Stigmatisation, Exaggeration, and Contradiction: An Analysis of Scientific and Clinical Content in Canadian Print Media Discourse About Fetal Alcohol Spectrum Disorder

Abstract

Background: Fetal alcohol spectrum disorder (FASD), a complex diagnosis that includes a wide range of neurodevelopmental disabilities, results from exposure to alcohol in the womb. FASD remains poorly understood by Canadians, which could contribute to reported stigma faced by both people with FASD and women who drink alcohol while pregnant. Methods: To better understand how information about FASD is presented in the public sphere, we conducted content analysis of 286 articles from ten major English-language Canadian newspapers (2002-2015). We used inductive coding to derive a coding guide from the data, and then iteratively applied identified codes back onto the sample, checking inter-coder reliability. Results: We identified six major themes related to clinical and scientific media content: 1) prevalence of FASD and of women’s alcohol consumption; 2) research related to FASD; 3) diagnosis of FASD; 4) treatment of FASD and maternal substance abuse; 5) primary disabilities associated with FASD; and 6) effects of alcohol exposure during pregnancy. Discussion: Across these six themes, we discuss three instances of ethically consequential exaggeration and misrepresentation: 1) exaggeration about FASD rates in Indigenous communities; 2) contradiction between articles about the effects of prenatal alcohol exposure; and 3) scientifically accurate information that neglects the social context of alcohol use and abuse by women. Respectively, these representations could lead to harmful stereotyped beliefs about Indigenous peoples, might generate confusion about healthy choices during pregnancy, and may unhelpfully inflame debates about sensitive issues surrounding women’s choices.

News Media Representations of Responsibility for Alcohol-Related Liver Disease Requiring Liver Transplantation

“…Individuals are positioned as responsible for developing their liver disease, treating their ARLD, and maintaining their transplant. These findings are consistent with results from media analyses of addiction discourses in Canada, Italy, Finland, and Poland that found increasing rates of individualization, where personal responsibility is ascribed to people living with addictions (14,30,31). Positioning people as personally responsible for their ARLD is a moralizing action that is aligned with ingrained social and cultural values in North America and the UKwhich include neo-liberal values of productive citizenship, vulnerability, risk and self-controlvalues thought to be threatened by people who consume high volumes of alcohol or other substances (52).…”

“…Further, these stigmatizing portrayals may impact public perceptions of addiction and mental illness, how US courts address these issues, and how public health authorities employ health promotion strategies. Aspler and colleagues explored how information about fetal alcohol spectrum disorder (FASD) is presented in the Canadian print media and found evidence of "ethically consequential exaggeration" about FASD and women's alcohol consumption, and particularly how it is represented in Indigenous communities (30). In another international study of addiction discourses in news media, Bujalski and colleagues suggest that from 1991 to 2011 the media in Finland, Italy and Poland increasingly presented issues related to substance use in two ways: in terms of scientific advancements and from the perspective of individualism (14).…”

Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder

“…Another layer of stigma that is unique to FASD is the shame and blame that is targeted toward women and mothers ( Corrigan et al, 2017 ). FASD has been inextricably linked to women’s behavior and mothers are often held responsible for “victimizing” ( Aspler et al, 2019 ) or “causing” harm to their child ( Bell et al, 2015 ). This stigma can be particularly harmful as it impedes women from seeking support or discussing alcohol consumption with care providers out of fear of judgment, child removal, or incarceration ( Poole et al, 2016 ).…”

“…Another unique layer of stigma in FASD exists at the sociocultural level, whereby it is commonly, and incorrectly, misperceived to be an “Indigenous issue” ( McKenzie et al, 2016 ; Aspler et al, 2019 ). In fact, there are no recent or rigorous prevalence studies to support this misconception ( Flannigan et al, 2018 ).…”

“The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

“…However, for those who use alcohol post-pregnancy recognition, intersecting contextual factors may influence their use, such as: peer influences and social pressures; limited provision of prenatal alcohol use risk information due to discomfort on part of health and social care providers to discuss alcohol use with women and their support networks; or conflicting or unclear information received from health care providers surrounding ‘safe levels’ of alcohol during pregnancy [ 15 , 16 ]. Confusion around what is safe may also result from women’s exposure to conflicting messaging in public discourse, or from family and friends, the media, or online pregnancy content where information around healthy behaviours during pregnancy may be outdated, incorrect, or not evidence based [ 17 , 18 ].…”