3.2 Safer environments
Through the enormous progress that has been made in biomedicine over the past half century, a very different picture of integrative physiology has emerged – one in which the social environment has a cumulative impact on physical and mental health and the progress of a number of specific diseases.” (McEwen, 2005, p. 315).
Physical and social environments are strong influences on health. According to the Public Health Agency of Canada (n.d.-c), healthier lifestyle behaviours occur within the context of social environments, which can be viewed from the perspective of how people behave in the following three intersecting spheres:
- people as individuals
- as individuals within social environments (e.g., community, workplace, peer and family contexts)
- as individuals in relationship with their social environments.
This broader perspective of social environments views health as a shared issue that should be considered when planning interventions. Of tremendous influence on gestational parent and fetal well-being may also be considerations for the quality and design of various aspects of the physical environment where people may live, work and play (such as access to safe drinking water, smoke-free air or having safe places to sleep).
Social environments
Listen to Monica’s husband Chris talk about how his personal quality of calmness is an attribute that supports Monica’s emotional well-being. He also identifies her personal attributes that contribute to effective stress management during the pregnancy.
How might Chris be an influence on Monica’s emotional well-being and on healthy fetal development?
What might be some other ways a partner could provide support for healthier prenatal behaviours and environments during pregnancy?
Partners are in a key position to be a supportive influence on health and well-being during pregnancy. Unfortunately, not every individual will experience safe, trusting, helpful relationships within their social spheres. In the next video, Dr. Maggie Morris discusses the responsibility of health care providers when working with adolescent prenatal clients to screen for violence and intervene if needed. She also reveals there may be an increased risk for an exacerbation of violence within a less healthy relationship during the prenatal period.
Are you aware of resources within your community that can provide emergency assistance with safety planning and provision for physical safety needs for those at risk of being harmed during pregnancy?
In the next video, Dr. Pablo Nepomnaschy, associate professor in the Faculty of Health Sciences at Simon Fraser University, speaks about the importance of women understanding the need to: find balance in life, find effective ways of managing stress and feel supported within the context of their larger social environments.
Nepomnaschy discusses the importance of women having reliable social supports and believing they have support at a societal level – including from their government. How well do you think women are supported by the government where you live? Can you think of examples of government policies and programs that demonstrate support for women?
Do you have ideas for ways to enhance support for people of all genders in the community where you live?
Read more about the fifth Sustainable Development Goal, to “achieve gender equality and empower all women and girls”, on the United Nations website.
Having education about and access to birth control methods is one way people may be empowered in decision-making about the timing of a pregnancy. The opportunity to plan for a pregnancy may allow individuals (who would like to bear children in the future), the desired time to pursue other goals or to work at improving their health status in preparation for pregnancy. Birth control use may also decrease the occurrence of a more mature-aged pregnancy and its associated increased level of risk. According to an Ontario-wide survey on preconception health and behaviours in 2008, the Best Start Resource Centre (2009) reports 70% of women responded that their last pregnancy was planned, while 30% indicated theirs was unplanned.
Because timing of pregnancy is another influence on maternal and fetal outcomes, family planning remains an important topic. Read more about the benefits of planning for families through the use of various contraceptive methods on the World Health Organization (WHO) website.
A number of possible barriers to birth control usage were outlined in the previous reading. What individual and social environment influences might affect sexual health behaviours and use of birth control?
The following example features Suzanne Reier, former technical officer with the WHO. She describes how with support, nursing students in Zimbabwe were empowered to develop and use their own birth control clinic.
Many people find themselves dealing with an unplanned pregnancy – an event the adolescent population is particularly vulnerable to experiencing. Morris provides some helpful advice on how to best support an adolescent who is facing an unexpected pregnancy.
Global binary sex ratios (the proportion of females and males in the population) are approximately equal. However, with increasing age, women outlive men, which results in a larger proportion of women in a given population. Although each year more males are born, there are higher numbers of deaths in males than in females during childhood. Increasing knowledge of genetics, development in utero, and medical advances have allowed us to radically modify this sex ratio. Using this knowledge has ethical considerations.
Many societies have allowed practices that favour male birth and survival, such as female infanticide, and the divorce or killing of wives that only yield daughters. With advances in prenatal assessment, we can determine the sex of the embryo early in development. Such knowledge has been exploited in China, where because of preferences for sons, and their one child per family policy, over one million female fetuses per year were aborted (between 1990-1993). China has now outlawed this practice. Consequently, nearly all international adoptees from China are female. As a result, men now outnumber women by 33 million in China. This binary gender imbalance is the most serious in the world (Guilmoto, 2012).
Explore more on the UNFPA – United Nations Population Fund website about how the attribution of greater value to males over females has become apparent during prenatal development in many countries around the globe. As you read, consider what strategies might promote greater gender equality.
Physical environments
Gestational parent environmental exposures to harmful substances or infections may present risks for harm during prenatal development. For example, if an infection is passed along to a person through a sexual partner (either before or during their pregnancy), this infection may also potentially be passed to a developing fetus. Sexually transmitted infections may be present in a person who is pregnant – even without physical signs or symptoms of illness. Prenatal care that screens for these types of infections can in many cases identify and treat the infection, as well as monitor the fetus as needed for potential effects. Read more on the USA government’s Centers for Disease Control and Prevention website about some of the sexually transmitted infections that may be transmitted to a fetus, how they may harm development, and what can be done in some cases to treat or potentially reduce these risks.
