OTTAWA -- A decade ago, a Manitoba MP convinced most of her colleagues to back her call to put labels on liquor bottles warning consumers about the dangers of drinking while pregnant.
Six health ministers and three prime ministers have come and gone since then and not one has followed through on the motion.
When she left Parliament last year, Judy Wasylycia-Leis said it was one of her biggest disappointments that the warning labels had never come to fruition.
"Passing that motion was the highest moment in my political career," she said.
"Not getting it done is the lowest."
Her motion is just one of many ways the issue of FASD warning labels has been raised in the last 25 years. According to a government briefing note from 2006 obtained through an access to information request, four standing committees of Parliament, the Royal Commission on New Reproductive Technologies and the National Advisory Committee on Fetal Alcohol Spectrum have all recommended the government put warning labels on liquor bottles.
In Canada, some liquor companies -- including the Wayne Gretzky Estates winery -- add the labels themselves. The Yukon territory is the only jurisdiction that requires them.
The U.S. surgeon general began requiring warnings about drinking and pregnancy in 1989. That means Canadian companies' bottles warn American consumers that drinking while pregnant can harm the baby but are silent on their labels on their Canada-bound products. At least two dozen countries, including France, the United Kingdom and Japan, also require warning labels.
Earlier this year, an Australian panel looking at food-labelling policies found while there was no specific evidence warning labels work, not posting them on bottles is a "glaring omission in the overall public-health communication about FASD."
Shortly after that, Australia's largest brewery voluntarily agreed to begin putting warnings on its beer bottles. It means nearly half the beer sold in Australia will include a warning about the impact on a baby of drinking while pregnant.
Yet, as briefing notes to Canada's health ministers between 2001 and 2010 show, the government has always insisted there is no proof the labels help and therefore there is no reason to add them.
"Experience to date indicates that while there is widespread public and stakeholder support for warning labels on alcohol containers, there is no evidence to suggest that warning labels have the desired impact on reducing at-risk behaviours," reads the background text on a 2006 briefing note.
Other briefing notes to ministers between 2001 and 2009 add other reasons including that alcohol, unlike tobacco, is not always harmful, and someone consuming alcohol doesn't always see the container from which it is poured, such as when drinking in a bar.
The only evaluations of warning labels come from the U.S. Those evaluations found warning labels contributed to an increased awareness of the dangers of drinking while pregnant among people who read the labels, but only a small decrease in people who drink while pregnant and virtually no decrease among heavy drinkers.
Wasylycia-Leis asks if warning labels don't work, why then is the Canadian government a world leader in forcing tobacco companies to put graphic warning labels on their cigarette packages?
Studies have shown the labels -- first added in Canada in 2001 -- have helped the country's smoking rate drop. One study suggested people who read, thought about and discussed the labels were more likely to have tried to quit smoking.
Last fall, Ottawa expanded the tobacco labels to make them take up 75 per cent of a cigarette package, up from 50 per cent.
"If labels work in the tobacco industry, why not for FASD?" Wasylycia-Leis said.
An Australian team reviewing the issue ahead of that country's call for warning labels, said one of the reasons liquor-warning labels may not have been as effective as those on tobacco is simply that liquor warnings are most often in small print, without graphics while tobacco warnings are so large they are impossible to miss and quite graphic. The team suggested liquor labels should be big, attention-getting and involve rotating messages so people don't tune them out.
The liquor industry in Canada has been against the idea from the start. A spokesman for the Brewers Association of Canada did not respond to a request for an interview on the subject.
But at a 2006 hearing on a private member's bill that would have implemented warning labels, the brewers group said there is no evidence warning labels work, and they are very expensive to add. One estimate suggested for domestic brewers alone the cost would be upwards of $10 million, mainly for new equipment.
Association officials point out the amount of time and money beer companies expend battling FASD, including funding a national FASD resource centre, conferences and other prevention efforts.
The Canada Safety Council has also expressed concerns about the high cost of adding labels and whether the money would be better spent on initiatives that have proven successful.
That 2006 private member's bill never made it past the committee stage.
Wasylycia-Leis, however, said the industry's alarm is for fear their product might be seen in a negative light.
"We just can't get past the blockage from the beer lobby," she said. "They don't want anything to take away from the idea their product is healthy."
And she said if estimates suggest FASD costs Canada $5 billion a year just for the health care, social service and education costs associated with FASD, how could spending a mere $10 million to add warning labels to beer bottles be considered a waste?
"Given the cost of a child with FASD, given the anguish that child has to go through, surely the value of a human life should be first and foremost here," she said.
Anne McLellan, who was the Liberal health minister in 2002 and 2003, said FASD was a growing concern during her years heading the department. She said she never met with lobbyists from the beer or spirits industry, but people from her department did on several occasions and the industries made it clear they opposed the labels.
But McLellan said the main reason it never went forward, as far as she knows, was that nobody could prove it would work.
"I don't remember any convincing empirical evidence," said McLellan.
She said she's never been against the idea, but she feared labels might be an easy way to say something was being done on prevention. During her years at the helm, the health department was focused on both treatment and prevention.
In 2009, McLellan chaired a jury at an FASD conference hosted by the Institute for Health Economics. She said that conference recommended warning labels be put not on liquor bottles, but on pregnancy tests and birth control packaging.
"There are points of time which are key moments we would want every woman to stop drinking," she said.
McLellan said from her perspective, if labels were one part of a broad strategy, they could be supported.
Health Minister Leona Aglukkaq's office did not respond to repeated requests this year for an interview about the government's current thinking on warning labels.
Wasylycia-Leis is still hopeful that one day the government will take the step to ensure the products that create the harm come with a warning.
"No one has ever claimed this is going to be the cure, but it's one more thing that can help," she said. "I do believe someday it will happen.
"It's just such a simple thing."
Some countries with policies requiring FASD warning labels on alcohol containers: the U.S., France, Russia, South Africa, China, England, Sweden, Finland, Thailand.
What does the public think?
A Winnipeg Free Press/Probe Research poll found just one in four Manitobans believes warning labels on alcohol bottles would be effective at reducing drinking during pregnancy. The poll, completed last September, is considered to be accurate within three percentage points, 19 times out of 20.
The largest support for such an initiative comes from Manitobans with a high school education or less, with one in three of those respondents expressing support for the idea. Comparatively, fewer than one in five university-educated Manitobans supports the idea.
That poll differs somewhat from a survey conducted for Health Canada in 2006. Those surveys found 62 per cent of Canadians strongly supported warning labels on liquor bottles and 24 per cent somewhat approved. More than 70 per cent strongly supported warnings on alcohol advertising, 60 per cent strongly supported warnings in bars and 45 per cent strongly supported warnings in restaurants.
Conversely, eight per cent of Canadians in that survey somewhat disapproved of warning labels on bottles and four per cent strongly disagreed with it.
The survey was conducted by Environics and considered accurate within 1.8 percentage points, 19 times out of 20.