Conceiving Risk, Divergent Responses: Perspectives on the Construction of Risk of FASD in Six Countries

Abstract

Conceptualizations of risks related to women's alcohol use during pregnancy, and the attendant response to preventing fetal alcohol spectrum disorder (FASD), are examined in six countries: the United States, Canada, the United Kingdom, Uganda, Uruguay, and China. Considerable differences were found in how risks were conceptualized across countries and in contextual factors that influence research, prevention, and intervention efforts. Differences in conceptualizations were also apparent within countries. Differences also existed in the degree to which the issue of drinking during pregnancy has been minimized or amplified and in whether and how responses are linked to treatment or other public health interventions.

RÉSUMÉ

Compréhension du risque et réponses divergentes:Perspectives sur la construction du risque de l'ETCAF dans six pays

Les conceptualisations du risque lié à la consommation d'alcool chez les femmes enceintes et les réponses concomitantes concernant la prévention de l'ensemble des troubles causés par l'alcoolisation fœtale (ETCAF) sont examinées dans six pays: les États-Unis, le Canada, le Royaume-Uni, l'Ouganda, l'Uruguay et la Chine. Des différences importantes ont été soulignées dans la façon dont les risques sont conceptualisés dans ces pays et dans les facteurs contextuels qui influent sur la recherche, la prévention et les efforts d'intervention. Des différences de conceptualisation étaient également apparentes au sein des pays. Il y avait aussi des différences concernant le degré avec lequel la question de la consommation durant la grossesse a été minimisée ou amplifiée, et si et comment ces réponses sont liées aux traitements ou à d'autres interventions de santé publique.

RESUMEN

Consideraciones sobre riesgos y diferentes respuestas: Perspectivas en la construcción del riesgo de los desordenes del SFA en seis países

Se estudiaron las conceptualizaciones del riesgo relacionadas con el uso del alcohol de las mujeres durante el embarazo, y las respuestas correspondientes para prevenir los desordenes del síndrome feto alcohólico (DSFA), en seis países: Estados Unidos, Canadá, el Reino Unido, Uganda, Uruguay, y China. Se encontraron diferencias importantes en cómo los riesgos fueron conceptualizados entre los países y en los factores del contexto que influencian la investigación, la prevención, y los esfuerzos de las intervenciones. Fueron evidentes diferencias de conceptualizaciones entre los países. Las diferencias también existieron en relación a si el consumo en el embarazo se había reducido al mínimo o si el mismo había aumentado, y si habían habido o no respuestas ligadas al tratamiento u otras intervenciones de la salud publica.

Keywords :

• alcohol consumption
• construction of risk
• gender
• international perspectives
• pregnancy

THE AUTHORS

Laurie A. Drabble, Ph.D., M.S.W., M.P.H., is an associate professor in the School of Social Work at San José State University. Dr. Drabble's research activities focus on understanding and addressing alcohol and other drug-related problems among women with a special emphasis on three areas: collaboration between substance abuse, child welfare, and other allied fields; substance abuse issues among sexual minority women; and relationships between alcohol consumption, health, and mental health among women.

Nancy Poole, M.A., is the Director of Research and Knowledge Translation for the British Columbia Centre of Excellence for Women's Health and the Provincial Research Consultant on Women and Substance Use issues for BC Women's Hospital in Vancouver. She is a coleader of the Network Action Team on FASD Prevention from a Women's Health Determinants Perspective affiliated with the Canada Northwest FASD Research Network.

Raquel Magri, M.D., is a medical doctor, with postgraduate degrees in Pediatrics, Intensive Care, and Neonatology. She was the Executive Secretary of the Presidential Board on Drugs (Junta Nacional de Drogas) since its creation in 1987 until 1994, when she became Regional Director of the United Nations Drug Control Programme (UNDCP) for Mexico and Central America until 1996. From 2000 to 2005, she was the General Secretary of the Board. She is also the lead survey researcher for Uruguay for the GENACIS. She works as an independent researcher in the area of pregnancy and legal and illegal drugs consumption.

