Q&A: Senator proposes state-funded pregnancy tests in 'war' on FASD

From Kyle Hopkins in Juneau --

Senate Finance co-chairman Pete Kelly, who says he is declaring war on fetal alcohol spectrum disorders in Alaska, this week described his plan of attack.

Kelly says he will propose that the state:

-- Flood Alaska bars and restaurants with publicly funded pregnancy tests. The tests would be available for free, with the effectiveness of the plan studied by university researchers.

-- Spend millions on an FASD awareness blitz. 

-- Recruit a network of citizen "helpers" who could counsel women in their towns and villages who are drinking while pregnant. The volunteers might refer women who can't stop drinking for treatment at regional prematernal homes.

Interviewed on a sunny Juneau day in his office high in the capitol building, here is what the Fairbanks Republican had to say about funding FASD prevention in an era of state spending cuts, why he doesn’t want to give out free birth control in bars and how the conversation may one day turn to involuntary commitment of pregnant women who refuse to stop drinking.

Kelly created a “think tank” board last year to tackle long-running substance abuse problems in the state.

"It just dawned on me that we had not treated the problems in rural Alaska in the same manner that we have treated other legacy issues," Kelly said. While FASD is a statewide problem, rates are highest in rural areas. 

“You should be able to look back and say there was a problem that faced us that ... we either tried to address or at least tried and failed,” he said. 

Q. Given this atmosphere of budget-tightening within the Legislature now, is the project going to cost the state money?

A. Yes, but far less than if we did it another way. The idea here is that the community is involved, the private sector is involved and the government is involved. The government will be involved at a far lesser rate than, say, a traditional program.

But we’re going to have to seed it. We’ve already seeded it.

Q. How much is it going to cost?

A. Part of this is the public-relations effort. We’re going to spend a lot of money on high-quality communications. YouTube, social networks, television, radio. That’s just going to be funded at whatever level is required.

Then we’re also going to get pregnancy tests. 

They’re not that expensive. They’re $1.50, $2 per pregnancy test when you get them in mass quantities, and then distribute them. We’re probably going to have to contract with a non profit of some kind to distribute them and service them in the bars and restaurants. Public places where people go. 

So that they can test to see if they’re pregnant. Under the assumption that if you know you’re pregnant, you won’t drink. That is true for much of the population.

(Note: Watch the story of a mother of a child with FASD who says she learned she was unexpectedly pregnant only after weeks of bar-hopping and a "party cruise" in this Alcohol & Me video.)

Q. The idea is to make pregnancy tests available for free?

A. You grab one. Literally, you can go into the bathroom at the bar and test. So if you’re drinking, you’re out at the big birthday celebration and you’re like, ‘Gee, I wonder if I ...?’ You should be able to go in the bathroom and there’s that plastic, Plexiglas bowl in there and that’s part of the public relations campaign too. Is you’re going to have some kind of card on there with a message.

… With the consent of the other senators, I’m going to put some money in the budget to fund these things.

Q. Have you talked with CHARR (the bar and restaurant lobby)?

A. We’ve given them a heads up. We don’t want to surprise anybody. We’re not requiring them to do anything. We’re going to be paying for these tests. It’s going to be voluntary at first.

It possible that in the future, we might be asking them to support having it be part of your licensing. 

Q. Would you support doing the same thing with birth control? Making free birth control available in the bars?

A. No. Because the thinking is a little opposite.

This assumes that if you know (you are pregnant) you’ll act responsibly. Birth control is for people who don’t necessarily want to act responsibly.

I’m not going to tell them what to do. Or help them do it. That’s their business. But if we have a pregnancy because someone just doesn’t know, that’s probably a way we can help.

Q. But isn’t the act of using birth control, in itself, acting responsibly? 

A. Maybe, maybe not. 

...That’s about a level of social engineering that we don’t want to get into. All we want to do is make sure people are informed. They’ll make the right decision.

