Addiction in Pregnancy
What is harm reduction?
“Harm reduction refers to policies, programs and practices that aim to reduce the negative health, social and economic consequences that may ensue from the use of legal and illegal psychoactive drugs, without necessarily reducing drug use.” Canadian Harm Reduction Network, http://canadianharmreduction.com
Since the 1990s, services for pregnant women and mothers using harm reduction approaches have emerged in many areas of Canada. Harm reduction is an approach that helps to reduce the negative effects of alcohol and drug use at the same time as helping women to meet their immediate health, social and safety needs.
Pregnancy is often described as an opportunity to support women in improving their health, including efforts to decrease or stop substance use or increase safer use of drugs. Harm reduction approaches are a practical ways to addressing substance use. They recognize that substance use is just one factor among many that shapes a healthy pregnancy and that reducing or stopping substance use at any time during pregnancy can have positive effects on women’s health and the health of the fetus.
Many Canadian programs and services are gaining attention for their successes in using a harm reduction approach to engage pregnant women with problematic substance use, improving women’s health, and ensuring that women and their babies have the best possible start in life.
What does Harm Reduction in action look like?
Strong evidence demonstrates the following strategies are effective in supporting pregnant and new mothers struggling with addictions:
• Education and outreach, including sharing information about safer drug use and distributing clean needles and other supplies.
• Easy access to services which emphasize physical and emotional safety, relationship-building, have short or no waitlists, and are provided in an accessible geographical location.
• Meaningful collaboration between health care and child welfare sectors.
• Buprenorphine and methadone maintenance treatment.
• Provision of food vouchers, daily hot lunches, and prenatal vitamins.
• Testing for Sexually Transmitted Infections and other sexual health services.
• Addiction counselling, including help with quitting smoking.
• Assistance with transportation and child care to attend appointments.
• Access to integrated program models ie: on-site pregnancy, parenting, or child related services offered with addiction services or coordinated referrals to other health and social services.
Research shows that harm reduction activities and approaches during pregnancy can:
• Increase engagement and retention in prenatal services and addiction treatment.
• Increase referrals to other health and social services and increase engagement in services following birth.
• Reduce alcohol and drug use and improve nutrition.
• Reduce health care costs.
• Improve health outcomes for women and their babies, including fewer preterm births and babies born with low birth weight.
• Increase the number of babies discharged home with their mothers following birth.
• Encourage breastfeeding, early attachment and improve early childhood development outcomes.
Substance Use During Pregnancy in Canada
Tobacco
Fewer women smoked daily or occasionally during the last three months of pregnancy (10.5%) than before pregnancy (22.0%).
Alcohol
The proportion of women who reported drinking alcohol during pregnancy was 10.5%, compared with 62.4% of women who reported drinking alcohol during the three months prior to pregnancy.
Street Drugs
Seven percent (6.7%) of women reported using street drugs (including cocaine, heroin, marijuana and amphetamines) in the three months prior to pregnancy and 1.0% reported using street drugs during pregnancy.
Source: What Mothers Say: The Canadian Maternity Experiences Survey, Public Health Agency of Canada, 2009
Quick Facts
• Substance use during pregnancy is common.
• Women from all social and economic groups may use substances while pregnant.
• Many women are able to stop using substances when they learn they are pregnant. Other women continue to face addiction and related health and social challenges when pregnant.
• Overall, alcohol and tobacco are the most commonly used drugs during pregnancy; marijuana is the most commonly used illicit drug during pregnancy.
• Tobacco and alcohol are the drugs that can be most harmful for fetal health during pregnancy, and in the long term for those prenatally exposed.
• Infants who initially show withdrawal effects from substances such as heroin and methadone at birth do not necessarily have any effects later on as children or as adults.
• Some research suggests that infant health outcomes are more closely related to factors like homelessness, poverty, poor nutrition, stress, and infections than to drug use itself.
Excellent list of resources for women across Western Canada:
http://www.atira.bc.ca/maxxine-wright-community-health-centre
https://fasdprevention.wordpress.com/2015/08/01/h-e-r-pregnancy-program-in-edmonton-alberta/
http://www.viha.ca/children/pregnancy/herwayhome.htm
https://www.mountcarmel.ca/ways-to-give/the-mothering-project/
This resource was developed following a panel held at the HerWay Home Community Conference on September 29, 2014. The conference was generously supported by the Children’s Health Foundation of Vancouver Island. To read the full document visit: http://bccewh.bc.ca/category/post/substance-use-pregnancy/