Nazarius Mbona Tumwesigye, Ph.D., M.A., M.Sc., is a lecturer and chair of the MUIPH-ICT Committee at the Makerere University School of Public Health, Uganda. His areas of special interest include the following: dynamics of condom use and abstinence, alcohol consumption levels, patterns and associated factors, monitoring and evaluation, and estimation and projections of disease/infection prevalence and incidence. He is also the lead survey researcher for Uganda for the GENACIS.

Qing Li, M.D., Dr. P.H., received her M.D. and OBGYN residency from Sun Yat-sen University, and her Dr. P.H. in Maternal and Child Health with a focus on perinatal epidemiology from University of Alabama at Birmingham. She was a postdoctoral fellow on: (1) GENACIS and FASD in the Department of Clinical Neuroscience and the North Dakota Fetal Alcohol Syndrome Center, University of North Dakota; and (2) venue-based alcohol and HIV risk reduction in the Pediatric Prevention Research Center, Wayne State University. Her primary research interests are social, reproductive, and perinatal epidemiology, gender, birth outcomes, partner violence, alcohol consumption, and HIV, using the life-course, social–ecological, and cross-cultural perspectives.

Moira Plant, Ph.D., R.G.N., R.M.H., has worked in the “alcohol field” as a therapist and researcher since 1970. She has published widely and is a regular broadcaster on issues related to alcohol consumption and its effects. She was the chair of the expert working group on drinking and pregnancy of the International Life Sciences Institute, and has served as an advisor to the WHO for many years. In 1998, she was elected as the President of the International Kettil Bruun Society for Social and Behavioural Research on Alcohol. She is the senior research consultant to the Addiction Research Institute in the Netherlands. Moira is the Director of the UK and Isle of Man components of GENACIS.

GLOSSARY

• Alcohol use-related birth defects (ARBD): A diagnostic category within the larger umbrella term Fetal Alcohol Spectrum Disorders that includes confirmed maternal alcohol exposure and one or more congenital defects, including malformation of the heart, bone, kidney, vision, or hearing system.

• Alcohol use-related neurodevelopmental disorder (ARND): A diagnostic category within the larger umbrella term Fetal Alcohol Spectrum Disorders that includes confirmed maternal alcohol exposure and central nervous system neurodevelopmental abnormalities and/or complex pattern of behavior or cognitive deficits.

• Block grants: A sum of money granted by the federal government to regional (e.g., state) government that includes general provisions about how funds may be spent.

• Burden of disease: Impact of a health problem based on cost, morbidity, mortality or other indicators.

• Construction of risk: The process by which prevailing social values, norms, and beliefs inform how social problems are defined and addressed.

• Determinants of health: The WHO, governments, and individual researchers have identified social, structural, genetic, biological, and environmental determinants that act and interact to affect health, income and social status, employment, education, social support networks, physical environments, healthy child development, personal health practices and coping skills, health services, biology and genetic endowment, gender, and culture.

• Fetal alcohol ethyl esters (FAEES): A biomarker (a substance used as an indicator of a biological state) to detect prenatal alcohol exposure in meconium.

• Fetal alcohol syndrome (FAS): A diagnostic category within the larger umbrella term Fetal Alcohol Spectrum Disorders that includes confirmed maternal alcohol exposure combined with characteristic pattern of facial features, growth problems, and neurodevelopmental abnormalities.

• Meconium: A baby's first stool.

• Phosphatidylethanol (PEth): A biomarker that is highly correlated to alcohol intake; diagnostic sensitivity using PEth appears to be higher than that for previously established biomarkers for alcohol intake.

• Postpartum: The time period after childbirth.

• Preconception: The time period before becoming pregnant.

• Teratogen: An agent that may interfere with the development of a fetus, which may cause birth defects.

• Women-centered: An approach to the delivery of services and health policy that attends specifically to the needs and interests of women, as opposed to a generic approach.

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.