What is Foetal Alcohol Syndrome?

Foetal Alcohol Syndrome (FAS) is a 100% preventable condition that is caused by a mother consuming alcohol during pregnancy.

However, despite being a preventable condition, the South African National Council on Alcoholism and Drug Dependence (SANCA) for the Western Cape notes that “South Africa has one of the highest incidences of FAS (Foetal Alcohol Syndrome) globally.”

Moneybags journalist Jessica Wood looks at the issues surrounding FAS.

According to a 2012 study, “Prevalence of [foetal] alcohol spectrum disorders (FASDs) is remarkably high in several provinces of South Africa; yet population-level knowledge of the harms of maternal drinking remains low.”

A press release from the Saartjie Baartman Centre for Women and Children stated: “An estimated 25 000 babies are born with Foetal Alcohol Syndrome (FAS) every year in South Africa, [which] is the highest reported incidence in the world.”

Leana Olivier, chief executive officer at the Foundation for Alcohol Related Research (FARR) explains that FAS results in irreversible damage to the unborn child.

“[FAS is] Permanent irreversible damage to any organ (especially the brain) of the unborn baby due to a pregnant woman’s alcohol use during pregnancy.”

However, Olivier highlights that a woman does not need to be an alcoholic for their child to suffer from FAS.

What is Foetal Alcohol Syndrome?

According to the Western Cape Government Health Services, “Foetal Alcohol Syndrome or FAS is a common, preventable form of intellectual disability and a serious public health problem in the Western Cape.”

It went on to say that FAS affects children by slowing their physical growth and results in central nervous system abnormalities.

Children are born with FAS when their mothers drink alcohol while they are pregnant.

FARR notes that FAS is claimed to be one of the most frequent causes of preventable mental handicap.

“In South Africa, the condition has been evaluated in several communities thought to be especially at risk and, from a population totalling 49 million, it has been estimated that at least 1 million [people] have FAS with a further 5 to 6 million exhibiting signs of the lesser form of the condition, namely foetal alcohol spectrum disorders.”

If a woman drinks during pregnancy, regardless of whether or not they are an alcoholic, the unborn child is exposed to alcohol, which can result is a variety of Foetal Alcohol Spectrum Disorders (FASD).

Effects of FAS

FARR points out that this alcohol exposure can have three different effects.

  1. FAS: This is the most severe form of FASD and results in the child have “growth retardation, nervous system problems (such as an intellectual disability) and organ abnormalities,” along with typical FAS facial features. According to a paper released by the Nutrition Information Centre at the University of Stellenbosch, typical FAS facial features include: a low nasal bridge, epicanthic fold, small and wide-set eyes, a short, upturned nose, small and low-set ears, a thin upper lip with a flat philtrum, and a small and recessed chin.
  2. Alcohol-related birth defect (ARBD): Here the child will not have the FAS facial characteristics, however, the child will have alcohol-related organ abnormalities, which may affect any organ.
  3. Alcohol-related neuro-developmental defect (ARND): With ARND the child will have nervous system problems, like an intellectual disability, however, organ abnormalities and FAS facial characteristics will not be present.


How is it diagnosed?

FARR highlight that FAS and FASD “must be diagnosed by specialised professionals (medical specialist, neurodevelopmental psychologist and a trained counsellor) working with FASD. It requires a multi-disciplinary approach by these professionals.

“The diagnosis of FASD must be based on solid evidence as a FASD diagnosis is of great importance for the entire lifetime of the child, not to speak of its implications for the child’s mother and other family members.”

According to FARR, FASD can only be diagnosed using a three pronged approach which is used internationally.

  • First is a clinical or medical evaluation of the child,
  • Followed by a neuro-developmental assessment, and
  • Lastly is the maternal interview.

FASD is usually diagnose between the ages of three and ten.

The effects of FAS

Unicef highlights that there are many social implications to FAS. “A high prevalence of disrupted school experiences, trouble with the law, confinement, inappropriate sexual behaviours, and alcohol and other drug problems have been described in adolescents and adults with FASD in the USA… The prevalence of these outcomes have not yet been quantified in South African studies.

Some of the developmental characteristics of FAS, as explained by Unicef, include problems with verbal learning, and language, as well as certain aspects of visual learning including visual representations and spatial relationships.

Unicef goes on to point out that there are also several behavioural effects to FAS.

  • Hyperactivity,
  • Poor judgment when making decisions,
  • The inability to understand the consequences of your actions, and
  • A bad short-term memory.

The costs of treating FAS?

Olivier highlights that there are several medical costs associated with FAS. However, she notes that these are hard to quantify as various factors need to be considered, and the degree of treatment needed will differ according to the severity of the FAS.

“[FASD and FAS] have never been costed as there are so many factors to take into consideration. For example, what is the cost to a family and society if a child with FAS drops out of school (like so many of them do)?”

However, Olivier points out that any medical costs that may be endured will most probably be long term, as FASD conditions are life-long conditions.

“The alcohol exposure in utero can affect any organ, so the person with FASD can be born with eye, heart and any other defect which might require lifelong treatment.”

Globally there have been very few studies that look at the cost of FAS, with most, if not all, of the studies available coming from the United States and Canada.

According to the most recent study conducted in Canada in 2007, the annual cost per individual with FASD was between 19 842 and 24 041 Canadian dollars (between R189 779.72 and R229 900.43).

Western Cape Government Health Services explains: “Apart from physical abnormalities, children with FAS can also have neurological, behavioural, and learning problems. Programmes are currently being developed to identify and assist high-risk mothers and to diagnose children with FAS as early as possible.

“Although many of these children experience learning problems, stimulation and management programmes are being developed to assist parents and caregivers. Should a parent/caregiver or teacher be worried about a child, the child can be taken to the nearest clinic from where the child will be referred to the most appropriate service for further assessment.”

How to prevent FAS

The FARR stress that it is not safe to consume any amount of alcohol during pregnancy. “Not even one glass of alcohol should be taken as no research can state how much alcohol is required to cause damage to the unborn child.”

To prevent your child from having FAS or FASD is simple, do not consume alcohol while you are pregnant.

Raising awareness

According to Olivier, “comprehensive educational and support programmes are successful.”

One of the initiatives that is run to raise awareness around FAS is International Foetal Alcohol Syndrome Day, which is held on 9 September every year.

According to the South African Government website, “World Foetal Alcohol Syndrome (FAS) Day is commemorated each year at nine minutes past nine on the ninth day of the ninth month to draw attention to the fact that women should not drink alcohol while pregnant.

“The alcohol the mother drinks enters the unborn baby’s bloodstream causing damage to the foetus. Such damage is permanent and irreversible. FAS children will have physical and intellectual problems.”

Other educational programmes and initiatives are run by organisations such as: