more than seven times more likely to have their child placed in care at any point before their child’s second birthday.

Even though all teenage mothers are at high risk of having their child placed in care, why are teenage mothers who give birth while in care at a significantly higher risk?

Young women in foster care face many challenges and often lack the financial and parenting supports provided to teenage mothers by their families. Although becoming a mother can be a joyful time and can give young women an opportunity to create a family that they may not have had, parenting while in care comes with additional challenges. These young mothers often feel like they are under constant scrutiny by their social workers and are always needing to prove to everyone that they are able to parent.

Keeping mothers with babies

Placement in care within the first week of life is sometimes associated with substance use by the birth mothers, which is more prevalent among adolescents in care. However, evidence shows that treatment for substance use disorder is less successful when women are separated from their children.

Programs such as Portage’s Mother and Child Program in Montreal have found success by providing accommodations for mothers and their children in their rehabilitation program. More such facilities should be made available across Canada.

When a child is placed in care, the government takes on the role of surrogate parent to that child. But by separating a quarter of young mothers from their infant within the first week of life, and almost half before the child turns two, the government is failing in its role of surrogate parent, and in these cases, surrogate grandparents.

A much greater emphasis needs to be put on dual placements – whenever possible, mothers and children should be placed together. This ensures that mothers and children have the chance to bond. This should be supplemented with specific supports to mothers (e.g., financial, housing, child care and education) to assist young mothers in their transition to motherhood.

In general, we know that most children are placed in care due to neglect, not due to abuse. Dedicated funds for prevention, as well as support workers committed to working with mothers and their children in this period of transition, can help to address that.

Our study used data from Manitoba, which has the highest rate of children in care among the provinces. However, this is not an issue that is limited to Manitoba. Canadian provinces with relatively low rates compared to other provinces still have higher rates of children in care than many other countries, and Indigenous children are hugely overrepresented in the child welfare system across the country.

The tireless work of many children’s advocates has resulted in a renewed effort to address challenges in the Canadian child welfare system, specifically in Indigenous communities. Failing to support young mothers who are in care is contributing to what has become known as “the millennial scoop,” sadly analogous to the systematic removal of children in the Sixties Scoop.

To prevent this cycle of involvement in care from continuing, the child welfare system needs to put in place dedicated resources (money and support workers) to help families stay together. Let’s make sure that these families get the support they need to ensure they are the last generation with this experience.

This column is part of CBC’s Opinion section.

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In The News: Township trauma: the terrible cost of drinking during pregnancy (The Guardian)

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Mentors helped Veronic Blom stop using alcohol and crystal meth when she was pregnant with her youngest son. Photograph: Kate Hodal for the Guardian

In a dusty township in South Africa’s sun-drenched wine country, Charay Afrika says only one thing helped numb her through a turbulent relationship and two pregnancies: alcohol.

She drank all day, every day, throughout her full-term pregnancies – unaware of the effect alcohol could have on her children.

Afrika was still at school when she met her first boyfriend, a man who would go on to beat her and rob her at gunpoint multiple times before she finally escaped him. “He’d beat me and lock me in the house with no food and then disappear for days,” Afrika, 28, says quietly. “I once had to drug him with sleeping pills so that I could call the neighbours and beg for help to sneak out. But he found me again and robbed me at gunpoint, and the whole thing started all over again. I drank as a way of escaping it all. I drank the whole time. I didn’t stop.”

Now eight years old and at school in Roodewal township, her eldest child has learning difficulties and behavioural problems – telltale signs of foetal alcohol syndrome (FAS), a condition under the broader umbrella of foetal alcohol spectrum disorder (FASD), which can manifest in birth defects such as brain damage, physical and mental impairments and stunted growth. It is directly caused by the mother’s drinking during pregnancy.

FAS affects more children in South Africa than anywhere else in the world: prevalent in 111 per 1,000 children, a rate 14 times higher than the global average of 7.7 per 1,000, according to the American Medical Association journal JAMA Pediatrics. But even this estimate may be lower than the true figure, say social workers in the Western Cape, as FAS is often a “hidden disability” that can affect a child in a number of ways, not all immediately obvious to parents or doctors.

“It’s a development issue,” says Sudene Jeftha, a social worker with FASfacts, an NGO based in Worcester. “You can’t necessarily see it when the child is born, only later when the child isn’t talking or crawling or walking like other children.”

