Drinking during pregnancy

Babies thrive on love, not alcohol - but do all South African mothers know that? And, if they know, is that enough to stop fetal alcohol syndrome? By SANDRA MARAIS

A sad and serious consequence of alcohol use by pregnant women is that it may lead to fetal alcohol syndrome (FAS). This disorder - the impact of which stays with affected children their whole lives - is solely attributable to the harmful effects of drinking alcohol during pregnancy.

And its consequences are severe: the alcohol a mother consumes during her pregnancy damages the developing brain, resulting in mental retardation. Children with fetal alcohol syndrome struggle to learn and reason. It also causes abnormalities in the nervous system, organs and limbs, and leads to characteristic facial features.

The impact of fetal alcohol syndrome seems to be the highest in the Northern Cape Province. Results from a study in the town of De Aar showed that 122 out of every thousand children starting school were affected - officially the highest frequency yet reported in one population in the world.

In the Western Cape, ongoing research indicates that the number of affected children has nearly doubled between 1997 and 2001: from 46 to 88 out of every thousand children. In the United States, fewer than one child in a thousand are affected.

The occurrence of fetal alcohol syndrome has not been determined in all South African provinces, although studies in non-wine-growing communities in Gauteng indicated a high prevalence rate among Grade 1 children. This underscores the fact that fetal alcohol syndrome is a significant public health problem in South Africa. If the whole spectrum of disorders that may be caused by even moderate use of alcohol during pregnancy is taken into consideration, it is clear that the problem is even bigger - and prevention efforts all the more important.

On an individual level, it may seem a simple matter for a woman to prevent fetal alcohol syndrome, by simply not drinking during her pregnancy.

But the use of alcohol during pregnancy is a complex problem, inseparable from many other factors - such as a woman’s mental health, her socio-economic status, power relations between her and her partner and the attitudes of her family and community towards drinking.

The good news is that public awareness of fetal alcohol syndrome and the dangers of drinking during pregnancy are now much higher than before, thanks to combined and systematic efforts by many role players, including the South African Medical Research Council, led by the Western Cape Department of Health.

The department, and specifically its Mother, Child and Women’s Health sub-directorate, became active in the identification and prevention of fetal alcohol syndrome as early as the 1980s.

Recognising the potential public health threat of the problem, the sub-directorate organised a provincial meeting in early 2001 to set goals and plan a strategy.

A provincial reference and working group was established shortly thereafter, comprising members of the Department of Social Services, the Department of Education, a geneticist (University of Stellenbosch), a neuro-developmental paediatrician (University of Cape Town), FARR (Foundation for Alcohol-Related Research) and Dopstop (with the mission to enable people in rural communities in the Western Cape to take control over alcohol in their lives). The Medical Research Council joined later as a member.

Since 2001, the working group has developed a standardised training manual with the help of experts in the field of fetal alcohol syndrome.

The first two modules of the manual, which explain what fetal alcohol syndrome is and how to identify high-risk groups, is being used as one of the courses taught to clinical nurses in the region.

The third module for the manual - concerning the most effective ways of reaching women at clinics and other primary health care facilities - is soon to be added. It will be based on recent research by the MRC in rural and urban communities.

This research showed that most women in these communities are aware of the dangers of drinking alcohol while pregnant. In fact, one third of the sample also knew what fetal alcohol syndrome was and could identify certain key characteristics of the syndrome correctly.

But this had little or no effect on the levels of alcohol use during pregnancy, the study found.

Clearly, interventions will have to go further than merely raising awareness about the problem and handing out information.

A recommendation was made that primary health care staff at clinics become involved in routine screening of women at risk of alcohol abuse, and that motivational talks aimed to reduce their alcohol use becomes routine.

Together with screening and motivational talks, an appropriate referral system will have to be put in place. However, interviews with staff members at primary health care facilities showed that, although most staff members were willing to become involved in prevention activities at their facility, they also said their participation wasn’t realistic, given their present workload.

This poses a challenge to the health services, but given the current emphasis by the Department of Health on the development of social capital, partnerships can be entered into with appropriate organisations, NGOs and community-based organisations to strengthen services delivered to clients.