Fetal Alcohol Spectrum Disorder is more prevalent, and more serious, than you think


9 September is International FASD Day
9 September is International FASD Day

Did you know that Fetal Alcohol Spectrum Disorder (FASD) is the most common cause of permanent mental disability in the world?

Alcohol has a teratogenic (poisonous) effect on the developing cells of the fetus, causing damage, or sometimes even preventing the development of certain cells. 

As the central nervous system (brain) starts developing soon after conception and continues to develop right throughout pregnancy, the brain is especially vulnerable to the harmful effects of alcohol. 

Children with FASD therefore always have brain damage. There is a range of disorders in the spectrum, and the extent of the brain damage differs and this, together with the support provided to the individual and family will determine his or her outcome. Fetal Alcohol Syndrome (FAS) is the most severe form of the Fetal Alcohol Spectrum Disorders.

And did you know that South Africa has the highest reported FASD rates in the world?

According to Dr Leana Olivier, CEO of the Foundation for Alcohol Related Research (FARR), the FASD rates in South African communities’ are as high as 2.7% in Gauteng and 13% in the Eastern Cape and Free State.

In the Western Cape the rate is 25% and in the Northern Cape Province it’s 28%.  

For context, the WHO sets the estimated global FASD prevalence rate at 1.5%. 

No FASD prevalence studies have been done to date in KZN, Mpumalanga, North West or Limpopo Provinces, so there are no official FASD rates available for these provinces.

Prevalent in all cultural, income and religious groups

Dr Olivier shared with Parent24 that FASD is prevalent in all cultural, income and religious groups.

"It is very underreported in middle- and higher-income groups," she said, "mostly due to the unavailability of diagnostic clinics – it is a very complicated and difficult diagnoses to make – and there is a very strong stigma attached to it."

"Children in these income groups often receive other more ‘acceptable’, but incorrect, diagnoses," she says.

"A woman does not need to be a heavy drinker or alcoholic to have a child with FASD, even light to moderate drinking has the potential to cause permanent damage to the unborn baby" she warns.

The brain damage is permanent

"The brain damage presents as developmental delays, learning disabilities and behavioural problems," Dr Olivier says. "The last two challenges sometimes only present when the child reaches school-going age. The brain damage is permanent, so it is a lifelong condition."

The prenatal alcohol exposure can also cause damage to any of the other organs of the fetus’ body, resulting in birth defects such as heart problems and eye abnormalities, amongst others.

Dr Olivier explains that great emphasis is often placed on the so-called ‘facial features typical to FASD’, but it is important to note that close to 70% of people with FASD do not have any physical signs of FASD, but all have some form of brain damage.

Doomed to a life of crime?

"It is not true that a person with FASD is doomed to a life of crime, violence and abuse," Dr Olivier stresses. "People with FASD can, with the necessary support, be guided to lead a full life within their limitations."

Due to the learning and behavioural problems, people with FASD often find it difficult to understand and cope with daily living and rules.

Some individuals, for example, might have problems understanding the cause and effect of their behaviour resulting in risk-taking behaviour; others might have a problem with impulse control, resulting in unpredictable emotional outbursts; others might have problems with social boundaries, resulting in inappropriate and/or risky sexual behaviour, and more.

Without even realising it

Dr Olivier says that 78% of pregnancies in South Africa, in all cultural and income groups, are unplanned, so quite often women continue to use alcohol without knowing that they are pregnant and might therefore expose their fetuses to alcohol, without even realising it. This is especially prevalent during the early days/weeks of pregnancy.

She also says that women often continue to drink because they are unaware of the harmful effects of alcohol on their foetuses, or they have received incorrect information from their gynaecologist or health care practitioner regarding alcohol use during pregnancy.

Others drink while pregnant because of pressure from their partners, family or friends, or as a form of self-medication, or because they do not understand that the risks pertaining to FASD apply to them too.

FARR's message then is that no amount of alcohol is safe to consume during pregnancy.

No amount of alcohol is safe during pregnancy

9 September is International FASD Day

FARR was established in 1997 as a research-based non-profit organization, a Training Unit offering CPD accredited training to professionals across the country. 

"To date we have conducted all of the SA based FASD community prevalence studies in 5 provinces (a total of 16) and have project offices/centres in 12 sites in 4 provinces," Dr Olivier says. 

FARR’s focus areas in these project sites are on research, awareness, prevention, community development and the training of professional service providers working in the area, such as health staff, social workers and educators/teachers.

Stay tuned for more on FASD topics, as we'll be sharing personal and inspiring stories over the coming weeks. 

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