The condition is endemic in the Western and Northern Cape, where high levels of unemployment, alcohol and substance abuse and teen pregnancies are intrinsic to daily life. In high-risk rural areas, up to 72% of school-age children are believed to suffer from FAS. Experts point to the 200-year-old dop system, in which Afrikaner farmers pay black and mixed-race workers in wine, or dop, as the primary cause of the regions’ high prevalence of alcoholism. Although the system was outlawed long ago, as many as 20% of vineyards are estimated to still pay their workers in wine, and binge-drinking in the Western Cape is a major health concern.

There is no concerted national health effort to tackle the issue, nor have there been any government studies to measure the socioeconomic impacts. But in a country where as many as six million people are thought to be affected by FASD and an additional three million are thought to have had foetal alcohol exposure, comparisons with other nations come in handy. In the UK, research has shown that it costs £2.9m to raise a child with FASacross their lifespan, while a Canadian study found that FAS youths were 19 times more likely to end up in jail than their peers.

A number of NGOs, including FASfacts, now run courses in at-risk communities to spread awareness of the condition, as well as “mentor mother” programmes, which rely on local mothers going door-to-door to speak to pregnant women about drinking. FASfacts, founded in 2002 by François Grobbelaar (an Afrikaner whose father used to pay his farmworkers in dop), claims this approach has helped reduce the number of pregnant women who drink by as much as 84%.

Veronic Blom, 33, drank and used tik (crystal meth) throughout her first two pregnancies. She was approached by one of FASfacts’ mentor mothers and stopped using both during her third pregnancy. Blom is now a mentor mother herself. “I smoked heavily – heavily – for the whole nine months of the pregnancy,” she says of her second child, now aged two. Making a rectangle with her thumb and forefinger, she indicates the size of a full gram of meth. “I’d smoke the full packet and smoke the whole day. I can only thank God he wasn’t born with any problems with his face.”

From the corrugated-iron shack in the Esselen Park township she shares with her two youngest children, Blom says the programme has changed her for the better. “I’m very talkative and I like to give back and speak to other mothers,” she says. “I usually tell them my own story so they know they don’t have to use their stories as an excuse: they can do better. The women are mostly keen to do better, but teenage pregnancy here is very common, you know, women selling their bodies to buy drugs or food.”

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8th International Conference on Fetal Alcohol Spectrum Disorder: Research, Results and Relevance


8th International Conference on Fetal Alcohol Spectrum Disorder

Research, Results, and Relevance

Integrating Research, Policy and Promising Practice Around the World


March 6-9, 2019

This advanced level conference/meeting continues to bring together global experts from multiple disciplines to share international research. From the pure science to prevention, diagnosis, and intervention across the lifespan, the conference will address the implications of this research and promote scientific/community collaboration. It provides an opportunity to enhance understanding of the relationships between knowledge and research and critical actions related to FASD. First held in 1987, the conference brings together people passionate about this work in a stimulating environment where they can learn and forge new partnerships.


  • consider the implication and potential application of emerging evidence-based, and cutting-edge research
  • expand and challenge their knowledge and understanding of hard science
  • explore different models of advanced practice from and across disciplines
  • engage in knowledge exchange and focused dialogue through formal sessions, networking, and onsite meetings
  • develop connections and partnerships among global researchers, networks, governments, communities, service providers and families

Who Should Attend

This interdisciplinary conference/meeting will be of interest to the following audiences: researchers; scientists; students; clinicians; health/mental health clinicians; physicians; addictions specialists; primary prevention workers; child welfare professionals, justice; FASD specialists; women’s service providers; educators; elected officials; policy-makers; administrators; community members; family members; and anyone interested in an advanced understanding in the field of FASD.


March 6 – 9, 2019


The Westin Bayshore
1601 Bayshore Dr, Vancouver, BC V6G 2V4 Canada


Call for Abstracts is now open for submissions! See here for more information on how to submit your abstract.

The advanced notice is available online! Click here to see (pdf)

If you are interested in finding out more about how you financially can support this initiative, please contact Kristina Hiemstra at


If you have any questions about this conference, please contact Kristina by email


I always enjoy the opportunity to see what is happening across the country, in the US, and around the globe. I come away from the conference feeling excited as I do think work is being done to advance the field in all areas.

– (Social Worker – FASD 2017)


Registration is currently not available.

