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Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States. Studies from the Centers for Disease Control and Prevention (CDC) find that each year approximately 500,000 pregnant women report they drank alcohol in the past month, and approximately 80,000 pregnant women report binge drinking (five or more drinks on any one occasion). Fetal exposure to alcohol results in a spectrum of adverse effects that has been termed Fetal Alcohol Spectrum Disorders (FASDs), with the brain and central nervous system being particularly sensitive to the effects of alcohol. Alcohol exposure during pregnancy can have profound and life-long consequences for children. Fetal Alcohol Syndrome (FAS) is one of the most involved conditions along the spectrum and affects up to two out of every 1,000 infants born each year in the United States. The estimated lifetime cost of FAS is $2 million per case, with an annual cost for all cases of $4 billion to the nation. Most women reduce alcohol consumption after learning they are pregnant. Others do not recognize they are pregnant in the early weeks of gestation and continue to drink at high levels. Among women of childbearing age (18-44 years), more than half report they drank alcohol in the past month, and one in eight reports binge drinking in the past month. Women who are planning to become pregnant or are at risk of becoming pregnant should avoid using alcohol if they are sexually active and not using contraception. Studies find that about half of all pregnancies in the U.S. are unplanned. About half of these unplanned pregnancies occur in women who are using contraception but not effectively. Enhancing effective contraception in women who are drinking at risk levels could help them avoid having an alcohol-exposed pregnancy (AEP). This manual is based on a multisite, evidence-based intervention study. In that study, investigators found the CHOICES intervention could help women lo