Another example of possible transmission from a birthing parent to baby is a more common bacteria that may be present in the vagina called Streptococcus B. This bacteria may create no signs of illness in a gestational parent, yet still be passed along to the baby during delivery. Read more about Streptococcus B and ways to reduce risk to the baby during delivery on The Society of Obstetricians and Gynaecologists of Canada website.
With the legalization of marijuana across Canada, there is heightened interest in what we are learning about the impact of this substance on gestational parent and fetal outcomes. Read more about cannabis use before and during pregnancy on the Government of Canada website.
Many chronic conditions of a gestational parent can give rise to detrimental effects on an embryo or fetus through either disease processes or treatments for disease. In many instances, taking steps prior to pregnancy, as well as during pregnancy, with the assistance of a professional care-giver can help decrease risk of harm.
Work can influence one’s well-being through psychosocial and physical environmental influences. Most individuals are able to continue working safely throughout their pregnancies. Read more about working during pregnancy, including some possible hazards and examples of when physical demands may be excessive, on The Society of Obstetricians and Gynaecologists of Canada website.
Another environmental hazard which may be experienced in utero is through first or second-hand smoke (cigarettes or e-cigarettes [vaping]) in a gestational parent. Watch the following video as Dr. Wanda Phillips-Beck recounts a Manitoba Hydro campaign promoted by the Strengthening Families program in some First Nation communities to help reduce negative effects of second-hand smoke.
Read more about first and second-hand smoking effects and access helpful resources from the USA government’s Centers for Disease Control and Prevention website.
Additionally, with Cannabis use legalized in Canada and being viewed as a “natural” substance, pregnant individuals may feel it is safe to use cannabis for nausea, pain and anxiety; however, current evidence shows potential risks to fetal growth and brain development, and no safe level has been established during pregnancy (Health Canada, n.d.). Read more on the Health Canada website about the use of cannabis before and during pregnancy.
Between January 2009 and December 2022, there were 419 hospitalizations in Canada (excluding Quebec) involving pregnant individuals due to substance-related poisonings. The number of cases peaked in 2021, with 62 hospitalizations, which was a 63% increase compared to 2020 (PHAC, 2023). Substance use during pregnancy remains a significant public health concern in Canada. Current data indicate that approximately 1.4% of pregnant individuals report opioid use and 3.1% report cannabis use. Prenatal substance exposure is associated with a range of adverse outcomes, including preterm birth, low birth weight, stillbirth, neonatal abstinence syndrome, congenital anomalies, and potential effects on fetal brain development.
With rising use of substances such as opioids, cocaine, and methamphetamine, it is important to provide education on associated risks while using a harm reduction approach. This includes trauma-informed, non-judgmental care that prioritizes safety, adapts to individual circumstances, and supports trust-building. The goal is to reduce harm and promote the health and well-being of both the pregnant individual and the fetus (PHAC, 2023).
On the Public Health Agency of Canada website, David Butler-Jones (2009) highlights strategies that have had some success in targeting higher risk prenatal behaviours to improve health during pregnancy and create safer fetal environments. Begin by reading about the “Sheway program” on page 53 of the Report on the State of Public Health in Canada (2009): Growing Up Well – Priorities for a Healthy Future. This unique program seeks to address important determinants of health while providing prenatal care. Then, read “Targeting high-risk behaviours” on pages 54 – 55.
Can you think of any examples of programs, resources or campaigns where you live that demonstrate a shared level of responsibility for reducing prenatal risks?
Watch as Sir Peter Gluckman discusses the complexity in some situations of interrelated environmental factors that can contribute to less than optimal fetal outcomes. He reiterates the concept of balance (similar to what Dr. Nepomnaschy referred to earlier on the page), suggesting that enjoying the prenatal period and striving for a balance in diet and lifestyle during pregnancy is a healthier type of prenatal goal.
Mental health environment
Perinatal mental health disorders are among the most common conditions during and after pregnancy. In Canada, approximately one-quarter (23%) of mothers who recently gave birth reported symptoms consistent with postpartum depression or an anxiety disorder (Statistics Canada, 2019), with higher rates among adolescents, Black, Indigenous and People of Colour, immigrants and refugees, disabled individuals, gender-diverse individuals, those experiencing financial challenges or domestic violence, those who have experienced mental health issues in the past and those with little or no family or support networks. These trends highlight the urgent need for improved mental health support and services for women, particularly during the perinatal period (SOGC, n.d.).
As mentioned by Bocking in section 1.2 Pregnancy in context: Influence of fetal health and recent evidence indicate that maternal depression during pregnancy is associated with adverse fetal and offspring outcomes. Depressive symptoms have been linked to altered fetal growth trajectories, including reduced fetal size and weight, as well as changes in brain development such as reduced hippocampal and cerebellar volumes. These prenatal exposures may have lasting effects, contributing to cognitive, emotional, and behavioral challenges in offspring across the lifespan (WHO, 2026; Wu et al., 2024; Zhang et al., 2023).
If you are a health care provider of pregnancy individuals read the link below.
If you are a pregnant individual, read the links below for resources across Canada, as well and tips for self-care.
Relaxation techniques can play a meaningful role in improving mental health by helping calm the body’s stress response and quiet the mind. Practices such as deep breathing, progressive muscle relaxation, and mindfulness meditation can reduce levels of stress hormones, lower heart rate, promote emotional balance, improve sleep, and enhance overall well-being. Read below on a variety of stress relieving techniques the pregnant individual can incorporate into their daily routine.