Vast majority of poor, urban women don’t use prenatal vitamins before pregnancy, study shows


May 24, 2018, Johns Hopkins University School of Medicine

A study of more than 7,000 low-income, urban mothers enrolled in the Boston Birth Cohort found that fewer than 5 percent of them started folic acid supplementation and used it almost daily before pregnancy, a widely recommended public health measure designed to prevent potentially crippling birth defects.

A report of the findings was published on April 19 in the American Journal of Public Health.

“The findings are concerning because they show that public health interventions aren’t always effective in reaching vulnerable populations who need them the most,” says Tina Cheng, M.D., M.P.H., co-director of Johns Hopkins Children’s Center and the study’s lead author.

Numerous studies have shown that prepregnancy use of prenatal vitamins containing folic acid can prevent 50 to 70 percent of neural tube defects. Since 1992, the United States Public Health Service has recommended all women of reproductive age take folic acid supplementation.

Development of the neural tube is completed about 28 days postconception, Cheng notes, often before a woman’s aware she is pregnant, and because nearly half of all U.S. pregnancies are unintended, it’s important for all women of reproductive age to routinely take folic acid supplementation. Prenatal vitamin sold over the counter cost about 30 cents a day.

To better understand the pattern of prenatal vitamin supplementation and the blood levels of (a biomarker of circulating folate nutrition status) in U.S. high-risk populations, Cheng and her colleagues focused on a group of 8,494 mother-infant pairs recruited into the Boston Birth Cohort between 1998 and June 2014 at the Boston Medical Center.

For the purposes of their analysis, the researchers looked only at data for women with single, live births without major birth defects, which narrowed the study population to 7,612 . The study included 3,829 black and 2,203 Hispanic mothers. Of these, 2,633 (34.6 percent) were married; 2,692 (35.4 percent) had a college education; 870 (11.4 percent) smoked; 643 (8.5 percent) reported using alcohol; and 3,845 (50.5 percent) said their pregnancy was planned.

All women had reported their use of folic acid supplementation during preconception and each trimester of pregnancy through a questionnaire interview one to three days after giving birth.

The research team found that of the 7,612 mothers, 325 (4.3 percent) took folic acid supplementation almost daily preconception; 4,257 (55.9 percent) took it almost daily during the first trimester; 4,520 (59.4 percent) took it almost daily during the second trimester; and 4,416 (58 percent) took it nearly daily during the third trimester.

Overall, 6,592 (86.6 percent) mothers took no prenatal vitamins preconception at all.

Of those study women, 2,598 had maternal plasma folate concentrations available for analysis. Black and Hispanic mothers had lower plasma folate concentrations (averages of 28.2 nanomoles per liter and 30.4 nanomoles per liter, respectively) than white mothers, who had an average of 34.2 nanomoles per liter. Black and Hispanic mothers also had higher rates of folate insufficiency (defined as plasma folate concentration less than 13.5 nanomoles per liter based on World Health Organization criteria), at 12.2 percent and 8.1 percent, respectively, than white mothers, who had a 5.1 percent rate of insufficiency. Previous studies suggest babies are most at risk for neural tube defects if their mothers had insufficient folate intake.

The research team also saw a wide range of maternal plasma folate concentrations; at high end, 595 or 22.9 percent, had elevated concentrations (defined as plasma folate concentration greater than 45.3 nanomoles per liter based on WHO criteria). This suggests that folic acid supplementation is only one factor affecting plasma folate. To ensure optimal folate levels, health care professionals need to obtain a good history of maternal vitamin supplementation and diet and consider blood folate levels as indicated, explains Cheng.

Cheng and her team acknowledge that their study is limited by its use of one dataset in one city, and caution is needed to generalize to populations with different characteristics. They also note that self-reported vitamin supplementation may be inaccurate. Lastly, while the blood folate level is an objective measure, this study only measured at one time point, which at best reflects the folate concentrations during the third trimester.

But Cheng pointed out that the findings are an important step forward toward understanding folate supplementation and levels in vulnerable populations, as well as informing strategies going forward to reduce health disparities. For example, there is growing knowledge on the importance of maintaining optimal folate nutrition for maternal and fetal health, as well as long-term health of the child. Health professionals should make sure that all women of childbearing age and pregnant mothers are adequately advised and monitored with regard to folate intake, with the goal of maximizing its health benefits and minimizing adverse effects associated with excessive folate levels.

