Fetal alcohol syndrome is the most common preventable form of mental retardation in the world. FAS causes a range of disorders, is found in all ethnic groups and populations and is most prevalent is impoverished communities. In South Africa, epidemiological studies have shown that rural populations in the Western Cape are particularly affected and have FAS rates exceeding those reported in other world communities.
Fetal Alcohol Syndrome is a series of birth defects caused by alcoholism or consumption of alcohol on a regular basis during pregnancy. The baby, who has no part to play in the mother’s drinking, ends up with severe problems before and after birth. (Kibel, M., & Wagstaff, L. (Eds.). (2001), (p.67.)
What is Fetal Alcohol Syndrome?
Fetal alcohol syndrome is a condition that results from alcohol exposure during pregnancy. Problems that may be caused by fetal alcohol syndrome include physical deformities, mental retardation, learning disorders, vision difficulties and behavioral problems. There is no amount of alcohol that’s known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome. (Fetal alcohol syndrome: Retrieved from http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184)
How is FAS characterized in the community?
Fetal Alcohol Syndrome is a wide spread health problem in South Africa. It is estimated that there are 10 000 to 12 000 new cases of FAS babies born annually, constituting the single most common serious birth defect (Kibel p.71) * A national FAS awareness program was launched in South Africa in 1998, aiming to reduce the burden of FAS in the communities, where it is highly susceptible. Awareness in the Western Cape is high. Local prevention workshops, upliftment programs, campaigns against the “dop” system and new labor laws have been introduced. Community education on the damages of alcohol needs to be addressed. State funded in-patient and outpatient facilities need to be built. Because of the growing number annually, FAS is a massive financial burden to the community. The costs are high, because children with FAS require special schooling and other forms of special care. *
* The Western Cape Department of Health launched a documentary television series called “Booza TV”, to help educate people on the effects of alcohol. “Booza TV” is targeted specifically at the youth (18-35 years), communities affected by alcohol abuse, Organizations concerned with community development, youth development, employment, poverty, violence, HIV/TB, child health, chronic diseases, mental health, alcohol abuse and/or gender and Media agencies. (Booza TV: Retrieved from http://boozatv.com/what-is-boozatv/)
Workshops, educational programs and campaigns have recently been introduced to create awareness and prevention of FAS in South Africa. South African Breweries, (SAB), the largest beer manufacturer in South Africa, has recently launched a “Reality Check FAS awareness” campaign that aims to communicate the harsh truth about drinking whilst pregnant. SAB has developed strategic partnerships with non-governmental organizations in the Western and Northern Cape by funding intervention programs to increase the awareness and reduce the number of babies born with FAS. Assessment clinics have been set up in major centers for diagnosis, ongoing intervention and support. School systems are challenged to provide appropriate services for children with FAS/FAE, many of who are placed in the emotional/behavioral disorder special education programs. Individual education plans will be very important. Anger-management programs may be helpful, and building self-esteem will be a goal. Protecting the child from competitive situations, and trying to avoid exposure to violence in the media can be helpful as the child may not be able to separate fantasy from reality. (Fetal Alcohol Syndrome: (2005) retrieved from http://www.health.state.mn.us/divs/fh/mcshn/bd/fetal.htm)
Describe how babies with FAS are affected.
Fetal Alcohol Syndrome (FAS) is a specific birth defect, which can be identified by the following characteristics: facial abnormalities, growth deficiency and central nervous system effects.
Alcohol is a substance that is toxic to the brain of a developing fetus. Damage can occur in various parts of the brain. The areas that are affected by alcohol exposure during pregnancy, depend on which areas of the brain are developing at the time that the alcohol is consumed (Kellerman (2010) p.1.) The brain of a fetus is developing throughout the pregnancy. Therefore the baby’s brain is always vulnerable to damage by exposure to alcohol.
During the first Trimesters, alcohol interferes with the migration and organization of brain cells (Journal of Pediatrics, (92), p.64-67.) During the second trimester, (10th to 20th week after conception) heavy drinking causes more clinical features of FAS that at other times during pregnancy. (Early-Human-Development, (1983) Jul Vol.8. p.99-11). During the third trimester, the hippocampus is greatly affected, which leads to problems with visual and auditory information (reading and mathematics). (Coles, C.D. (1991) p.357-367.)
Prenatal alcohol exposure inhibits the regions of the brain to function normally as follows:
Corpus Callosum – passes information from the left brain to the right brain and vice versa. The Corpus Callosum is smaller than normal in a baby with FAS or could be nonexistent. Hippocampus – responsible for memory. The ability to retain information, especially the short term, is evident in children with FAS. Basal Ganglia – affects the spatial memory and behavior such as perseveration, the inability to work towards goals or to predict the outcome of certain behavior, as well as the perception of time. Frontal Lobes – controls impulses and judgment. The most damage occurs in the prefrontal cortex, which controls the executive functions. Executive functions can be identified as behaviors related to inhibitions, problem solving, sexual urges, planning, memory, verbal self-regulation, fine motor coordination, motivation and judgment. (FAS: Kellerman (2000-2006) www.fasstar.com)
The adverse effect of alcohol on the fetus does not simply end at brain damage. Drinking during the second trimester of pregnancy, the baby’s clinical and facial features are affected.
Babies with FAS generally have low birth weight and may also experience trouble in gaining weight. The head circumference (32.4cm) in comparison to a baby that was not exposed (34.7cm) to alcohol during pregnancy is significantly smaller. It is primarily due to failure of brain growth.
