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

Al­co­hol is used and abused in all the dif­fer­ent cul­tural and so­cioe­co­nomic groups across our coun­try

Mail & Guardian - - Fetal Alcohol Syndrome -

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.

The Foun­da­tion for Al­co­hol Re­lated Re­search runs a num­ber of cam­paigns to re­duce and/or elim­i­nate Fe­tal Al­co­hol Spec­trum Dis­or­der (FASD) in South Africa, which has one the high­est rates of FASD in the world. Pho­tos: Sup­plied

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