As More Hoosiers Report Drinking During Pregnancy, Calls for Task Force Grow

By Leslie Bonilla Muñiz

Hoosiers increasingly report drinking alcohol during pregnancy, jeopardizing the physical and neurological development of those fetuses, according to a new report.

The news is leading fetal alcohol spectrum disorder advocates to renew calls for improvements first proposed in an initial report sixteen years ago.

“This is not going away,” said Susan Elsworth, who directs the Indiana Alliance on Prenatal Substance Exposure. She cited estimates that one in 20 school-aged children live with the impacts of such exposure.

“That means that’s in our neighborhoods, our schools and all of our programs, and they’re showing up in our juvenile justice systems and [Indiana Department of Child Services] cases,” Elsworth said Tuesday.

She presented on Wednesday the results of a state needs assessment completed in September to the Commission on Improving the Status of Children in Indiana.

“I can’t tell you how many pre-sentence reports I’ve read where it said ‘suspected fetal alcohol,’ said Chief Justice Loretta Rush after the presentation. “I mean, lots. A lot of kids in the system, and adults in the system.”

Indiana hasn’t tracked total alcohol use during pregnancy on an annual basis since a 2006 natality report, when just 400 mothers — 0.4% — reported drinking while pregnant. The fetal alcohol spectrum disorder report the same year said that data “should be monitored for Indiana on a routine basis” — but in 2007, the state adopted a standardized live birth certificate that doesn’t ask about alcohol during pregnancy.

Still, IUPUI in 2012 estimated that about 900 Hoosiers are born with a fetal alcohol spectrum disorder annually, and that more than 63,000 Hoosiers in total have such a disorder.

Alcohol use on the rise?

In a survey of 47 people, just 63% of respondents reported not drinking in the last three months of pregnancy, a steep drop from 90% in a 2006 survey of 773 people. And 9% of 2022 respondents reported having 14 or more drinks in an average week during that period of time.

More also said they drank in the three months before becoming pregnant than in 2006 — including more instances of binge-drinking, or having five-plus drinks in one sitting. About 34% of 2022 respondents reported binge-drinking during this period of time, compared to 22% in 2006.

That’s key because about half of pregnancies in Indiana aren’t planned, according to 2016 research by the Guttmacher Institute, a reproductive health policy organization.

“It’s not that alcohol exposure is always intentional, or irresponsible,” Ellsworth told commissioners. “It’s that people who aren’t expecting to be pregnant are not finding out until starting six weeks after conception that they’re pregnant.”

While the report indicated that more respondents understand that no type or amount of alcohol is safe at any point during pregnancy, they’re still reporting drinking more.

And while misinformation lingers among everyday Hoosiers, it also persists in small numbers of service providers such as social workers and nurses. About 4% of 279 providers said a glass of wine a day is safe, as is the occasional drink.

Another 14% of service providers said they didn’t feel comfortable talking with clients about their alcohol consumption during pregnancy, up from just 2% in 2006. And just 4% of providers said they report diagnoses of any of the five fetal alcohol spectrum disorders to Indiana’s Birth Defects and Problems Registry, which is how the state determines the prevalence of the disorders.

What’s lacking

Elsworth recommended expanding public education about the disorders, establishing training for service providers, boosting availability of screening tools and stepping up data collection efforts. She also recommended that Indiana establish a statewide task force with an array of members and a dedicated coordinator.

Verbal screening, she said, isn’t cutting it: new mothers in hospitals answering lengthy surveys are exhausted, and may not remember alcohol use, or fear admitting such use and inviting a visit from the Department of Child Services.

Indiana Health Commissioner Dr. Kris Box noted that test-based screenings by default included multiple drug types, but that screening for alcohol added $45, with hospitals absorbing the costs. She also said that ideally, health care providers would meet with women before conception to talk about alcohol habits and pregnancy.

The birth defects registry isn’t up to par either, Elsworth said. It only includes diagnoses from age zero to five, but most diagnoses of a fetal alcohol spectrum disorder aren’t made until after five.

“It never ties back to our prevalence rates,” Elsworth said. “We already know that this is underreported. So we’re looking at getting this changed … to age zero through lifespan.”

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