Robin Gearing, MSW, RSW, Ph.D. (cand.) Hospital for Sick Children & University of Toronto

1. Father Involvement & FASD: Developing Best Practices6th Annual Fetal Alcohol Canadian Expertise (FACE) Research Roundtable Robin Gearing, MSW, RSW, Ph.D. (cand.) Hospital for Sick Children & University of Toronto September 9, 2005

2. Acknowledgements • Ted McNeill, Ph.D., R.S.W., • Fernand A. Lozier, M.Ed. Public Health Agency of Canada The Hospital for Sick Children Journal of FAS International http://www.motherisk.org/JFAS/(keyword: father)

3. Overview • Introduction: A) Objective: Father involvement B) Method: Investigating FASD and Fathers • Fathers and FASD: • Statistics • Economic Costs • Fathers • Fathers and FASD • Father Involvement: Developing Best Practices • The Self • The Couple Relationship • The Family • The larger Environmental Factors • Future Directions • Question & Answer Period

4. Objective • One fundamentally important, but frequently minimized and ignored factor is the role of fathers in FASD. • From a population health perspective fathers are associated with a number of determinants of health including a number of genetic, relational, familial, and environmental factors that either contribute to or protect against maternal alcohol consumption.

5. Introduction to Investigating FASD and Fathers • Since FASD was defined some 32 years ago in 1973- the problem/concern of FASD has not gone away or been addressed • Father involvement has been absent/missing • In the 30 years since this disability was identified, we have made too little progress in preventing it and in knowing how to help those who are affected (Devries & Waller, 2004, p. 125)

6. Statistics and FAS • One half of all pregnancies in the U.S. are unplanned (Forrest, 1994) • 90% of the general U.S. population believed drinking alcohol could adversely affect the unborn baby and 64% had heard of FASD (Williams & Gloster, 1999) • National U.S. Study 1991 • 60% of women drink occasionally; 44% of women in a were considered light drinkers, 12% moderate drinkers, and 3% were classified as heavy drinkers (Leonardson & Loudenburg, 2003) • In a large (9,845) cohort study- “20% of the male partners of pregnant women were drinkers daily before conception, and 8% were considered moderately heavy to very heavy drinkers” (Passaro et al., 1998) • About 75% of children born with FAS have biological fathers who are heavy drinkers and alcoholics (Abel, 1983; Abel, 2004)

7. Economic Costs and FASD • Life time costs for each case of FASD ranges from US$ 1, 000, 000 to US$ 2, 000, 000 (Abel & Sokol, 1987;Burg, 2004) • Annual U.S. costs $5 Billion to $10 Billion (Burd et al., 2003; Weinberg, 1997) • Impossible to directly measure the real economic costs, let alone the indirect societal or familial expenses

8. Overview: Fathering Literature • Positive child outcomes associated with involved fathers • Negative child outcomes associated with absent/abusive fathers • Do fathers make unique contributions? • Need to understand fathers' experiences in context

9. Understanding Fathers • Social ecological model • Factors influencing fathers at biological, individual, family, and broader social context • Critical realism • Balancing individual responsibility for behaviour and social/structural factors that shape behaviour

10. Reviewing the Research • A review of the current literature on fathers and FASD. • A specific focus on four distinct spheres in which fathers influence this condition emerge from the literature: genetics, being in couple relationship, part of a family, and in the larger environment.

11. The Self: Genetic Impacts of Paternal Alcohol Use The “focus on the singular role of the pregnant female in the health of the fetus and neonate has tended to minimize concern for possible male-mediated effects” (Friedler, 1996). • Animal studies • Males who drink alcohol are exposed • Paternal alcohol use negatively impacts

12. The Couple: Fathers and Relationships • Male involvement in a relationship with women of childbearing years • The relationship’s environment • The supportive or stressful nature of the couple relationship • The level of relationship stability

13. The Family: Paternal Influences in Extended Families • Role models • Childhood physical and sexual abuse • Supporting adult daughters and sons • Support network

14. The Environment: Structural and Societal Factors • Socioeconomic status (SES) • Ethnicity

15. Areas for Best Practices • Self • Couple • Family • Larger Environmental Factors

16. “Men, however, are more likely to correctly indicate that the father’s alcohol intake does not directly affect the unborn baby, biologically” (Williams & Gloster, 1999, p. 835)

17. The Self: Individual Involvement and FASD Best Practices Guidelines (1 of 2) • Alcohol is a toxin that impacts their health • Alcohol is a recognized teratogenic drug that potentially affects semen • Alcohol is associated effects on testicular function, spermatogenesis, less sperm concentration & output • When men drink alcohol & contribute to a pregnancy, animal models suggest that they have done so with semen that may possess toxins, which can damage genetic material of the children • Alcohol consumption in males is an associated risk to a number of birth malfunctions and abnormalities

18. The Self: Individual Involvement and FASD Best Practices Guidelines (2 of 2) 6. Alcohol consumption in fathers has been associated with a number of health problems in their children (ventricular sepal deficits, hormonal & nervous system abnormalities, spontaneous abortions) 7. Paternal alcohol use in the preconception period can negatively impact intelligence & cognitive ability in their children 8. Paternal alcohol use in preconception, during pregnancy, and after birth is associated in hyperactivity & oppositional behavioural in kids 9. Paternal drinking without maternal alcohol consumption can not cause Fetal Alcohol Spectrum Disorder; however, fathers who drink may contribute to this condition through their influence on women’s alcohol use in pregnancy

