Hon. Nancy J. Hartling: Honourable senators, I rise today to support Bill S-253, An Act respecting a national framework for fetal alcohol spectrum disorder.

As a member of the Senate Human Rights Committee and the Indigenous Peoples Committee, and from my many years working in the community as a social worker, I am deeply aware of the impact of fetal alcohol spectrum disorder, or FASD, on our most vulnerable populations.

Congratulations to Senator Ravalia for initiating Bill S-253. I would like to recognize that this bill was developed through extensive consultation with the Canada Fetal Alcohol Spectrum Disorder Research Network, also known as CanFASD, which is a collaborative interdisciplinary research network with partners across the nation, so I am very confident that this bill is informed by the most up-to-date knowledge and expertise.

Thank you, CanFASD, for your incredible work and your ongoing commitment.

Thank you to our colleagues who have spoken in support of this bill. Today, following my speech, Senator Duncan will speak to this.

Fetal alcohol spectrum disorder is a lifelong neurological disorder that is caused when a fetus is exposed to alcohol in utero. It is the leading cause of developmental disability in Canada.

Health Canada estimates that between 1% and 5% of the population may have the disorder; however, given that it is difficult to diagnose, it often goes undetected. Some groups are more impacted by this than others. For instance, among Canada’s prison population, the number of affected people ranges from 9.8% to 23.3% for the general prison population and could be as high as 50% for Indigenous offenders.

The disorder can affect many bodily systems, but its impacts are felt primarily in the brain. Many people with FASD show no outward signs of a disability, but this may mask a range of learning difficulties and memory impairments.

Here are some examples of what people with the disorder may demonstrate: forgetting how to do something they’ve already learned; problems with social communication despite, in many cases, having strong verbal skills; trouble reading social cues and understanding others; trouble understanding abstract concepts and internalizing rules; difficulty concentrating due to impaired self-regulation, and this is made more difficult because they may find it harder to grasp abstract concepts, such as reasoning, problem solving and connecting cause and effect. People with the disorder often have disrupted school experiences, have trouble interacting with others and keeping their jobs and may encounter financial difficulties.

The impact of the social determinants of health leads to a higher risk of depression, drug and alcohol addiction, homelessness and poverty. Without adequate interventions and supports, people with FASD and their families and communities are at a greater risk of negative outcomes.

I believe prevention with a pan-Canadian approach is critical. The development of a national framework provides an opportunity to explore this further at committee.

Early intervention for women who are at risk is key to better pregnancy outcomes and also to better outcomes for children who are born with FASD. CanFASD and the Centre of Excellence for Women’s Health co-developed a made-in-Canada model based on four levels of interventions focused on prevention where each level builds on the previous one. As time doesn’t permit me to go into the details of all of their tremendous work, I will simply give you the highlights of the levels of intervention, prevention and treatment of FASD.

Briefly, the first level of intervention includes raising awareness about the risks of alcohol consumption during pregnancy and empowering women and communities with the information needed to make decisions. This can take the form of national media campaigns, developing health promotion materials and producing easy-to-understand and readily available low-risk drinking guidelines. Culturally appropriate and trauma-informed approaches are extremely important for community-based health promotion strategies, especially in the context of Indigenous communities. Increasing awareness is included as an element of the framework under Bill S-253.

The second level is a provision of safe, non-judgmental spaces for all women of child-bearing age to have discussions on reproductive health, contraception, pregnancy and substance use with their health providers. Research has pointed to the importance of “brief alcohol interventions,” which are collaborative, often informal conversations that can occur between women and their health care providers and can provide an opportunity to engage openly on alcohol use and other risk factors that may not be immediately obvious.

These interventions can be the basis for lasting change by connecting women to the supportive services they need. They are valued by health practitioners as they are seen as less stigmatizing than screening for alcohol use and as open opportunities to discuss issues related to substance use, such as mental wellness and gender-based violence.

