As an Advanced Nurse Practitioner who has worked for more than 30 years in Alaska, I applaud the Anchorage Daily News' efforts to bring new focus to the topic of prenatal alcohol exposure and the toll it takes on our communities. Prevention will require a multifaceted approach as the "alcoholic" woman is not the only woman producing a child with fetal alcohol spectrum disorders (FASD), as was poignantly described recently in the Daily News profile of birth mothers.
In my experience, it is the rare woman who is drinking uncontrollably or intentionally during her pregnancy. Half of pregnancies are still unintended, despite numerous new birth control options. I regularly see women who do not understand their menstrual/fertility cycles and/or who have misunderstandings about how contraceptives prevent pregnancy. We need to change this through quality reproductive education for parents and students at multiple times during the formative years of childhood/adolescence.
Socioeconomically disadvantaged women may be living at the lowest level of Maslow's Hierarchy of Needs (with unmet basic needs for food, shelter, warmth, or safe relationships) and their life is focused on survival, not prevention. Sexuality is one of the basic biological human needs. We need to accept this reality.
At every opportunity, health care providers need to assess reproductive-age women (13-45) for alcohol use and effective contraception. The CDC-funded Project CHOICES demonstrated that women who received brief intervention related to their "at risk" alcohol use and/or ineffective contraception use do alter their behavior in relation to their alcohol use, use of a more effective contraceptive, or both.
We need funding to support more of these evidence-based programs and contraception needs to be accessible and understandable -- with side-effect management readily available. The use of effective contraception and/or altering a woman's "at risk" alcohol use, are both examples of responsible actions.
American culture uses sex and alcohol to promote sales for many things. We wonder why our youths are confused about the twin forbidden fruits of sex and alcohol.
According to a 2010 position statement of the American Academy of Family Practice, students will spend about 18,000 hours in front of television and will watch about 2,000 alcohol commercials before graduating from high school. Alcohol advertisements reach youth through varied media including Internet, billboards, magazines, sports stadium signs, and mass transit. In all, youth view 45 percent more beer ads and 27 percent more liquor ads in magazines than do people of legal drinking age. This needs to stop and kids need classes in media literacy to learn how to disassemble the "hidden messages" that they are being exposed to regularly.
FASD diagnosis is an intervention. Individuals who receive a diagnosis early in life, who have not experienced multiple home placements or abuse and who are found eligible for developmental disabilities services have a different life trajectory than those who are undiagnosed. Individuals with FASD know they are different and often blame themselves. A diagnosis provides a road map to help them understand their strengths and to shore up their areas of challenge. "It takes a village" to provide services to some of these kids but their outcomes can be quite remarkable.
Finally, more effort needs to go into:
• Identifying newborns who have had prenatal alcohol exposure.
• Providing that information to pediatric providers for consideration in differential diagnosis if there are any future developmental delays or behavioral challenges (that may be evident as early as preschool).
• Fully supporting innovative efforts to provide quality FASD diagnosis services throughout Alaska.
• Providing case management to help exhausted families seek services for an affected family member.
• Exploring and filling the gaps in our service system.
Is this a tall order? Yes, but Alaska is already a recognized leader in the world of FASD and we can aim higher. The alternative is to continue to cost shift from prevention, identification and effective interventions, to continuing to add to our already overburdened social service and justice systems.
We pay as a society in either case, but in the former example the affected individual has a chance for the life of dignity that he or she deserves -- or better yet, there was no exposure at all.
Marilyn Pierce-Bulger, ANP, is the founder and a member of the Anchorage FASD Diagnostic Team at Assets, Inc., works part-time at Southcentral Foundation Primary Care Clinic as a certified nurse-midwife and is affiliate faculty for the UAA Arctic FASD Regional Training Center.
By MARILYN PIERCE-BULGER