‘Think before you drink’: Challenging narratives on foetal alcohol spectrum disorder and indigeneity in Canada

Abstract

Foetal Alcohol Spectrum Disorder (FASD) has emerged as a significant public health issue, in Canada and elsewhere. Health experts increasingly acknowledge that the disproportionate impact of FASD on indigenous people is driven by social and historical contexts, especially in settler colonial states like Canada. However, they generally frame FASD as preventable through abstinence and the effects of FASD as manageable through provision of appropriate medical and legal protection to affected offspring. Drawing from Marxist, anticolonial and anti-imperial theories and applying a Critical Discourse Analysis approach, we identify the (re) production of colonial and capitalist dominance in the expert literature. We show that dominant narratives depoliticize FASD by conceptualizing settler colonialism as a past event, ignoring ongoing, contemporary forms of settler colonial dispossession and resituating FASD within an expert language that locates solutions to FASD within affected individuals and communities. In so doing, these narratives legitimize, and contribute to perpetuating, existing disease inequities, prevent the formulation of policies that address the very real and as yet unmet needs of FASD affected individuals, families and communities and erase from the public discourse discussions about changes that could truly address FASD inequities at their root. We conclude by elaborating on the implication of these narratives for policy, practice and equity, in Canada and other settler colonial states.

Toward Effective Identification of FASD

“…1,10,47,51,60 Care must also be taken to ensure that FASD surveillance and inquiry is applied objectively, in line with evidence, and without bias in light of structural racism and ongoing inaccurate and harmful stereotyping leading to assumptions about disproportionate risk for FASD in some communities and populations. [61][62][63][64] FASD can affect all populations, regardless of factors such as socioeconomic status, ethnicity, or culture. Thus, screening only members of highly stigmatized groups may lead not that as many cases as possible are accurately detected.…”

“…This includes selecting the appropriate tool based on evidence, setting, and population, ensuring that only to missed cases among less stigmatized groups but also an overrepresentation of these populations among those identified as having FASD, which may in turn perpetuate stigma among these groups. 13,[62][63][64][65] Ensuring community-engagement and planning together with impacted stakeholders, including those with lived experience, provides a necessary foundation for informing procedures and approaches to ensure shared goals. These processes also work to ensure that screening practices are conducted in a manner that is FASD-informed, person-centered, culturally safe, and both gender-and traumainformed.…”

The geopolitics of anti-Asian racism: A critical discourse analysis of dominant Western narratives on China in the COVID-19 era

“…Methodologically, we applied a critical discourse analysis (CDA) approach, a method of inquiry that allows scholars to identify how discoursesoral, written, or visual communications operate as social practices that dialectically interact with other social practices and can be deployed to legitimize or challenge relations of domination (Fairclough, 2013). As scholars have noted, discourses that stand out, i.e., that dominate (henceforth "dominant narratives"), often take for granted unproven assumptions, frame solutions to social problems in terms of false alternatives, prioritize "technical fixes" while downplaying the role of power, rely on "experts" to the neglect of individual critical judgment and experience, assume that said experts are committed to the public good whatever they do in practice, and determine which voices are worthy or unworthy of being heard, in so doing manufacturing consent (Herman & Chomsky, 1988;Yousefi & Chaufan, 2021). We merged CDA with thematic analysis, which involves immersion in the data to gain familiarity, close reading of documents to identify salient themes, selection of quotations to illustrate these themes, and interpretations of the meanings of these themes in the social world (Braun & Clarke, 2006).…”