“Using alcohol prenatally is almost never a deliberate choice to cause harm”: Breaking down stigma around FASD and improving support during pregnancy

In this Q&A, Claudine Evetts, National Lead Nurse for WithYou, shares expert insights on Fetal Alcohol Spectrum Disorder (FASD)—explaining what the condition is, how non-judgmental support empowers families, and how WithYou's collaborative new resources are helping maternity teams deliver compassionate, stigma-free harm reduction.

 

For people who may not be familiar, how would you explain Fetal Alcohol Spectrum Disorder and why awareness is so important?

Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodevelopmental condition caused by alcohol exposure before birth. It is estimated to affect between 3% and 5% of the UK population. It exists on a spectrum, meaning it affects each individual uniquely—ranging from subtle learning and behavioral shifts to more complex physical and cognitive challenges.

At its core, FASD is a physical condition that affects how the brain develops, processes information, and manages sensory input.

It’s really important to emphasise that using alcohol (or any other substances) prenatally is almost never a deliberate choice to cause harm. Substance exposure often is because of complex life factors; such as alcohol exposure during early pregnancy when someone doesn't realise they are even pregnant, confusing and outdated advice on light or occasional drinking being safe, or substances being used as a survival mechanism or coping tool in unaddressed trauma, domestic violence, poverty or mental health struggles.

How does FASD affect children, families and wider support networks, and why is early intervention so crucial?

FASD affects children as often there are no visible physical traits and they are then treated as neurotypical.  This can lead to overwhelm, frustration, exhaustion and low self-esteem when they struggle to meet expectations in society. Loud classrooms and busy spaces can quickly trigger sensory overload and lead to dysregulation and emotional meltdowns. There are also challenges with their executive functioning and increased vulnerability especially around understanding social dynamics and making and keeping friends.

For families, supporting a child with high sensory and executive function can require continuous structure, oversight and advocacy which can ultimately exhaust the parent or caregiver. Furthermore, isolation and stigma through the fear of judgement from those they come into contact with lead to feeling socially-isolated. Families also have to spend a lot of time navigating systems such as healthcare and education that lack the training in FASD which forces parents to have to re-explain their child's needs constantly.

Through the wider support networks such as schools, healthcare and community there is the misinterpretation of behaviour as the FASD brain causes processing delays which can be seen as defiance, which are typically responded to through ineffective disciplinary responses rather than environmental adaptations.

What role do drug and alcohol treatment services like WithYou play in preventing FASD and supporting pregnant people who may be worried about their alcohol use?

Drug and alcohol treatment services like WithYou play a vital role in preventing FASD by bridging the gap between healthcare, drug and alcohol support, and compassionate maternal care. For pregnant individuals, or those planning a pregnancy who are worried about their alcohol consumption, our services are safe and confidential, working in an integrated way with maternity services by offering expert harm reduction strategies while addressing the root cause for the drinking. Every client is cared for holistically.

Pregnant individuals struggling with substance dependence often hide their use because of shame or fear of judgement, and worry about legal repercussions, and child protection involvement. We send a clear counter-message: you can speak to us safely. Our role is to create a safe space where they can speak openly. We reassure them that they can talk to us without fear of judgement. Early, honest conversations allow us to provide support, reduce harm, and plan safely for both parent and baby. 

What prompted the development of new WithYou materials for pregnant people, and what gaps in current practice are they designed to address?

This was a collaborative initiative started in Stoke-on-Trent with a variety of key workers and highlights a proactive approach to addressing service gaps in prenatal harm reduction and substance support. The project recognised that while existing engagement focused on pregnant clients with active prescriptions, broader substance use—including alcohol—required structured harm reduction resources. Therefore we created harm reduction materials, carefully-designed to engage both parents, reinforcing shared responsibility to help further reduce stigma. It’s important to note that semen can also be compromised by drug and/or alcohol use, and including both parents in conversations, where possible, is key.

The materials provide non-judgemental information that empowers people to build confidence, make informed choices, and work at a pace that feels safe and achievable for them and their families. 

How can clear, non‑judgemental information help pregnant people understand the risks of alcohol use without creating fear or shame?

Clear, non-judgemental health communication bridges the gap between biological facts and human behaviour. If healthcare is provided with judgement then this creates barriers to care, driving people away from a system when they need it the most. Transparent and empathetic communication ensures that people engage with services so that correct evidence-based information can be provided to the expectant parents, reducing fear and shame and creating a supportive network for expectant parents.

Having honest conversations about alcohol or drug use in pregnancy relies on trauma-informed practice, respectful language, and real partnership. The priority is to remove shame and fear, creating a safe space where pregnant people feel confident sharing their experiences and asking for support. 

Pregnancy is a time of profound physical, emotional, and mental change. Taking a holistic, person-centered approach is essential to helping pregnant people feel safe, supported, and confident in the care they receive from both maternity services and WithYou practitioners.

When people feel secure and valued, trust builds—improving engagement and enabling effective, cross-service collaboration. Most importantly, this unified support empowers people to maintain agency and control over their own health, bodies, and care journeys.

How does early, compassionate support for pregnant people contribute to the long‑term health and wellbeing of their unborn child?

Early, compassionate support for pregnant people serves as a foundation for lifelong health, development and wellbeing of the unborn child.

Major public health frameworks such as the 10 Year Health Plan for England advocate shifting from treating sickness to delivering prevention, therefore a harm reduction approach applies preventative logic to perinatal care.

Early intervention helps to address the substance use and help the people to safely manage this minimising the risk of structural neurological impacts, low birth weight and organ damage.

Whilst creating psychological safety will help to reduce physiological stress and cortisol levels within the expectant person and directly improve the intrauterine environment.

Psychological safety further reduces cortisol levels and ensures the person remains engaged with antenatal care, nutritional advice and screening which again directly impacts on the unborn child's birth outcomes.

How could these resources help midwives, maternity teams, and drug and alcohol practitioners feel more confident discussing substance use in pregnancy?

Having a greater understanding about the direct impact that the substances have on both the pregnant person and the unborn child during the development whilst in utero will help the workers to discuss this matter with other professionals they are involved with.

The leaflets give them critical information but also highlight areas they may want to research further.

The key is to ensure that they impart their knowledge around holding discussions in a compassionate, non-judgemental and stigma-free manner with professionals that are not specialised in our field.

Why is it important that this work is led by WithYou but developed collaboratively with nurses and maternity specialists nationally?

As substance use specialists, it is vital that we lead the agenda by proactively dismantling the stigma surrounding perinatal alcohol and drug use. Foetal Alcohol Spectrum Disorder (FASD) is estimated to affect between 3% and 5% of the UK population—making it significantly more common than autism—yet it remains critically underdiagnosed due to diagnostic gaps and widespread societal shame. By driving down stigma, we break the barriers to help-seeking, encouraging individuals to access support early. This non-judgemental, early intervention model is essential to preventing intrauterine harm and ultimately reducing community rates of FASD.