Where To Start: Accepting that women may not be able to quit but can reduce harm. A harm reduction approach involves supporting people in making whatever change is possible in their use of alcohol and/or other drugs, and/or changes in behaviours related to their use, so that harm to themselves and to others is reduced. The Rationale Since we do not know a safe level of alcoholor other drug use in pregnancy, it has always been recommended that women not drink or use drugs before or during this period and while breast-feeding. However, with an abstinence approach, we may "drive away", "turn off" or otherwise not reach many of the women at highest risk of having a child affected -- women who are still using alcohol and other drugs, who have significant problems with their use and have difficult lives. Such women will respond best to flexible support when it is not conditional on abstinence. Harm Reduction Values The harm reduction approach emphasizes: Women's right to non-judgmental services Belief in the competency of women to make choices and changes in their lives and their substance use Reducing the harm arising from use, rather than focusing on the drug itself -- whether legal or illegal Involving the women and their communities in jointly coming up with strategies that will work Modifying our attitudes towards women who use, so we can truly provide non-judgmental caring assistance. Getting over our urgency that she stop her use! Providing advocacy and services to address her needs within a social context e.g., housing, child-care, transportation Staying hopeful! Options for Reducing Harm HARM REDUCTION Range of Options/Approaches "Using" <---------- Continuum ----------> "Non-using" Harm reduction support to pregnant women includes: To reduce (if they can't stop) their use of alcohol To stop, or reduce the use of any or all other drugs being used with alcohol To access good prenatal care and health care overall in a holistic way To eat well during pregnancy To reduce their stress and/or stabilize their living situation. Caution: For pregnant women who are tolerant and dependent on alcohol, opiates and benzodiazepines, abrupt reduction or cessation of use is not recommended. Any reduction or cessation by a pregnant woman of use of alcohol, opiates or benzodiazepines should be done under the supervision of a physician familiar with withdrawal management. Source: FAS Community Action Guide (1998). BC FAS Resource Society, BC Ministry for Children and Families, ISBN 0-7726-3483-1