Question Period Note: Fetal Alcohol Spectrum Disorder and Impats of COVID-19

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Fetal Alcohol Spectrum Disorder (FASD) is the leading known cause of preventable developmental disability in Canada. Caused by prenatal alcohol exposure, FASD has life-long impacts. With Canadians consuming more alcohol during the COVID-19 pandemic, there is concern about how this may influence alcohol consumption during pregnancy and the risk for FASD.

Key Messages
• The Government of Canada recognizes that FASD is a serious public health issue. Services and supports for FASD are multi-jurisdictional and multi-sectoral, and addressing FASD will take a coordinated effort across federal departments and across all levels of government.
• Funding of $1.5 million is allocated through the Public Health Agency of Canada’s FASD National Strategic Projects Fund on an annual basis to collaborate with key stakeholders across Canada to develop nationally applicable tools, resources and knowledge that can be used to prevent FASD and improve outcomes for those who are already affected, including their families and communities.
• The Government of Canada is continuing to explore options to work with key partners to address existing knowledge gaps regarding national prevalence estimates of FASD in Canada, which will inform effective approaches to FASD awareness and prevention.
• The Public Health Agency of Canada also leads surveillance activities with respect to maternal and child health issues, including prenatal alcohol exposure and neurodevelopmental disorders such as FASD, and is piloting options for FASD prevalence estimation.

If pressed on Bill S-253 – An Act respecting a national framework for fetal alcohol spectrum disorder
• The Public Health Agency of Canada is currently reviewing Bill S-253.
• We look forward to working with the sponsor of this Bill as it moves forward.

