“There is a lot he wants to do, but I must remind him he’s not like other kids,” says 45-year-old mother Marion Williams, a Stellenbosch resident whose child suffers from foetal alcohol syndrome (FAS). Williams is one of many mothers in the Western Cape with an FAS child.

FAS is a condition in which a child’s mental and physical development is damaged due to high levels of alcohol consumption by the mother during pregnancy. Research done by numerous health organisations, including the World Health Organization (WHO) confirms that the Western Cape has the highest prevalence of FAS in the world.

According to Denis Viljoen, a researcher and geneticist based in Cape Town, approximately seven to eight percent of babies born in the Western Cape have FAS. This is distressing when considering the fact that the prevalence of FAS in developed countries only ranges from 0,1 to 0,2%. Wellington, a small town in the Western Cape, has become notorious for its high rate of FAS. The Foundation for Alcohol Related Research (FARR) reports an increase in the prevalence of FAS among Wellington pupils entering school, with an alarming 88 out of every 1 000 grade-one pupils having the syndrome. The town of De Aar in the Northern Cape faces the same problem.

This social concern is not just one of other provinces, but also of our own. Studies done in Gauteng by FARR report an FAS rate of 1,2% in Lenasia, 2,2% in Soweto and 3,7% in Westbury. According to Viljoen, approximately one million people in South Africa have foetal alcohol syndrome and another five million suffer from similar alcohol exposure disorders. “It’s tragic because it’s completely preventable,” he says.

The foetus is exposed to alcohol from the mother when it crosses the placental barrier. The child is subjected to the alcoholic effects for an extensive amount of time as it cannot process the alcohol quickly enough. Alcohol intake poses a risk during any point of pregnancy but especially during the first three months, when the chance of miscarriage is highest.

The consequences of alcohol exposure – which include physical, behavioural and cognitive problems – are debilitating. Children with FAS are born with a below-average height and weight. Since there is no cure, the child has permanent brain damage (often made visible through facial abnormalities) which can affect all aspects of his or her life. FAS sufferers tend to have learning disabilities, with an increased risk for ADHD (attention deficit hyperactivity disorder) and a number of behavioural problems including poor anger management, poor judgement and a lack of social and communication skills.

It is believed that locally, the syndrome has a historical origin in the wine-growing areas of the Western Cape, where farm workers were paid with alcohol. This controversial method of payment was known as the “dop system” and no longer exists.

Despite proof that FAS mostly affects those at a lower socio-economic level, Viljoen maintains that “[there] are an increasing number of children with [FAS] from middle and higher socio-economic groups” who visit his private practice, which offers support to children who have been subjected to alcohol exposure.

It is generally accepted among the medical community that binge drinking while pregnant is harmful to an unborn child but questions regarding light drinking and its effects on the foetus remain mostly unanswered. A controversial study done by University College London found that light drinkers (those who consume one or two units of alcohol per week) were 30% less likely to have children with the social or emotional difficulties generally associated with FAS, compared to those who abstained from alcohol completely while pregnant. Critics have condemned the study, as it suggests that light drinking is beneficial to a growing foetus.

Many argue that the ever-changing advice on how much alcohol is allowed is conflicting. In an article published in The Telegraph, Abigail Flanagan of (an online forum for mothers) says, “The constantly changing information does scare people and some find themselves halfway through their pregnancy when the rules change.” Flanagan recommends that women ignore the changing information and instead “use common sense” by avoiding drinking and seeking advice from medical professionals. Most health departments in countries around the world insist that alcohol should be completely avoided during pregnancy.

According to the Nutrition Information Centre of the University of Stellenbosch, most South African women are aware that drinking alcohol during pregnancy is harmful but this knowledge has little effect on their alcohol consumption. “People know about [FAS] but they drink anyway,” says Anna Marie Kok, a mother from Sunrise Township. “They have so many other problems to deal with that they need to escape.”

FASfacts, a South African NGO, believes that prevention and treatment programmes for alcoholic women could greatly reduce the incidence of FAS. Prenatal screening for maternal alcohol use and education through national awareness programmes are also crucial.

The WHO has revealed that FAS is the leading cause of mental retardation in North America, Canada and South Africa. With the knowledge that this syndrome is entirely preventable, society should not passively accept these statistics but should instead turn their attention to resolving the issue at hand.

Image: Charné Fourie

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