Urgent need to tackle foetal alcohol syndrome
Great deal of commitment vital in quest to make a difference
THE complex social, cultural and political history of South Africa, as well as the enforcement of apartheid government policies prior to the attainment of democracy has moulded South Africa’s alcohol consumption.
In coloured communities, the impact of the dop system saw farmworkers being paid part of their wages in the form of alcohol. In black townships, there was a proliferation of illegal small-scale alcohol outlets due to restriction of access to alcohol by black communities.
In 2016, the national prevalence of foetal alcohol spectrum disorder (FASD) was reported to have ranged from 29 to 290 per 1 000 live births. At that stage, already representing the highest rate of FASD globally.
In 2007, the prevalence of FASD in Grade 1 learners was estimated at 89.2 per 1 000 in the Western Cape. In 2013, the prevalence was reported to have doubled to 135.1 to 207.5 per 1 000 Grade 1 learners and having further increased to 170 to 233 per 1 000 Grade 1 learners by 2016. More recently, the prevalence of FASD in the Western Cape was estimated to be between 196 to 276 children per 1 000, representing the highest prevalence in South African provinces.
This is especially so in low-income areas, in which binge drinking is common and the sale of alcohol poorly regulated.
Risk factors which entrench highrisk drinking are described in varying detail. These include, but are not limited to, low socio-economic status, low educational achievement, an alcohol problem in one or more family members, regular binge drinking, insufficient nutrition, as well as high gravidity and parity.
Some studies have shown that mothers of children with FASD report drinking an average of 13 drinks per week and that in most cases, this is done in all three trimesters, with less than half of pregnant women quitting in the second or third trimester.
More surprisingly, the literature shows that a large percentage of heavy drinkers are aware of the impact of alcohol on the developing foetus; however, this does little to discourage the mother from high-risk drinking.
Also, individuals with family members with an alcohol problem may well result in a pregnant woman developing high-risk behaviour long before becoming pregnant.
The high prevalence rates of FASD must be ascribed to the lack of a comprehensive and multisectoral policy. In South Africa, the approach to addressing FASD at all levels of government remains non-specific, as demonstrated by the presence of generic and poorly implemented policies.
Appropriate prevention and management efforts continue to pose a challenge for policymakers and service providers. A sustained call for a coordinated effort for the prevention and management of FASD has been made by stakeholders.
The literature supports the importance of a co-ordinated, whole-of-society, policy development approach for the prevention and management of FASD, but it will require commitment from all spheres of government.
During the past financial year, the City’s social development and early childhood development department has run 34 city-wide foetal alcohol syndrome simulator programmes, reaching up to 1 020 learners aged 16-18 years old.
The simulators are able to illustrate quite vividly the impact of substance abuse during pregnancy and the programme encourages responsible lifestyle choices, while raising awareness of FAS and the effect of alcohol on unborn babies. City Health has a basic antenatal care programme where they create awareness and reinforce messages of alcohol or harmful substances during pregnancy.
The reality is that no amount of alcohol is safe during pregnancy and it’s never too late to stop drinking.
I call upon the political principals at national and provincial governments to renew their commitment to making use of evidence-based practices to guide co-ordinated policy development within their ambits.
The City remains committed to play its role in developing policy and programmes to tackle FASD across all of our communities.