Explore further: Folic acid in pregnancy: MTHFR gene explains why benefits may differ

New Zealand: Warning labels on alcohol containers highly deficient, new research shows


Comparison of warning labels, from left to right: current “pea-sized” pregnancy warning labels (NZ beer can and NZ bottle), beer imported into NZ from Canada with much larger warning label (middle), mock-up of a warning label with more consumer information, and a current day NZ cigarette pack with a large pictorial warning. Credit: University of Otago

Current health warning labels on alcohol beverage containers in New Zealand are highly deficient, new research from the University of Otago, Wellington shows.

The researchers suggest that current voluntary labelling has not worked in New Zealand and mandatory standardised labelling which outlines major -related risks including pregnancy, drink-driving and cancer, are probably required.

The study found a total absence of any labels on some containers, on others there were “pea-size” pregnancy warnings, and there was a lack of detail generally about risks, for example only 19 per cent warned about drink-driving.

The research was conducted by a group of fourth-year medical students, led by Georges Tinawi and Tessa Madeleine Gray, at the University of Otago, Wellington, and published in the international journal Drug and Alcohol Review.

They examined 59 alcoholic beverage containers available in New Zealand. These included local and imported brands, and featured beers, wines, and ready-to-drink beverages (RTDs). The researchers studied labels on the common beer varieties, and the cheapest wines and RTDs.

The study found striking variations and inconsistencies between the health messages displayed on different alcoholic beverages. While most had pregnancy-related warnings (80 per cent), these were predominantly found on beer, a product more commonly marketed to men.

“Only 19 per cent of drinks across the range had any warning regarding drink-driving, which is concerning given the persistent and significant role of alcohol in fatalities and injuries on New Zealand roads” says the lead author of the study, Mr Tinawi.

The researchers found that warning labels were markedly smaller than promotional elements on the drinks. On average, warning labels had a cross-sectional area similar to that of a pea (36-45mm2), and warnings tended to occupy well under 1 per cent of the total surface area available on the (actually under a fifth of 1 per cent at only 0.12-0.13 per cent of the surface area).

The study also found that around three quarters of beverages (73 per cent) had industry-led messages such as “Cheers!” or “Enjoy responsibly”.

“These messages are ambiguous from a health perspective and could even encourage further drinking,” says Mr Tinawi.

The researchers explored what is known about the characteristics of effective warning labels (large size, readable text, a clear message) and noted that “there is a discrepancy between what we know works, and what is actually on the container surface,” says Mr Tinawi.

“It was clear that marketing material dominates what is on the alcohol container and there is little attention paid to consumers’ right to know the health risks of the product,” says Ms Gray, another of the researchers.

In New Zealand, warning labels on alcohol are voluntary, in contrast to regulated mandatory labelling seen elsewhere; for example in the EU, Canada, and the USA. Some of these warnings are many times larger than the New Zealand equivalents. The voluntary labels are in striking contrast to the large pictorial warnings now featured on all tobacco packaging sold in this country. The researchers believe that the size and design of the alcohol warnings does not reflect the evidence that the total health harm from alcohol is similar to that caused by tobacco.

The authors are calling for mandatory standardised labelling in New Zealand to avoid the inconsistencies identified in the study, and to also minimise attempts by the manufacturers to obscure health warnings.

Explore further: Why alcohol health warning labels are a good idea: findings from the latest Global Drug Survey

More information: Georges Tinawi et al. Highly deficient alcohol health warning labels in a high-income country with a voluntary system, Drug and Alcohol Review (2018). DOI: 10.1111/dar.12814


New Terrain: Tools to Integrate Trauma and Gender Informed Responses into Substance Use Practice and Policy



There is growing evidence of the effectiveness of trauma, gender, and sex (TGS) informed approaches in all areas of the substance use field, including prevention, education, harm reduction, treatment, policy, and research. Trauma-informed practice (TIP) is an important approach to improving substance use services, programming, policy and health promotion initiatives. Equally important is the integration of sex and gender based evidence into the substance use response system. Ultimately, creating gender transformative approaches to substance use can help to reduce gender and health inequities.

This field is constantly changing, with scientific and social understandings of trauma, gender and sex continuing to evolve. This toolkit is intended to contribute to the ongoing growth and sophistication of substance use responses in Canada.

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