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

Re­cent stud­ies have re­vealed that alcoholism in men af­fects gene reg­u­la­tion and may cause FASD

Mail & Guardian - - Fetal Alcohol Syndrome - Keale­boga Mokolo­bate

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 alco- hol 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 mon­thend 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; FASDre­lated 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.

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