FASD is a diagnostic term used to describe the impact on the brain and body of individuals prenatally exposed to alcohol. It is a lifelong disability and people with FASD will experience some degree of challenges with their motor skills, physical health, learning, memory, attention, emotional regulation, and social skills. The number of people with the disorder is unknown. Recent studies from Canada, the US and Europe estimate that 1% to 5% of the population have the disorder.
A 2013 cost-of-illness study examined the impact of FASD on the material welfare of Canadian society by analyzing the direct costs of resources spent on health care, law enforcement, children and youth in care, special education, supportive housing, and long-term care. The results from this analysis demonstrated that the economic cost associated with FASD in Canada was approximately $1.8 billion annually in direct costs alone.
Further, Indigenous partners have signalled the importance of preventing FASD through two recommendations in the Truth and Reconciliation Commission of Canada’s Calls to Action (#33 and #34). These recommendations focus on FASD, calling for culturally appropriate preventive programs and criminal justice system reform.
Bill S-253 – An Act respecting a national framework for fetal alcohol spectrum disorder was tabled by Senator Mohamed Iqbal Ravalia (an Independent Senator from Newfoundland and Labrador) on October 19, 2022. It is now at second reading stage in the Senate. The Bill calls for the Minister of Health to develop a national framework on fetal alcohol spectrum disorder. It includes specific measures that the framework must include (i.e., training, education, guidance, research, national standards for prevention and diagnosis, a strategy to increase awareness of risks, etc.) It also calls for consultations to develop the framework, and it sets out accountability and reporting requirements. The Bill would require the Minister of Health to table the framework within one year after the day on which the Act comes into force.
The Public Health Agency of Canada (PHAC) is the federal lead for addressing FASD in Canada through the FASD Initiative, which includes the FASD National Strategic Projects Fund (NSPF). The Fund allocates $1.5 million annually for projects that promote education and awareness; harm reduction approaches; and research into the social determinants of health that impact alcohol consumption and FASD.
Three contribution agreements were funded through the NSPF in 2022-23. These projects supported prevention and reduction of stigma, and reached an audience of non-pregnant women of childbearing age, pregnant women and their partners, young adults, individuals with FASD, service providers and policy makers. Through the NSPF, PHAC is currently pursuing a directed solicitation with CanFASD to assess the effectiveness and uptake of the current FASD Diagnostic Guidelines across Canada.
PHAC leads surveillance activities with respect to maternal and child health issues, including prenatal alcohol exposure and neurodevelopmental disorders such as FASD. Collecting data to determine how many Canadians are living with FASD is associated with many challenges. For instance, population-based surveys tend to underestimate the true prevalence of FASD as they rely on self-reported diagnosis and use sampling strategies that often miss important segments of the population. However, at present, such surveys are our best source of information to estimate FASD prevalence in Canada. Using the 2019 Canadian Health Survey on Children and Youth, PHAC estimated the prevalence of FASD among Canadian children and youth aged 1 to 17 years living in private dwellings was 1 per 1000 (0.1%). Canadian children and youth who identified as Indigenous and lived off reserve had a significantly higher prevalence of FASD than those who did not identify as Indigenous (1.2% versus 0.1%). Other Canadian studies have employed various methods to estimate the prevalence of FASD, while focusing on different population groups, jurisdictions and age ranges. These estimates range from 0.09% - 4.4%. Through the Centre for Surveillance and Applied Research, PHAC is piloting options to strengthen FASD prevalence estimation, with a view to identifying proper surveillance approaches for FASD.
The Government of Canada also promotes healthy pregnancies, including FASD awareness and prevention, through other supportive policy and programs by (1): supporting evidence-based policy and guidance for health practitioners and the general public on prenatal issues,; and (2) investing in community-based programs to promote the health of pregnant people, young children and families facing barriers to health equity, including the Canada Prenatal Nutrition Program (CPNP) and the Community Action Program for Children (CAPC).
PHAC’s FASD Initiative (which includes the NSPF) is currently undergoing a planned evaluation through the Office of Audit and Evaluation. The results of the evaluation will inform the development of a new FASD Five-Year Strategic Plan, and will guide future investments under the FASD NSPF.
Indigenous Services Canada (ISC) currently invests $17.9 million annually to support FASD prevention activities in First Nations and Inuit communities through regionally based solutions. This includes a funding increase as part of the Budget 2017 announcement of an additional $83.2 million over five years to expand Indigenous maternal and child health services with $3.7 million ongoing for FASD starting in 2022-23.
Health Canada leads the Canadian Drugs and Substances Strategy (CDSS) that aims to protect the health and safety of all Canadians by minimizing harms from substance use for individuals, families and communities, including harms caused by alcohol consumption (e.g., FASD). Health Canada is currently advancing a proposal to strengthen and renew the CDSS, including investments related to prevention, as well as community-based supports to advance public education and awareness through the Substance Use and Addictions Program.
The Canadian Institutes of Health Research (CIHR) invests over $6.5 million in projects that are currently investigating social epigenetics, the use of magnetic resonance imaging, brain development and mental health, proteins that may be developmentally protective, pediatric neuroimaging, neurobiomarkers, and nutritional preventive intervention in the context of FASD.
The Kids Brain Health Network (KBHN) is receiving $50.8 million from 2009-2024 to improve the outcomes for children and families impacted by neurodevelopmental disabilities, including FASD as a national Network Centre of Excellence under the Networks of Centres of Excellence Program (NCE). The NCE is a Canadian government initiative, which funds partnerships between universities, industry, government and not-for-profit organizations to create large-scale research networks. As a research network, KBHN engages with community groups, non-profit organizations, industry, parents, clinicians, health professionals, provincial and federal governments to advance knowledge to improve outcomes for children with neurodevelopmental disabilities, including FASD, and their families.

• Fetal Alcohol Spectrum Disorder, or FASD, is a serious public health issue. It is difficult to diagnose and often goes undetected. In many cases, people with FASD require life-long assistance from a wide range of services including health, community, remedial education, and many others. Early and appropriate support can improve outcomes for people with FASD.
• There is evidence that Canadians increased their alcohol consumption during the COVID-19 pandemic, which raises concerns about increased alcohol consumption during pregnancy and this potential impact on FASD.
• The Government of Canada invests $1.5 million annually to build public awareness and help prevent alcohol use in pregnancy and support individuals with FASD through the FASD National Strategic Projects Fund (NSPF). The Fund supports projects that undertake work related to FASD awareness, prevention, surveillance, diagnosis, and coordination activities.