Prevalence of foetal alcohol spectrum disorders highlight South Africans' 'complicated relationship' with alcohol

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'Even small amounts of alcohol have the potential to cause harm.'
'Even small amounts of alcohol have the potential to cause harm.'

Alcohol exposure during pregnancy is the most common preventable intellectual disability in the world. It can lead to serious and lifelong disabilities collectively referred to as Fetal Alcohol Spectrum Disorders (FASD). 

Knowing the difficulties faced by individuals with FASD and their caregivers it is abundantly clear that we must all work together to prevent FASD births and to support those with FASD.

What makes this a matter of utmost urgency is that South Africa has by far the highest FASD rate in the world. 

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'No alcohol is safe'

The World Health Organization estimates the global FASD prevalence rate to be approximately 15 per 1000 live births (1,5%).  

In South Africa, research that was done by the Foundation for Alcohol Related Research (FARR) in 5 of the 9 provinces, revealed rates as high as 282/1000 live births in some communities in the Northern Cape Province.  The Western Cape Province has areas with rates as high as 250/1000 live births (25%) (FASER-SA report).

FASD can only be caused by alcohol exposure during pregnancy, so if we can prevent alcohol exposure in the 9 months a woman is pregnant, we can prevent FASD. 

The damage that we can prevent includes organ damage, such as brain damage, leading to life-long learning and behavioural challenges.  

Even small amounts of alcohol have the potential to cause harm. We cannot say with any certainty that there is an amount of alcohol that is risk-free. 

Even if a baby is born without FASD, we cannot be sure that there was not still damage done to critical brain functions. This is why our message is that no alcohol is safe at any time during pregnancy.

'The complicated relationship South Africans have with alcohol'

To spread this message and to prevent FASD, FARR has completed 14 FASD Prevalence Studies in the Free State, Gauteng, as well as the Western-, Eastern- and Northern Cape Provinces since its establishment in 1997.  

At present, FARR has 11 project sites from where comprehensive FASD research, awareness, prevention and training programmes are offered.  The main objectives of these interventions are to increase the knowledge about alcohol harm amongst community members and service providers (such as health professionals, social workers and educators) and to provide them with the necessary skills to address the multitude of problems caused by alcohol abuse in their communities.

It is sometimes tempting to see FASD as someone else's concern, and to say that pregnant women "must just not drink". The past year has however shown us the complicated relationship South Africans have with alcohol and alcohol use. 

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'A teaching moment'

The temporary banning of alcohol sales and the restricted retail hours were implemented to decrease the pressure on Emergency Services and Units and to decrease the admission rate to Hospitals. 

This was met with significant pushback, not only from sellers and distributors, but also by people suddenly cut off from what can be vice, but also a source of relaxation and comfort.  

Published reports indicated that it had the desired outcome, bringing much-needed relief to overburdened health workers during the pandemic, yet it was still decried as government overreach and it was clear that many people resented not being able to use alcohol as they please.

Perhaps this can be a "teaching moment" to help those who chafed against restrictions on sales of alcohol, even though they are not addicted to or dependent on alcohol, understand the complexities of abstaining from alcohol for long periods, even if lives depend on it! 

'Maintain the status quo'

Our country constantly rates amongst the 5th highest per capita alcohol users in the world (WHO reports). 

It is clear that our relationship with alcohol can be unhealthy. It is also clear that an alcohol ban has significant negative outcomes, not only for individuals, but also companies and employees. 

How are we to address these problems then? 

The answer is not to turn a blind eye to the problem and to maintain the status quo. 

We must stand up and do our part in creating a country with a healthier relationship with alcohol use, and to support those who do struggle with substance use.

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'Facts are facts'

The first step is always education and awareness. 

You may know that people who walk next to the road while under the influence of alcohol are at risk of death, but did you know that in the Western Cape up to 72% of pedestrians in accidents were under the influence of alcohol? 

We often talk about responsible alcohol use, but do we even know what that means? 

If you drink more than 2 quarts of beer in one sitting you are binge drinking, and binge drinking is definitely not responsible use.

Even if we do not agree with them, facts are facts. 

Alcohol use impairs cognitive function, alcohol use can negative health impacts, and alcohol exposure during pregnancy can lead to FASD. 

'The principle of harm reduction'

Awareness on its own is however not enough. We have seen during the pandemic that information and misinformation are in a constant tug of war and that even when people know what is in their best interest, it does not necessarily mean they will act. 

The next step is to focus on programmes that focus on harm reduction and responsible alcohol use. 

We cannot keep the liquor shops locked down, but we can help people decide to not overindulge, and not to place themselves, and others, at risk of harm.

The principle of harm reduction is also crucial in FASD. 

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'We must do something urgently'

A mother may not have known that she was pregnant and may have exposed the fetus to alcohol, or a mother may have a substance use problem and be addicted to alcohol. 

Stepping up and helping the mother to stop using alcohol at the earliest possible moment, or to help her strictly limit her alcohol consumption, will improve on the birth outcomes of the baby.

We must do something urgently about the risks of alcohol use to our communities, our friends and our families, however today we ask you to join us in doing something about the risks of alcohol exposure during pregnancy. 

The complex relationship we have with alcohol means that it is not as easy as just not drinking during pregnancy. This year on the 9th of September, commit yourself to spreading awareness about the risks of FASD, but also commit yourself to love and support mothers-to-be during their pregnancies. Understand their struggles and stand by them, that is how you do harm reduction!

Submitted to Parent24 by the Foundation for Alcohol Related Research.

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