Exposure of the unborn child to alcohol in pregnancy can cause lifelong disabilities (fetal alcohol spectrum disorder, FASD) and is a massive public health concern around the world. As approximately half of all pregnancies are unplanned, the exposure of fetuses to alcohol is causing an epidemic of alcohol harm to others than the alcohol user themselves.
Today is September 9th and International FASD Awareness Day. It’s another opportunity to make the case for urgent action and to help raise awareness of the dangers and risks associated with alcohol use during pregnancy. It’s a day to spend alcohol free – in order to help prevent FASD.
Some FASD facts
- International research has shown that between 6% (Sweden) and 82% (Ireland) of pregnant women continue to consume alcohol, despite the fact that there is no known safe limit for alcohol use during pregnancy.
- In Australia FASD is the leading preventable cause of non-genetic developmental disability.
- In South Africa – the country with the highest rate of FASD worldwide – FARR evidence shows an FASD prevalence rate of 6.42% (64 per 1,000) among children in Grade 1.
- Very conservative and rough estimates show that ca. 1% of Canadians – or about 355,000 people – may have FASD.
- Alcohol consumption during pregnancy increases the risk for miscarriage and low birth weight, and can interfere with the developmental processes of the fetus in ways that lead to brain damage and physical abnormalities.
For over 40 years, we have known the causes for and consequences of FASD. Nevertheless, FASD continues to harm millions of people all around the world, to the rate of about one in every 100 live births. In countries where alcohol intake among women of childbearing age is common, the prevalence of fetal alcohol spectrum disorder can be substantially higher.
Urgent need for action
Alcohol is a carcinogen, toxic, terratogen and addictive substance. It’s foreign to the body and no amount of alcohol is “safe”. Alcohol reduces fertility, increases the risk of miscarriage and causes brain damage and birth defects.
Three main kinds of behavioural problems in children with FASD were examined:
- Internalizing behaviors, such as anxiety, withdrawal or depression
- Externalizing behaviors, such as aggression, delinquency
- Other problems, such as difficulties with social skills, thought processing and attention.
Prenatal exposure to alcohol can cause cognitive damage, learning disorders, mental retardation, as well as behavioral disorders such as ADHD and autism. Poor motor coordination is common. Difficulty with judgment and understanding social situations contributes to long term outcomes such as unemployment, psychiatric illness, and criminality.
Even low amounts of alcohol intake or a single binge can cause permanent damage.
A massive problem that can be prevented
Like much of the harm to others that alcohol causes, FASD can largely be prevented. The imperative for prevention measures is paramount because there is no cure for FASD.
The full scale of FASD prevalence is difficult to know because cases are often diagnosed as learning disorders, ADHD or other disorders while the underlying role of prenatal alcohol exposure remains unrecognized.
FASD prevalence rates have been evaluated in a variety of settings including the community, schools, foster care systems, prisons and correctional systems. The magnitude of FASD prevalence varies according to the setting in which it was evaluated, with higher estimates identified in foster and justice systems compared to those obtained from community and school samples. All of them, however, deserve attention for the planning and organization of prevention strategies. The epidemiology of FASD does not seem to be isolated into a specific region and impacts many communities around the world.
The usual estimates of prevalence in the western world run from 1 to 3 per thousand for full FAS, and 9.1 per thousand for all FASD. A recent and alarming study in the Lazio region of Italy showed that 20 to 40 children per thousand have FASD.
Prevalence estimates of FASD among children in foster care range from 30.5% to 52%, which translate to FASD rates of 305 to 520 per 1000 population in foster care settings.
When more than a million babies are born every year with permanent brain injury from a known and preventable cause, response should be immediate, determined, sustainable, and effective,” write Jonsson et.al. in The Lancet.
Broad-based policy initiatives and actions at different levels of every society are urgently needed to encourage abstinence from alcohol during pregnancy and to prevent fetal alcohol spectrum disorder.”
What works for FASD prevention
In the report “The Burden and Economic Impact of Fetal Alcohol Spectrum Disorder in Canada” the total costs associated with FASD in Canada for 2013 amount to ca. $1.8 billion.
The following cost drivers were included in this study:
- Direct cost of health care (speech-language interventions, prescription drug use, acute inpatient care, psychiatric care, emergency department and day surgery visits, screening and diagnosis, and specialized addiction treatment)
- Direct cost of law enforcement (corrections)
- Other direct costs (children and youth in care, supportive housing, long-term care, special education, andprevention and research)
- Indirect costs (productivity losses due to disability and premature mortality of individuals with FASD).
Loss of productivity of individuals with FASD due to disability and premature mortality was the biggest contributor to the overall cost, accounting for 42% of the total burden. Another contributor was the cost of corrections, representing 30%. Health care costs made up 10%, with the remainder split among other direct costs, such as children in care, supportive housing, and special education.
Alcohol policy measures help prevent FASD
Evidence-based, cost-effective, high-impact policy measures are available to help prevent FASD. The so called three best buys all help to reduce overall alcohol consumption in a population and alcohol’s physical, social, financial and psychological availability in communities and societies.
- Increase of alcohol taxation
- Banning of alcohol advertising and regulation of alcohol marketing
- Limiting alcohol availability
These alcohol control measures are proven to be cost-effective. Other (additional) measures are:
- The provision of quality preconception information and services, including information on the effects of alcohol on health outcomes for pregnant women and infants.
- Improved access to a better diagnostic system and interventions to help people with FASD and their families to have a better quality of life.
- Better early diagnosis and appropriate interventions can help to reduce or even avoid secondary disabilities and enable people with FASD to work and have families.
In many countries, the alcohol norm has to be changed and myths about alcohol have to be debunked. The alcohol industry is aggressively pushing alcohol into all aspects of life, thus making it more and more difficult for people to choose to live and stay free from alcohol.
As some of the facts in this blog show, pregnancy is really one of the phases in lives that should be alcohol free. And therefore, activities to challenge and change the alcohol norm are a crucial addition to the efforts to prevent FASD. Therefore, let’s spend September 9 alcohol free.
For further reading from our Newsfeed:
May 2016: South Africa’s FASD Problem
March 2016: New Study: Devastating Impact Of FASD
February 2016: Study: Dad’s Alcohol Use Tied To FAS
September 2015: Report: Recognize FASD As Disability In Australia
September 2015: FASD: On The Rise Globally
May 2015: High Socio-Economic Costs Of FASD