Fetal alcohol spectrum disorder in South Africa has the highest rates in the world

South Africa is facing a serious crisis: it has the highest rate of Foetal Alcohol Spectrum Disorder (FASD) in the world.

Despite this, the public response has not matched the scale of the problem. With International Foetal Alcohol Spectrum Disorder Awareness Day on September 9, it is more important than ever to address this preventable issue.

FASD is a crisis that threatens the future of our communities. It is a human rights issue, and every South African has a role to play in addressing it.

Understanding FASD

Foetal Alcohol Spectrum Disorder (FASD) is caused by alcohol consumption during pregnancy. Even small amounts of alcohol can harm a developing baby.

The effects are lifelong, impacting brain development, learning, behaviour and overall health. It’s the leading preventable cause of intellectual disabilities worldwide.

In the Western Cape and Northern Cape, FASD rates are among the highest in the world. In some communities, one in three children is affected. These numbers represent real lives and lost opportunities that can impact families for generations.

“When a pregnant woman drinks, it’s not just her health at stake; it’s the child’s entire future,” says Kashifa Ancer, campaign manager for Rethink Your Drink, an initiative working to reduce heavy drinking and protect children from harm.

According to the National Institutes of Health, FASD creates a ripple effect. Children born with the condition often struggle with:

FASD can cause a wide range of physical problems, which may manifest at birth or later in life. These include the below:

Facial abnormalities

• Growth deficiencies.
• Low birth weight.
• Poor growth during infancy and childhood.
• Shorter-than-average height.
• Organ damage
• Skeletal abnormalities.
• Hearing and vision problems:
• Delayed motor skill development, such as crawling or walking.

Cognitive and learning challenges

• Prenatal alcohol exposure disrupts brain development, leading to lifelong intellectual and cognitive impairments.
• Reduced IQ levels often range from borderline to low-average, with some individuals experiencing intellectual disabilities (IQ < 70).
• Memory problems.
• Difficulty retaining learned information.
• Poor short-term and long-term memory.

Learning disabilities

• Struggles with math, reading, and comprehension.
• Poor academic performance despite normal schooling.
• Attention and concentration problems.
• Hyperactivity and impulsiveness.
• Inability to sustain attention or complete tasks.
• Delayed language development.
• Problems with articulation, vocabulary and sentence structure.
• Behavioural and emotional issues.

FASD often leads to emotional regulation and behavioural challenges, which can significantly impact daily life:

• Hyperactivity and impulsivity.
• Difficulty sitting still or following instructions.
• Acting without considering consequences.
• Struggles with decision-making.
• Increased risk of engaging in unsafe behaviours.
• Frequent irritability or frustration.
• High rates of anxiety and depression.
• Limited understanding of social cues and norms.
• Prone to tantrums or outbursts.
• Difficulty managing anger or stress.
• Higher likelihood of substance abuse in adolescence or adulthood.

These challenges often continue into adulthood, affecting jobs, relationships and mental health. Without support and intervention, the problem can repeat across generations.

In South Africa, teenage binge drinking exacerbates the problem. A 2021 study by the Human Sciences Research Council found that nearly 50% of South African teenagers engage in binge drinking, putting not only themselves but future generations at risk.

FASD is preventable. However, without enough awareness, support, and strong policies, many children are denied their right to a healthy start in life.

The United Nations Convention on the Rights of the Child highlights every child’s right to education, health, and protection. FASD compromises all three. By failing to address this crisis, we fail our children and their future.

One of the biggest barriers to preventing FASD is misinformation:

Myth: A little alcohol during pregnancy is safe.

Fact: No amount of alcohol during pregnancy is safe. Alcohol crosses the placenta and directly affects the developing baby’s brain.

Myth: FASD only occurs in heavy drinkers.

Fact: Even moderate drinking can result in FASD.

Myth: FASD is rare.

Fact: In parts of South Africa, it’s alarmingly common, with rates far exceeding the global average.

The spectrum of harm from alcohol exposure during pregnancy is broad, and because the symptoms vary, many cases go undiagnosed. This makes the problem bigger than we even realise.

Preventing FASD starts with awareness and support. Here’s how we can make a difference:

1. Education: Communities need to understand the risks of alcohol during pregnancy. Campaigns like Rethink Your Drink and Hold My Hand are already making strides in spreading this message.

2. Early intervention: Pregnant women need access to affordable healthcare, counselling and support to stop drinking. It’s never too late to quit. Stopping alcohol use at any stage of pregnancy improves outcomes for the baby.

3. Policy enforcement: Stricter regulation on alcohol sales, especially to minors, is crucial. South Africa’s liquor laws need stronger enforcement to prevent underage and binge drinking.

4. Community support: Building a culture of accountability where families, schools, and local leaders step up to support pregnant women can create lasting change.

This is not just a woman’s issue, nor is it limited to affected families. FASD is a national crisis that requires collective action. Governments, NGOs, healthcare providers and individuals must work together to break the cycle.