Fetal Alcohol Syndrome and Community Health Interventions

The focus on the community as opposed to the individual and the traditional community health approach to looking at disease begin to make sense when you look at fetal alcohol syndrome. The way to prevent fetal alcohol syndrome is for the person to never start drinking alcohol, or to stop drinking alcohol before pregnancy. Efforts targeted at achieving those goals are primary interventions. Secondary intervention is for the pregnant woman to stop drinking as early as possible during pregnancy. Tertiary interventions are those activities that we do after the child is born.

Educational programs, notices of warning about drinking during pregnancy, doctors asking routine questions on drinking and educating their patients individually are all ways to prevent fetal alcohol syndrome. These kinds of activities are perfectly well- suited for the community health model mode and require mainly funding, a change of attitude by doctors, legislation requiring alcohol distributors to put notices on bottles, and requiring people who serve alcohol to provide warnings so that pregnant women will know that drinking is harmful to health.

Secondary prevention activities include education by the individual health care provider, intense counseling, and access to drug treatment programs. There are three problems with getting the problem drinker in drug treatment. First, if they are not in prenatal care, the health care provider can't assess their alcohol use, educate them, or make appropriate referrals. Yet, as important as prenatal care is, it is important for us to remember that prenatal care in itself does not prevent fetal alcohol syndrome.

Since many pregnant women willingly undergo significant behavior changes for the benefit of their developing child, the educational and drug treatment referral component of prenatal care is particularly effective. The problem with education is that it has little or no effect on problem- addicted drinkers. Their addiction gets in the way of their judgment. Because of their addiction, education is not enough for some women to interrupt their problem drinking. They need access to drug and alcohol addiction programs.

Access to drug and alcohol treatment programs presents several problems. First, most drug and alcohol addiction programs are built around a male mode. Women need treatment models based on social support. Second, many drug and alcohol treatment programs won't take pregnant women. Thus, both primary and secondary interventions will require at a minimum additional funding and additional funding presents conflicts with the majority group's actualization of needs.

In our society, we have articulated actualization as non-interference in both personal interests or property interests. Our ability to take our personal resources and property resources and use them in whatever way we see fit for ourselves is self-actualization. Interference with that is unacceptable. To get the kind and quantity of treatment centers that are needed necessarily implies some interference in property rights.

In part, fetal rights arguments may be motivated by a desire to "correct" the problem with minimum interference in property rights. For example, a clearly criminalization argument represents a desire to impact the fetal alcohol problem with minimal infringement on property interests. Expanding the existing criminal system would probably be less expensive than developing an intensive network of clinics and treatment centers specifically designed for pregnant women. Criminalization places the burden entirely upon the woman and presents the aura of working on fetal alcohol syndrome while at the same time protecting property interests. However, it is a false aura. First, criminalization of behavior has been ineffective in other areas. Murder laws have not prevented murder. There is no reason to believe that criminalization of alcohol use and drug use during pregnancy will be effective. Furthermore, property interests are not protected since presumably additional jails will have to be constructed.

Maternal rights advocates apparently are not as interested in protecting property interests since they promote more funding for prenatal and treatment centers. This will require funding. Maternal rights advocates promote access prenatal care as the way to deal with fetal alcohol syndrome. In the same way that the fetal rights people are looking at self- actualization, so are the maternal rights people. This actualizes individual interests. They want to work on the problem, but they do not want their individual interests interfered with. Their approach will in many ways be effective since prenatal care and education will take large groups of women out of the group of recalcitrant patients. However, the maternal rights groups are similarly in error. Inherent in their argument is a willingness to accept a certain amount of fetal alcohol syndrome babies to protect individual rights.

Community health policy, however, does not approach the solution as an either-or dichotomy. Community health policy accepts primary intervention that includes education, secondary prevention that includes pre-intervention such as prenatal care, and tertiary prevention which includes a mechanism to force people who are unwilling to obtain care. Community health policy then says that all three of these are appropriate and necessary and that no one or two alone are effective.