Q. Huge public relations campaign. You said a lot of money for that. How much money? 

A. Millions

Q. Tens of millions?

A. Here’s the deal. … If you have a child, and you know the numbers … (the lifetime cost to the public of a child with fetal alcohol syndrome) has been $860,000 to $4.2 million. 

 Lets pretend you’re only spending $1 million per kid in the 18 years that they’re in preschool and at school. Then many of them, unfortunately, go into the corrections population too. That’s a different story. So, how many millions of dollars do you spend? If you got one, if you spend $1 million and save one kid, you’re at zero. You’ve netted zero.

So we’re talking millions of dollars. . … We’re starting with $500,000. 

Q. It’s an ambitious goal, to eradicate FASD. Where do the resolutions that passed the Senate this week fit in?

A. What we’re trying to do is use some existing networks to deal with problems. We call them, “Natural Responders.” … In any small community, you’re going to find the one go-to person. The one that everybody knows is kind of in control or is the one that you turn to when you’re in trouble. Maybe a grandma or an auntie or a public health nurse, it’s going to be different in every community. 

 In school communities too, there are students within any high school, junior high school that people turn to when they are in trouble. 

We’re going to find those people (with the help of the First Alaskans Institute) and then encourage them … We’re going to put together a bit of a summit for kids form all over the state, both rural and urban, so they can be trained. Network with each other. They can become part of something and go out and start finding these people and saying, ‘Hey look, you’re drinking, you’re of child bearing age,’ or ‘We know you’re having unprotected sex, you’ve got to stop doing that.’

If that doesn’t work, we can then guide them into the system where there are some therapeutic beds where they can stay and we can attend to them through the health and social services department while they are pregnant.

Q. These Natural Responders see a person binging while pregnant, then what?

A. Then they come to them. They bring the community around them. One hopes they can get them in touch with somebody with the Indian health service beds … Health and Social Services has another (bed option).

They can hand them off. That’s part of how we’ll train them, is to hand them off to social services to get them away from alcohol and where they could be attended to, probably in a hub community.

Currently these beds exist. We’ve been told that we have the capacity to take on this task with the beds that already exist. We don’t know. We’ve been told that we have the capacity to take on this task with the beds that already exist.

Later on we may have to put some money in the budget for more infrastructure.

… Down the road, we haven’t had this discussion yet. As a community or as a Legislature. We haven’t had the discussion about involuntary commitment. That may be part of it in the future. That’s not what we’re doing right now.

Ultimately, you have to ask yourself, if someone is damning their child to a lifetime of mental problems and physical problems as well and it’s going to end up costing the state. Is it that time that we have to say, ‘OK, is there some level of involuntary commitment that happens?’ Just during the period of pregnancy?

We’re not doing that right now. That’s being discussed.

Q. Do you think involuntary commitment should be on the table?

A. It is not right now.

Q. What’s your personal view? 

I don’t have one right now. I don’t like the idea of involuntary commitment if you can avoid it. The discussion has to take place … Do we have to do that anyway? And we do involuntary commitment for people who are chronic inebriates now. We do it for their own safety. It’s a big discussion for the state to come in and say, 'You are now under the control of the state because you can’t control the addiction.'

That’s a discussion that we just haven’t had yet. We’re trying to do the possible right now.

Q. Australia has many of the same alcohol problems we do, including high rates of FASD. The attorney general in the Northern Territory there is talking about making it a crime to expose your (unborn) child to alcohol. What about criminal sanctions?

A. We’re just not there yet. This leadership team, not that I don’t have my own ideas, the leadership team hasn't had those kinds of discussions yet. What we’re trying to do is have the solution be a grassroots solution. If you declare drinking while pregnant to be illegal, you may or may not have any impact at all on fetal alcohol syndrome.

Who knows? It’s crazy sometimes, you do these things and then somehow you have the opposite impact. You can’t know until after you've done it. That’s more government control and we’re just not there.

Note: This sequence of questions in this interview was rearranged for clarity. 

Related:

-- What you don't know about drinking and pregnancy: Four mothers tell their stories

-- 4 families seek to confront, understand FASD 

-- Alaska families try to sever the link between sexual abuse and FASD 



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