Título: Una excusa para la emergencia de nuevas formas de intervenir la violencia en pareja.
TEXTO (TRANSCRIPCIÓN LITERAL DE TODO EL ESCENARIO
Fetal exposure to alcohol as the cause of FASD is not disputed, but this means that FASD is part of a much bigger problem system – alcohol and its attributed harms. Differences of opinion are noted when it comes to addressing responsibility. The alcohol industry is not sufficiently accountable for its products and the industry is highly influential inside government circles ‘to protect its commercial interests’ (Doran et al. 2010, pp. 468–470). A common criticism from public health professionals is that the industry has been influential in setting the policy agenda, ‘shaping the perspectives of legislators on policy issues, and pushing alcohol policy towards “self-regulation”’ (Doran et al. 2010, pp. 468–470). Any increasing disagreement from the general public over problem definitions or solutions in respect to alcohol use is suppressed with authoritative type strategies. The overall influence of leadership is in some doubt because of the power of the alcohol industry lobbyists and social and economic climates which value alcohol in all three countries. Alcohol is currently a highly profitable commodity and drinking alcohol is a cultural norm, and there seems to be little doubt in the
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minds of many of those interviewed that the issue of damage arising has been suppressed by the alcohol beverage industry.Interview data reveal a greater need for governments to be involved in the solution of FASD; however, for governments challenges are evident. First, governments must manage any perceived public
opposition to the ‘love of alcohol’, as this could cost votes, particularly with the prevention message conveying abstinence throughout pregnancy as the only risk-free option. Second, governments must balance the powerful interests of the alcohol industry and their own need for revenue generated by sales of the product. Third, these problems must be managed against a moral, ethical and perhaps legal obligation to alert their citizens to a major public health issue.
Differences also arise in prioritising public funding for FASD and where it may best be invested. The influence of national institutions has sustained FASD as a health issue, translated as policy-favouring solutions focused on researching clinical intervention and service delivery model outcomes and innovative ways to prevent alcohol use among women of childbearing age. A sharpened focus on alcohol, pregnancy and infant health, which gained momentum in the late 1970s in the United States, has continued with surveys to collect data on women’s use of alcohol during pregnancy and funding research into the personal characteristics and life experiences of high-risk drinking women to inform prevention efforts such as Project Choices. Printed and then online manuals with language content linking healthy pregnancy with healthy babies have been repeated in the United States.
Over time the problem for governments has been reduced ‘through a carefully structured expansion phase to keep the issue off both the formal and public agendas’ and to suppress the demands of the original proponents. The authority to define the problem and provide technical details is limited to the select group, and expansion is contained by limiting it to those groups where consensus with current position is most likely. There are reciprocal benefits of status and funding investment, and whether or not the public policy approach is to invest in research or to target only marginalised communities or some women drinkers, there are consequences to such discretionary policy-making. Government investment in preferred solutions diverts attention to primary prevention and efforts are not concentrated on children and others living with the problem, particularly those older children and adults who have been undiagnosed, misdiagnosed or unrecognised and have no voice.
The Federal government of Canada has had a national FASD strategic plan since 2001, which evolved from best practice research and consultation through stakeholder forums and was reviewed and updated in 2012. The provincial governments of British Columbia and Alberta developed their own FASD action plans, complemented by multiple partnerships across portfolio areas and sectors, based on the early understanding that FASD prevention did not fall within a single policy stream. No similar strategic document is noted in the United States. There, Bhuvaneswar et al. (2007) reported, 15 per
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cent of pregnant women consumed alcohol in pregnancy. In the detailed findings from the 2011 Australian National Drug Strategy Household Survey, the majority of pregnant women who reduced or abstained from drinking is documented; but half of all pregnant women still disclosed some alcohol use during pregnancy (Australian Institute of Health and Welfare 2011). In the subsequent 2013 report, more than 50 per cent of pregnant women said that they had consumed alcohol before they knew they were pregnant and 25 per cent ‘continued to drink, even once they knew they were pregnant’ (Australian Institute of Health and Welfare 2011).Accepting the complexity of the problem and the reliance on changes to belief and culture to foster change, may not be enough: the stories and results of interviews reveal a diversity of opinion about barriers to prevention and what needs to happen in the future, even from individuals who share similar backgrounds and stakes. The role and influence of governments, of medicine and medical
professionals dovetailing with both diagnosis and influencing the investment in research, and the contribution of parents/carers in ensuring support and services for those individuals who have no voice indicate how best to manage this problem in the future. In respect to the individual living with FASD, there is a constant theme of the need for consistency in diagnosis. Screening, assessment and diagnosis have been focused on to ascertain and estimate prevalence in both the United States and Australia. The link between accurate diagnosis and capturing data to estimate prevalence are noted as essential to convince government policymakers of the seriousness of the problem. The development of diagnostic tools in each of the three countries has been independently done and the lack of consensus adds to the conundrum surrounding the identification of individuals recognised at risk for a FASD but having none of the features characteristic of FAS. Reliance on known physical features of FAS (particularly facial features) as a reliable diagnostic criterion for prenatal alcohol exposure has been a driving factor in limiting the accuracy of true FASD prevalence. Secondly, failure to assess FASD, inclusive of neurodevelopmental anomalies in the absence of facial features, avoids naming maternal drinking as the causal factor. Limiting FASD to FAS alone has a major consequence and meant a stronger focus on women and their children in perceived higher risk populations where FAS is more likely found.