South Africa’s FASD crisis needs more than awareness campaigns, experts warn

South Africa is facing a Foetal Alcohol Spectrum Disorder (FASD) crisis, yet the country still lacks a dedicated and coordinated national response to prevent the condition and support those living with its lifelong consequences.

With an estimated one in 10 children affected, South Africa has the highest prevalence of FASD globally. In some communities, the figures are even more alarming, with prevalence estimated at nearly one in three children in parts of the Western Cape and one in five in the Northern Cape.

Despite the scale of the problem, researchers argue that efforts to tackle FASD remain fragmented between the health, education and social development sectors.

Advocates are now calling for a shift away from prevention campaigns that focus primarily on the choices of pregnant women towards a broader approach that examines the social and environmental conditions driving alcohol harm.

“Information alone is not a prevention strategy,” said Kashifa Ancer, project lead for Rethink Your Drink.

“We also have to ask what shapes behaviour around nutrition and alcohol use. Prevention cannot rest on individual choices alone. We need to look at the environments women live in and whether the systems around them make healthier choices possible.”

FASD refers to a range of lifelong conditions caused by exposure to alcohol during pregnancy. Children with Foetal Alcohol Syndrome and partial Foetal Alcohol Syndrome can require more healthcare and face increased risks of developmental challenges, intellectual disabilities, stunting and congenital heart defects.

The economic cost is also significant.

A 2011 study estimated that Foetal Alcohol Syndrome and partial FAS cost Western Cape society about R597 million annually in healthcare-related costs, based on 2009 prices. Adjusted for inflation, the cost would today exceed R1 billion.

But every September, around FASD Awareness Day, public messaging tends to focus heavily on warning pregnant women against drinking alcohol.

Advocates say this approach overlooks the wider systems that influence alcohol consumption and fails to address prevention at a national level.

Rethink Your Drink will explore this issue through The First Home, an immersive experience scheduled for Cape Town's Homecoming Centre on September 9. The exhibition will bring together art, history, lived experiences and policy discussions to examine the environments that shape alcohol-related harm.

“Children don’t choose the environments into which they are born,” Ancer said.

“If we want different outcomes for children, we have to be courageous enough to change what surrounds them.”

The organisation is also working with Hold My Hand, a public campaign supporting the goals of the cabinet-approved National Strategy to Accelerate Action for Children, which promotes a whole-of-society approach to protecting children and adolescents from violence, abuse, injury and harmful substances.

Advocates believe South Africa's response to HIV offers an important lesson.

The country's efforts to prevent mother-to-child HIV transmission moved beyond simply advising women on how to prevent infection. Instead, a national programme was developed around testing, counselling, treatment, maternal healthcare and continued support for mothers and children.

South Africa subsequently recorded major reductions in mother-to-child HIV transmission.

“South Africa’s HIV response showed us that prevention improves when systems change, not simply when individuals are told to change,” said Ancer.

Those calling for a stronger response to FASD believe the same thinking should now be applied to alcohol harm.

They argue that a coordinated national strategy should work alongside tougher alcohol regulations, including measures to reduce access to cheap liquor, increase alcohol prices and restrict alcohol advertising, sponsorship and promotion.

For a country carrying one of the world's heaviest burdens of FASD, advocates say awareness alone is no longer enough. The challenge, they argue, is to build systems that make prevention possible long before a child is exposed to harm.