Research Update

Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue

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3 Women's Alcohol Use Patterns

What the Studies Say Recognizing the data limitations, the surveys show that overall, approximately three quarters of adolescent girls and adult women in Canada reported the use of alcohol in the 12 months prior to the survey. On average, over 10% reported heavy drinking at least once a month, with the rate typically higher among young women. Among adolescent girls and young women, prevalence and frequency of drinking and heavy drinking are higher. Drinking among school-aged females appears to have increased from the late 1980s to the late 1990s, with relative stability since. These findings raise concerns for the health and safety of young women, and if pregnant, the fetus. Rates are understood to be higher still for female youth who are not enrolled in school or are living on the street, and their use is typically riskier in comparison with their high school counterparts.

It is well established in the literature that women in general have lower levels of alcohol use and problematic use compared with men,²⁷ yet women are at a greater risk of developing alcoholrelated problems.²⁸ This is due partly to biological factors, such as body composition and hormonal influences. Social factors specific to sex and gender, such as victimization and lack of social support, are also significant contributors to women's alcohol-related problems. To help inform current discussions on what works best to respond to pregnant women's use of alcohol and related harms, it is important to first become acquainted with the overall use of alcohol by women in Canada.

The data presented in this section and the next are gathered mostly from published articles reporting on national and provincial surveys.^xii These surveys typically report on prevalence, frequency and level of use (i.e. how many women use, how often and how much^xiii). This is important because, as mentioned, fetal development has been linked to the amount of alcohol used (i.e. peak blood alcohol levels) and frequency of drinking. Excessive alcohol consumption over time has also been linked to serious health problems in women, such as liver, heart, stomach and brain damage, as well as some forms of cancer.²⁹

According to a 2004 national survey³¹ of Canadians' (15 and older) use of alcohol and other drugs, 76.8% of females reported consuming alcohol in the past year. The 2000-01 Canadian Community Health Survey, Cycle 1.1 (CCHS) similarly reported on past-year drinking, for respondents 12 and older, with 73.1% of these females reporting use of alcohol. Of the females who reported drinking in the past year, their frequency of use ranged widely: 32.6% drank less than once per month, 13.4% once a month, 16.1% 2 to 3 times a month, 13.4% once a week, 19.7% 2 to 6 times a week, and 4.8% every day.³²

Looking at the level of alcohol used by Canadians, heavy drinking was defined in the 2004 Canadian Addiction Survey (CAS) as 4 or more drinks on a single occasion for women. Among female past-year drinkers (15 and older), 3.3% reported heavy drinking at least once a week and 17.0% reported heavy drinking at least once a month.³³ In the 2000-01 CCHS (defining heavy drinking for females as 5 or more drinks per occasion), 8.3% of women reported heavy drinking at least once a month. The CCHS data further relayed that twice as many Aboriginal as non-Aboriginal women reported drinking at this level.³⁴ In addition to the limitations of survey data already outlined, a further weakness is that differing definitions of variables make it difficult to compare datasets. This may help to explain the above difference in reported levels of heavy drinking between the 2004 CAS and 2000-01 CCHS.

Increasing attention is being paid to the use of alcohol by adolescent girls and young women. Adolescence is a time of brain and hormonal maturation, and adolescent drinking patterns can influence later patterns, so it is likely there are long-term consequences to alcohol use by this population. According to the 2001-2002 Health Behaviour in School Aged Children (HBSC) survey, 22% of females in Grade 10, 12% of girls in Grade 8 and 2% of girls in Grade 6 reported drinking any alcoholic beverage once a week or more.³⁵ Canadian studies have also revealed that young people are more likely to engage in sex without the use of contraception when they are drinking.³⁶ In a US study, one third of pregnant 14- to 21-year-olds reported they were drinking when they became pregnant.³⁷ There is some indication as well that young women tend to identify their pregnancy later in term than older women.³⁸ Also of concern are studies that report that the younger a woman is when she starts drinking, the more likely she is to develop a problem with alcohol later in life.³⁹

Insight: Substance Use Before Age 13

In an informal evaluation of the Edmonton First Steps Fetal Alcohol Spectrum Disorder program, which offers mentorship for women who are pregnant or who have recently given birth and have used drugs or alcohol during their pregnancy, it was found that of the 96 female program clients interviewed, all had begun to use alcohol and/or drugs prior to age 13.⁴⁰

Surveys conducted during the 1990s have indicated that the prevalence of drinking among high school students in Canada has increased substantially.⁴¹ The Ontario Student Drug Use Survey (OSDUS), which is commonly used as a proxy for drinking patterns among school-aged children in Canada, found that drinking declined during the late 1980s but increased during the late 1990s, and has shown relative stability since.⁴² The 2000-01 CCHS reported that 71.1% of females between 15 and 19 years of age used alcohol in the previous 12 months.⁴³ Although not differentiated by sex, the 2004 CAS survey reported that approximately 90% of Canadians between 18 and 24 consumed alcohol within the past year.⁴⁴ Data from the 1996-97 National Population Health Survey (NPHS) also showed that younger women were more likely to report regular drinking than older women: 59% of women 20 to 24 years of age and 56% of women 18 to 19 years of age drank regularly, compared with approximately 50% of women between 25 and 54, 41% of those 55 to 64, 34% aged 64 to 74, and 23% of those 75 and older.⁴⁵ There is little information available on youth who are out of the mainstream, but indications are that the percentage of these females drinking alcohol is higher and their pattern of use is riskier than their high school counterparts.⁴⁶ Young women who are homeless/living on the street are at particular risk for a range of harms related to their heavy substance use and other risk behaviours.⁴⁷

xii. There may be more recent data collected in Canada on women's use of alcohol during pregnancy than reported on here (e.g. 2003 Canadian Community Health Survey, 2002- 03 National Longitudinal Survey on Children and Youth); however, it was not publicly available for this report. As outlined in the methodology section, this research update focuses solely on published data.

xiii. Surveys typically also report on high-risk drinking and dependence using tools such as the Alcohol Use Disorders Identification Test (AUDIT), which measures hazardous and harmful drinking, alcohol dependence and some specific consequences of drinking.

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