Effects of alcohol consumption in South Africa: From the cradle to the grave

Foetal alcohol spectrum disorders is more likely to affect mothers who are more exposed to socioeconomic challenges. (Photo: David Harris)

Foetal alcohol spectrum disorders is more likely to affect mothers who are more exposed to socioeconomic challenges. (Photo: David Harris)

According to global statistics, South Africans are among the highest consumers of alcohol. Many have noted the obvious effects such as increased mortality related to road accidents, especially over the festive season. According to reports released by the World Health Organisation in 2012, approximately 6% of global deaths were attributed to alcohol consumption, and South Africa has been noted as the country worst affected by drunk driving in the world. Alcohol abuse in South Africa is also eroding our economy in countless direct and indirect ways and can be likened to the grim reaper, here to take the soul of the country in the dead of night, encouraged by each nonchalant alcoholic gulp.

Despite punitive measures by government such as ensuring drunk drivers get criminal charges, the source of alcoholism is not being tackled — only the consequences are being dealt with. Fortunately, some groups have tried to bring attention to the problem. As far back as 2008, the ANCYL spoke up about alcohol abuse in South Africa and recommended alcohol-free stadiums, especially with the 2010 World Cup looming.  There have also been debates as to whether alcohol consumption during pregnancy should be criminalised.

The Foundation for Alcohol Related Research (FARR) has for 20 years being documenting the history of alcohol consumption in South Africa and has tracked its effects on our country. The key issues that have emerged are around education, and taking responsibility as South African citizens.

One much longer-lasting and less obvious consequence of high alcohol consumption, which is far less talked about – is foetal alcohol spectrum disorders (FASD). These are disorders that affect the healthy growth of a foetus due to the mother consuming alcohol during pregnancy. These disorders range from physical, behavioural and intellectual symptoms to alcohol-related birth defects such as eye problems or heart defects. FARR has conducted numerous studies around the effects of FASD in South Africa and the results are bleak.

FASD in recent years has been reported to have a 25% prevalence in the Western Cape, 22% in the Northern Cape and 13% in the Eastern Cape.  Government became proactive in combatting in TB and HIV after it was reported that a substantial number of teachers were HIV positive. TB and HIV were recognised as dangerous barriers to growth in the country; they eroded the workforce and affected the quality of education of the future workforce.

Similarly, alcohol abuse leading to FASD poses a real threat to the economic growth of South Africa by producing a workforce unable to keep abreast of the changing world, due to the quality of the workforce and the governmental burden of overcoming health issues related to FASD.

South Africa is one of the top five economies in Africa, and with Africa having been recognised as the top emerging market in the world by projected population growth, many multinationals are adopting a pan-African approach and headquartering on the continent. The challenge around this is that, if the African workforce is not adequately equipped to take advantage of these opportunities, it will remain a continent characterised by poverty.

Many are unaware of the costs associated with alcohol abuse, and these include costs around drunk driving and the healthcare costs for families, as over-consumption of alcohol causes liver damage, kidney damage and brain damage. Many suicides and homicides are related to alcohol abuse, and businesses may incur costs due to alcohol abuse too. By law, employers have been mandated to assist employees in the workplace if they admit to alcohol abuse; the costs around the time and management of this process are apparent.

The high alcohol consumption in South Africa has deep roots in our history, such as the “dop” or “tot” system, where labourers in the Cape received part of their wages in cheap wine. A dangerous relationship between South Africans and alcohol commenced,  exacerbated by socioeconomic issues such as poverty and lack of education.

This relationship continued and deepened as millions of black people moved from rural to urban areas searching for jobs and “a better life”. In this environment, beer halls were born and commercial alcohol was introduced. The stress of apartheid on the (mainly black) work force was a likely contributing factor to deepening the relationship between alcohol and South Africans. It is also a likely causative agent of the high domestic violence prevalent in South Africa, even today.

With the advent of affirmative action measures and BEE, the relationship between alcohol and South Africans has evolved to where almost all corporate celebrations involve alcohol and where Friday or month-end drinks are the norm. Through clever advertising, alcohol has been associated with the ideals of capitalism: wealth and status.

Recent studies have revealed that alcoholism in men alters the quality of sperm and affects gene regulation. Through different DNA-altering techniques such as methylating and acetylating, the genes that a man contributes to the foetus are compromised and may also cause or contribute towards FASD. FARR research asserts that women must stop consuming alcohol if they are attempting to fall pregnant, but this rule may apply to men too.

The key challenge around combatting FASD is knowledge: knowledge of pregnancy, and basic knowledge of FASD. Diagnosing FASD is also a challenge as diagnosis is also not very easy, although guidelines have been put in place for assisting with this aspect.

It is clear that healthcare practitioners need further education about FASD as many have given incorrect advice around alcohol consumption to mothers. Some doctors have advocated a glass of wine until the first trimester, yet this is incorrect; FASD-related illnesses have been detected in infants even in cases of low consumption. A basic review of the literature on FASD reveals that terminology and standards around diagnosing and standardising prevention measures for FASD is still ongoing.

Exacerbating the healthcare costs and consequences of FASD is the fact that almost 80% of pregnancies in South Africa are unplanned. Most women are only able to confirm their pregnancy after approximately 15 weeks. This means that a mother may have been drinking since conception, and the risk to the foetus is apparent. Perhaps more disturbing are the psycho-social issues around single mother pregnancies. The stress of the situation may result in the mother drinking while pregnant, resulting in FASD in the fetus. FASD is more likely to affect mothers who are less knowledgeable and more exposed to socioeconomic challenges. These mothers are mostly poor, and by giving birth to a child with FASD, they may further entrench the family in poverty due to healthcare costs and the need for expensive special education for their children.

Companies that produce alcohol in South Africa have also joined the alcohol responsibility advocacy and are running campaigns around responsible alcohol consumption. Another hope for a decrease in deaths related to alcohol consumption in South Africa is the rise of companies such as Uber, which allow people to get home safely after a night of heavy drinking. At this stage, one thing is glaringly apparent — it time to treat the causes, not just the symptoms, to reduce the staggering and entirely preventable high rate of FASD in South Africa.