Fetal alcohol spectrum disorder (FASD) is a preventable disability, yet it remains a persistent public health challenge for Canada.
Prevention efforts – which focus on individual behaviour change, including those that help women to reduce or stop drinking during pregnancy – are necessary, yet policy that shapes alcohol use long before pregnancy begins, also needs action. If we are serious about preventing FASD and supporting healthy pregnancies, alcohol policy must move from the margins to the centre of prevention efforts.
Policies governing warning labels, point-of-sale signage, pricing and taxation, marketing, availability and health and safety messaging shape population drinking patterns and, in turn, prenatal alcohol exposure. Stronger warning labels and visible point-of-sale signage are associated with reduced alcohol use in pregnancy and improved birth outcomes, including fewer preterm births. In Canada, prominent alcohol warning labels were found to be linked to reduced alcohol sales – an effect that was reversed under industry pressure. Measures such as pricing controls, reduced availability and restrictions on marketing are not directed specifically to pregnant women; they reduce harm across the entire population while helping normalize shared responsibility for prevention in pregnancy and beyond.
Equally important are the services available to support women’s health. Research on FASD prevention shows that women who are pregnant or parenting while using substances often face intersecting challenges, including poverty, trauma, housing instability, poor nutrition, violence and limited access to care. Programs that provide integrated, non-judgmental supports – including prenatal care, substance use, mental health and parenting supports and practical assistance – are associated with improved outcomes for both women and children. These approaches work because they address the fundamental conditions that make alcohol use difficult to change.
Prevention also is driven by action in clinical settings. Canada has clear national guidance that no amount of alcohol is safe during pregnancy, yet awareness and uptake of this guidance among clinicians remains uneven. Many providers rely on outdated recommendations, lack training in prenatal substance use intervention or worry about stigmatizing women. Supportive policy environments involve clear health and safety messaging and routine, non-judgmental conversations about alcohol, with adequate training and resources. When health-care providers are confident, informed and supported by policy, women are more likely to receive timely, trustworthy information and feel safe asking for help.
The Canadian Academy of Health Sciences’ 2025 report reinforced these same recommendations, calling for stronger alcohol policy measures, expanded wraparound supports, improved health professional education and greater coordination across systems. In other words, it outlined actions we know are effective, but that we cannot implement in a coordinated way without leadership, funding and support from policymakers. More than a year after the report was published, there is still no clear federal action plan or accountability framework implemented to address these recommendations.
To reiterate: despite investing nearly $1 million into collecting the evidence, the federal government has yet to act on the recommendations that are shown to have significant results.
Without coordinated leadership, prevention remains fragmented and responsibility continues to fall on individual women rather than shared systems. Meanwhile, evidence from other jurisdictions shows what happens when policy moves in the wrong direction. Punitive approaches that criminalize alcohol use during pregnancy or trigger child apprehension do not improve outcomes. They are associated with delayed prenatal care, reduced treatment access and worse birth outcomes, particularly for women who are already marginalized.
The solution to FASD prevention is not simply to tell women not to drink, assuming they either don’t know enough or don’t care enough. That is outdated, individualistic thinking that ignores the social and cultural factors that contribute to alcohol use in pregnancy. The solution is to create policy environments that make prevention possible.
When alcohol policy reduces harm at the population level, when women and girls have access to wraparound supports and when health-care providers are equipped to offer accurate, compassionate guidance, prevention becomes a shared societal effort rather than an individual burden.
Canada has the evidence, the models and the expertise. What is missing is political will. If we want to prevent alcohol use during pregnancy, we must stop treating it as a personal failure and start addressing it as the policy challenge it is.