19. “parents typically receive inadequate information on the management and course of the illness” (Devries & Waller, 2004, p. 122)

20. The Couple: Fathers in Relationships and FASD Best Practices Guidelines (1 of 2) • Men & women in a relationship affect each others’ behaviours • Male partners who drink foster an environment where alcohol use is tolerated & encouraged • Male partners who are opposed to the mother’s intention to stop drinking may influence her inability to reduce alcohol consumption • Males are responsible for their own drinking behaviour and its potential impact on others • Males can directly and indirectly oppose abuse of females in any form (e.g., perpetrate, engage, condone, minimize, justify, association, passive observer) • Professional support may help to end abuse in relationships

21. The Couple: Fathers in Relationships and FASD Best Practices Guidelines (2 of 2) 7. Males & females are responsible for the promotion of a stable & committed relationship 8. Males & females in relationships considering children may want to plan together their use of alcohol 9. Males & females can positively encourage & support each other in reducing and/or eliminating their drinking before conception 10 Males & females can actively support & assist each other in family planning (e.g., birth control, time, finances, relationships stability) 11 Males & females can actively participate in the preparations for the new child (e.g., attending medical appointments, planning) 12 Males & females can promote, support, & advocate for a nurturing home environment

22. “In the case of FAS, the single-minded focus on alcohol as the sole cause of the observed outcome blinded doctors to the social context in which prenatal exposure to alcohol occurred and to any potential ameliorating or exacerbating factors (Armstrong, 1998, p. 2028)

23. The Family: Paternal Influences in Extended Families & FASD Best Practices Guidelines (1 of 2) • Fathers have the opportunity to set a positive role model for their children by not abusing substances • Children are more likely to become alcoholics as adults if their fathers are alcoholics • Physical or sexual abuse of children by father is associated with children abusing alcohol as adults • Fathers & mothers can support both yearly education in K-12 programs at school and discussions at home on FASD with their sons and daughters

24. The Family: Paternal Influences in Extended Families and FASD Best Practices Guidelines (2 of 2) 5. Fathers can capitalize on their role to encourage alcohol free pregnancies in their daughters 6. Fathers’ support is associated with increased success rates of adult daughters who are trying to reduce or eliminate alcohol consumption during their pregnancies 7. Fathers’ promotion of their adult daughters’ support network is associated with women who achieve absenteeism in alcohol consumption during their pregnancies 8. Fathers & mothers can promote, support, & advocate a nurturing home environment

25. The Environment: Structural and Societal Factors and FASD Best Practices Guidelines (1 of 2) • Men can positively influence & become involved in larger societal factors that impact FASD • Males & females can choose to no longer accept the incorrect assumption that FASD is an individual issue • Victim blaming does not help in reducing FASD • Males & females can promote FASD national social & health issues • Males can lend their voices as fathers to the advocating, promotion, creation, development, implementing, and monitoring of FASD programs and policies • Males & females can be involved with FASD policy planning, delivery, and implementation around the needs of families • Males & females can encourage greater collaboration between those providing health services & education with individuals impacted by FASD

26. The Environment: Structural and Societal Factors and FASD Best Practices Guidelines (2 of 2) 8. Males & females can encourage increased professional training (medicine, healthcare, legal system) on FASD 9. FASD strategies (prevention & education) need to include the community 10 FASD strategies need to reach out to diverse, ethnic, economically disadvantaged, and underserved populations 11 Greater linkages between service providers, educators, & gov’ts 12 Males & females can advocate for education that targets both knowledge transmission & behavioural changes 13 Men can effectively add their voice to the promotion of a National Strategy (education, research, service delivery, programs) for FASD

27. Influences on maternal drinking are complex and originate from a combination of factors: biological, familial, social, and psychological (Gomberg, 1993; Viljoen et al., 2002)

28. Conclusion • The complex factors that contribute to and support maternal drinking need to be addressed in confronting this national health issue. • FASD is not an individual issue; rather, FASD is a population health issue that requires prevention and treatment to consider related social determinants of health. • Fathers and their involvement is a distinct and significant factor that unmistakably exerts positive and/or negative influence on FASD across a number of domains, specifically genetics, partnering relationships, family life, and larger environmental and structural conditions.

29. Future Directions • The US National Task Force, chartered in 2000, for Fetal Alcohol Syndrome did not mention or make any reference to fathers in their recommendations • The time for father involvement is now

30. Future Directions • The inclusion of fathers in the education, treatment, and prevention of this burdensome illness requires a number of changes. • End mother blaming • Support the inclusion & active participation of fathers • Greater research support & activities • More concerted approaches that incorporate educators, service providers, families, health care professionals, and the various levels of government

31. More active father involvement will not end FASD, but in stepping forward, exerting their influence, and adding their voices, fathers can contribute to prevention and assist those with this condition.

32. Robin Gearing, Ph.D. (cand.), MSW, RSW The Hospital for Sick Children Department of Social Work 555 University Avenue Toronto, Ontario M4C 3X3 E-mail: robin.gearing@sickkids.ca