Fetal Alcohol Spectrum Disorders – What are you doing about it?

Twenty years after the Foundation for Alcohol Related Research was founded to conduct research on Fetal Alcohol Spectrum Disorders (FASD), South Africa is still facing the devastating effects of prenatal alcohol use, with FASD prevalence rates as high as 250/1000 (25%) in the Western Cape and 282/1000 (28%) in the Northern Cape provinces.

Elsewhere in the country, such as in the Eastern Cape province, rates as high as 130/1000 (13%) have been reported. A recent international meta-analysis, reviewing the reported global FASD prevalence rates, states that the South African FASD rates are 14 times higher than most of the rest of the world.

FASD is caused when a pregnant woman drinks alcohol during pregnancy. The teratogenic (poisonous/harmful) effects of alcohol on the developing cells of the fetus (unborn baby) causes lifelong and irreversible damage. A baby’s brain starts developing soon after conception, and is therefore the most vulnerable organ, but any other organ can also be seriously affected. These prenatal injuries present as heart defects, skeletal problems, eye/ear or other organ damage, including brain damage.

Due to the brain damage, individuals with FASD experience learning and behavioural problems and therefore find it difficult to manage the challenges of normal day-to-day living and schooling. This often results in early school dropout and may lead to delinquent behaviour, such as crime, violence and abuse.

Thinking about the reasons for our country’s high FASD prevalence forces South Africans to reflect on our drinking behaviour, cultural practices and inequalities. Alcohol consumption levels in our country place us amongst the six highest “drinking nations” of the world. When taken into consideration that only approximately 56.3% of men and 26.3% of women older than 15 years reported drinking during the past year in a 2014 World Health Organization report, one finds it difficult to understand why the average alcohol consumption rate in South Africa is estimated to be 11 litres of pure alcohol per person, compared to the global average of 6.2 litres per person. The reality is that many South Africans who drink alcohol are heavy drinkers and often engage in binge drinking, far exceeding the WHO recommended sensible alcohol use limits.

The so-called “culture of drinking” is deeply imbedded in the life of many South Africans. Historical practices such as the tot-system (“dop-stelsel”), which became illegal in the 1990s, or the mining beer halls are regarded by many as causal factors. Although these practices contributed to a legacy of drinking in some areas, we have to acknowledge that alcohol is used and abused in all the different cultural and socioeconomic groups across our country. The undisputable reality is that many South Africans find it difficult to celebrate or relax without a drink or more. With an unknown number of liquor outlets, many being unlicensed, alcohol is freely available even in deep rural areas where people are served by mobile shebeens.

Commercial beer is by far the South African drink of choice (>40%) followed by traditional beer (24%), wine (13%) and the other alcoholic drinks.

It is within this environment that women bear their children. Blaming women for being ignorant and irresponsible is common, but when confronted with the reality that 78% of South African pregnancies are unplanned and that women on average report their pregnancies at approximately 20 weeks’ gestation, one can understand why so many pregnancies are unintentionally exposed to alcohol.

Ignorance about the harmful effects of prenatal alcohol exposure appears to be one of the biggest hurdles to overcome in the fight against FASD. When faced with her child’s FASD diagnosis, the common maternal outcry is: “If only I had known!” (that I was pregnant or about FASD).

Of great concern is that even if a pregnancy is confirmed at an early stage, a disturbing number of women receive incorrect information from health professionals, such as “it is safe to drink one or two glasses of wine per day” or “you can start using alcohol again during the last three (or six) months of pregnancy”. The devastating result of this is often a FASD diagnosis.

Unfortunately some women do drink despite knowing that they are pregnant. Although this is difficult to comprehend, the psychosocial and economic burden placed upon often single women-headed households creates a scenario of immense stress and desperation.

During interviews these women often report that they drink in an attempt to alleviate stress, to forget or to numb emotional pain. Coupled with this, many women also experience pressure from partners, family and friends to participate in celebrations and social events, where they are sometimes encouraged by others saying “a drink or two cannot be harmful”.

Our country is facing a number of public health challenges such as HIV, TB and malnutrition, and in response to these government programmes have been initiated. Of great concern is our country’s alcohol and substance abuse problem, with crippling effects such as FASD. This is not only disabling the health and futures of our children, but also places a devastating socioeconomic and psychological burden on the affected family, community and country.

On the government level there are efforts in a few provinces to address FASD. Much more needs to be done in terms of legislation, policy, service provision, as well as post- and undergraduate training. However, to be truly effective each citizen has to take responsibility in terms of sharing information and encouraging pregnant women to seek the support provided by family, friends, churches/religious groups and service providers to protect against prenatal alcohol exposure.

Terminology

Absolute Alcohol: Refers to the pure ethyl alcohol contained in an alcoholic drink and is measured in millilitres. In South Africa a drink containing 10ml of Absolute Alcohol is described as “one standard drink”:

One standard drink of beer (5% alcohol) = 300ml

One standard drink of red/white wine (12% alcohol) = 125 ml

One standard drink of brandy/whisky/gin (40% alcohol) = 25 ml

Binge Drinking: Refers to five or more drinks (using the above-mentioned as criteria) during a two-hour (or less) sitting. This is usually preceded by a period of abstinence or low alcohol intake, for example no or little alcohol use during the week followed by binge drinking over the weekend or during a social event.

WHO Sensible Drinking: If the individual or his/her family has no history of addiction the following can be used as a guideline:

Women — no more than one standard drink per day

Men — no more than two standard drinks per day.

For more information on FASD, as well as research, awareness, prevention and training programmes, the private diagnostic and support clinic, FASD support groups and information regarding postgraduate studies and programmes for corporates provided by FARR, visit the website www.farrsa.org.za or contact the organisation at [email protected]