It is critical that these conversations happen in a non‑judgmental way because the factors that lead to women drinking can be highly complex. They are often driven by a number of social determinants of health. The stigma associated with drinking during pregnancy can result in women not seeking support, so it is important that women are able to participate in these interventions and follow-up treatments without the risk of losing custody of their children.

According to research by Dr. Shimi Kang, a professor at the University of British Columbia and a recent recipient of the Governor General’s Persons Case Award, an opportunity exists in the prenatal period to help women with addiction issues as they are then more likely to engage with the health care system and are more likely to abstain or reduce their substance use during this time. However, many women face barriers such as stigma in the form of guilt or shame, fear of losing custody of their children, prejudice towards mothers with substance problems, responsibility for dependent families and lack of child care and transportation.

Two thirds of all women entering addiction treatment services report a history of sexual or physical abuse — quite a lot when you think about it — which points to the need for an assessment of abuse history among addiction patients so that their trauma-related symptoms could then be treated, resulting in better addiction outcomes and therefore reducing the risk of negative pregnancy outcomes.

Brief interventions are important because they embody the “no wrong door” approach to care, where women and girls can access resources at any juncture in their lifespan through family doctors, midwives, nurses, anti-violence support workers and social workers. This goes hand in hand with preventing intimate-partner violence.

The third and fourth levels include holistic supports for pregnant women and new mothers with alcohol abuse and other health and social problems, including supports for child development. In a study of the most effective programs for reaching pregnant women at risk, researchers noted that the provision of the following were associated with the best outcomes: access to basic needs such as food and clothing; supportive housing; child welfare support; substance use supports; trauma and violence support; women’s health services, including parenting support; cultural programs; pre- and postnatal care and peer connection.

Colleagues, these interventions are at the core of the social determinants of health. These interventions can provide a strong base for future health of children with FASD because healthy mothers are more likely to be involved in care, are more likely to adhere to treatment and have healthier attachments to their children. This healthy attachment and family cohesion is emphasized in the Towards Healthy Outcomes for Individuals with FASD model developed by the Intervention Network Action Team of the CanFASD Research Network. Children who suffer from impaired detachments are at a higher risk of negative outcomes later in life, so a sense of stability, security and high family cohesion can act as protective factors. This document also contains a wealth of effective interventions which the committee could explore in larger detail.

With so much knowledge on early intervention, why are parents and children with fetal alcohol spectrum disorder still struggling? As Senator Ravalia aptly explained, provinces and territories each have different standards and resources allocated to the disorder. Although there are 73 diagnostic clinics in Canada, none are in rural areas, and they are not evenly distributed.

Diagnosis remains elusive for many due to the lack of resources dedicated to FASD. Some parents might fear obtaining a diagnosis because of the stigma associated with drinking during pregnancy.

In my home province of New Brunswick, we are fortunate to have the Fetal Alcohol Spectrum Disorder Centre of Excellence, located in Dieppe. They provide a range of services including prevention, diagnosis, intervention and support services, with special attention given to mothers’ needs and trauma. They now serve over 800 families a year. And although the centre of excellence is considered the gold standard in Canada, over 300 families in my region are still waiting for diagnosis, and many more cannot even get a referral because of circumstances out of their control. All of this is to note that with more than 4,000 youth in the school system in our area estimated to have FASD, most without a diagnosis, it is clear that the resources do not meet the needs.

Colleagues, there is a tremendous amount of research on FASD, and evidence-based best practices have been implemented in various ways across Canada. There may be other questions to explore, such as the father or male partner role in this issue. At committee, I hope that special attention will be paid to the social determinants of health for mothers, children and the family, and I hope the study will be bolstered with gender-based analysis and will take into consideration the many intersecting factors that lead to FASD.

The social determinants of health are at the core of prevention and lifetime interventions, and they deeply inform the treatment models that have emerged. Bill S-253 can provide a framework on which we can build, as an act of reconciliation and public health, to guide best practices in prevention, diagnosis and intervention across Canada.

I look forward to the next step by sending Bill S-253 to committee for further study. Thank you.