Dr. Theresa Tam, the Chief Public Health Officer of Canada, has just released a report summarizing the state of public healthcare in Canada. The 2019 report lists stigma as the major public health concern impacting the health and wellbeing of all Canadians.
Stigma is a negative stereotype or a “labelling of differences” that begins to separate people into categories of “us” and “them”. Stigma acts as a barrier, influencing an individual’s willingness to seek help, their access to services, and the quality of care that they receive. As we move into a new decade we’re very pleased to see that Canada is placing a strong focus on addressing stigma at an individual level, an institutional level, a community level, and at a national level.
In our field, we know only too well the impact that stigma can have on the health of Canadians. Individuals with Fetal Alcohol Spectrum Disorder (FASD) and their caregivers experience stigma on a daily basis. Despite the fact that FASD affects approximately 4% of Canadians (more than cerebral palsy, autism, and Down syndrome combined), the disorder is not well understood by the majority of our population. As a result, the challenges individuals with FASD face with emotional regulation and social interaction are often seen as “bad behaviour” and “poor life choices” by our society. This stigma impacts every aspect of their lives, from employment and education to involvement with the justice system and everything in between. Additionally, mental health issues and substance use disorders frequently co-occur with FASD. As a result, individuals with FASD face stigma in a number of different forms.
We’ve developed online training courses for community members and frontline workers to help them better understand FASD and give them tools to improve service provision for individuals with FASD. This is just one of the ways we are working to overcome stigma at an individual, institution, community, and national level.
The stigma surrounding substance use, particularly surrounding substance use and pregnancy, is also a major barrier to FASD prevention efforts and FASD diagnosis. Pregnant women using substances often experience feelings of shame and depression that can impact their mental health and relationships with their families. Fear of judgement from service providers prevents women from accessing the necessary pregnancy and treatment supports they need.
Disclosing substance use during pregnancy can be an important factor in receiving an FASD diagnosis for a child. However, the stigma surrounding substance use during pregnancy, and the judgement and discrimination that women experience from service providers often inhibits this disclosure.
The portrayal of the fictional “Cynthia” in this report paints a very real picture of the experiences pregnant women using substances have had with the healthcare system. Informed by very similar experiences from real-world mothers, the Centre of Excellence for Women’s Health developed a wonderful resource that provides service providers in the substance use treatment and child welfare fields the tools to work collaboratively to improve the health of women and children in Canada.
We are heartened by the focus and attention that organizations across Canada are giving to better understand and address stigma in their practices. However, there is more work to be done. As an organization we are thrilled that Canada’s leadership is taking preliminary steps to raise awareness of the impacts of stigma and improve healthcare policies and practices to better health outcomes for Canadians. We look forward to seeing the impact this national attention will have on the treatment and service provision for both pregnant mothers using substances and individuals with FASD and their families.
As an organization, our New Year’s resolution is to continue to conduct research on FASD and stigma and to develop evidence-based resources to address the role that stigma plays in hindering FASD prevention, diagnosis, and supports. We look forward to the opportunity to lend our voices to Dr. Tam and her team of experts working so diligently to address stigma in Canada.