Avoiding exposures before they happen and before they can do greatest harm is the key strategy for personal prevention.

"It is difficult, if not impossible, for individuals to completely avoid hormone-disrupting chemicals because so many decisions about the use of chemicals are outside of our personal control. " WWF Canada

Initiatives on the part of government and industry are crucial to reduce the exposure of the unborn and future generations to reproductively toxic contaminants.

Personal Prevention

Preventing reproductive problems and congenital anomalies is an immense challenge given the difficulty in pinpointing causal factors. Reproductive health and prenatal development is influenced by multiple factors including elements of nutrition and lifestyle. And many reproductive effects may not be recognized until long after the affected individual was exposed.

We also have to acknowledge that only a small fraction of chemicals and substances has been adequately tested for reproductive toxicity. Once reproductive and congenital or developmental effects are apparent, they are also unfortunately permanent. The complexity of the issue, however, means that clinicians are limited in terms of the advice they can provide patients to reduce the risk of adverse reproductive and developmental effects in their children.

Based on the existing evidence, avoiding or minimizing exposure is the most fundamental preventive advice that can be given to patients. Physicians can counsel patients on a number of different choices in their diet and regarding personal activities and work activities. The patients to target specifically include men and women who are considering having a child, pregnant women (and their partners) and the parents of infants and very young children. The clinician might advise these patients to take a prudent approach and avoid exposures to some suspected reproductive toxicants.

In particular, people are well advised to avoid certain practices such as:

• Use of pesticides, especially those that are sprayed and/or applied indoors. Spraying and indoor application are both associated with greater exposure of pesticides to humans and pets.
• Consumption of sport-caught fish, which is associated with much greater intake of persistent, bioaccumulating, biomagnifying contaminants is not advised for women in their childbearing years, nor for children under fifteen. Others should at a minimum follow the provincial guides to sport fish consumption to determine which are the least contaminated fish and appropriate ways to prepare such fish. They should also be mindful of special advisories that notify the public of unusual episodes of contamination.

In addition, patients should not be advised to avoid fish consumption altogether, as eating fish provides an important nutritional benefit. Commercially available, store-bought fish are indeed considered safe sources since they are monitored by government agencies. Patients should be reassured that not all fish are considered harmful.

Primary Prevention

Clearly, personal prevention is not the only consideration in protecting reproductive health. The fact that there are literally hundreds of hormonally active agents in use in our society and present in our environment means that we are all involuntarily exposed to suspect reproductive toxicants all the time. Primary prevention strategies is the most important way to protect human health.

In the case of POPs, where there is a great deal of uncertainty and yet the potential for widespread exposure and troubling health effects, a precautionary approach to regulating environmental chemicals will ultimately be the most effective strategy for protecting children. This includes a strong government stance and action to ban and reduce POPs in the environment globally. The recent international treaty to ban the "dirty dozen" POPs is an important step towards that goal.

Similarly, the Healthy Lawns Strategy is step one in the recently announced Federal/Provincial/Territorial Action Plan for Urban Use Pesticides, which promises to protect the health of Canadians by reducing use of pesticides. It will focus emphasis on pest prevention and the use of reduced-risk products as well as priority re-evaluations of pesticides currently in use. Such initiatives on the part of government and industry are crucial to reduce the exposure of the unborn and future generations to reproductively toxic contaminants.

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