The facial features of a FAS baby can be identified by small eyes, and exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip. The ears might be deformed which could cause hearing impairment. The visual ability of the child might be impaired, and in some cases babies with FAS are born blind.
Babies diagnosed with FAS may also have deformities of their arms, legs and fingers. In some cases FAS babies are born with heart defects.
The psychological effects of FAS may include the following: Damage to the brain from alcohol exposure can result in inappropriate behavior. The child has difficulty relating to the concept of consequence. Therefor it is often noted that children with FAS do things before they think about the consequence. When the thought enters the mind, the body does the act because the thought process is damaged. The child’s behavior could be interpreted as willful conduct, but essentially good behavior is out of the child’s control, especially in a time of stress or excitement.
Most children with FAS have attachment issues. They have difficulty in forming meaningful relationships. Some children also have problems showing affection. It becomes evident during later years, when the child has impulsive sexual behavior. (Fetal Alcohol Syndrome: (n.d.) retrieved from http://www.health.state.mn.us/divs/fh/mcshn/bd/fetal.htm)
The effect of alcohol during pregnancy is therefore immense and mothers should take into account what damage they are prepared to inflict on their child, which will affect the child for the rest of their lives.
In your view what are the symptoms of long-term alcohol use? In my opinion the first warning signs of a developing problem, is when the frequency of alcohol intake increases. Children are exposed to alcohol use from a very early age. They observe their parents’ drinking habits and it becomes the norm. Children are like sponges, and absorb habits and examples set by their parents from very early in their lives. Therefore, it is inevitable that children inherit these habits from their parents and often children of alcoholics become alcoholics themselves. When a person drinks for the effect that the use of alcohol has on their bodies and minds, the frequency of drinking increases and so does the dependency on alcohol increase. Many people drink to forget the reality of their day-to-day issues and problems. Instead of facing the issues and seeking professional help, they tend to seek the help and relief in a bottle. At the time of intoxication, the problem seems to be a lot less profound or disappears completely. The same concept would apply to release stress. In a stressful situation, it is easy to reach our to a bottle of wine to relax.
This way the bottle of wine becomes the crutch to release the stress. As the habit of stress relief by alcohol consumption develops, the frequency and volume of intake increases. Eventually the one glass of wine to relax is no longer enough. Soon it becomes a habit of any alcohol that is available in any quantity. The long-term effects of alcohol use, manifests itself in various ways, which becomes less easy to identify by the alcohol user. The psychological effect from a mother who reaches for alcohol as a coping tool on a growing child is immense. As the frequency increases, the effects have a snowball effect. Irrational behavior, violence, mood swings, memory loss invariably end up in marital problems and subsequent splitting up of families. Secret drinking is a great risk of alcohol becoming a problem. A person who stays up late at night and drink alone risks becoming an alcoholic. When a person starts hiding their drinks and drinking secretly to avoid family members finding out how much they consume it poses the risk of the dependence increasing.
Long-term alcohol use is an addiction with many diverse consequences. Family violence, child abuse, unwanted pregnancies and loss of employment are just a few of the tragic consequences that stems from dependence on alcohol. Because alcohol is a toxic substance, it could trigger aggression, which result in emotional and physical abuse. In many instances, people lose their sexual inhibitions because of excessive drinking which subsequently results in unwanted pregnancies or sexually transmitted diseases. In my view, long term alcohol use results in life time sadness, broken families, loss of dignity and general destruction, to name only a few.
What kind of role has the South African context played in FAS? There are two historical factors, which have had a major impact on alcohol abuse in South Africa. Firstly, the “dop” system, which was used on farms. In the 1700’s European Colonialists introduced this on wine farms in the Western Cape. The dop systems became unique to the Western Cape. Excess wine that was rejected on the open market was sold back to farmers at a very cheap price, who then in turn used for the farm workers as part payment. The practice continued, despite the system being made unlawful by an Act of Parliament in 1928. This “dop” system was largely found on a minority of farms in the Western Cape. The long-term effects of this system still impacts on the population today. The poverty and lack of recreational facilities encouraged weekend binge drinking. Secondly, beer halls, which were constructed, mostly in the mining industries, encouraged the use and abuse of alcohol. These beer halls are situated between the place of work and hostels or townships.
This facility encouraged men and women to drink after work. Women and men deviate from their tribal customs, which do not condone women drinking at all. Women started using alcohol more frequently, which lead to binge drinking and inevitably alcoholism. There are hundreds of illegal beer halls across South Africa, and not enough police forced to eradicate this. Binge drinking (6 or more beers in one drinking session), is extremely dangerous for the fetus, because of the very high blood alcohol concentration. In the Western Cape binge drinking is a common practice, especially on weekends. Binge drinking occurs in more than 20% of women in the Western Cape. Past surveys have shown that FAS was more common where the mothers were residing in rural areas. Yet, according to Denis Viljoen, who set up a Non Governmental Organization (NGO), called The Foundation for Alcohol Related Research, the number of children with FAS has increased in the middle and higher socio-economic groups. FAS awareness has grown, since it was coined in 1973, by Jones & Smith, two physicians from Seattle.
Fetal alcohol syndrome is a serious, irreversible disease that can be prevented at all times. If you are considering pregnancy, are at childbearing age, think about the consequences of drinking alcohol. No mother wants to deliberately cause long-term irreversible effects of an innocent human being, who has no choice in drinking while developing. No amount of alcohol is known to be safe during pregnancy. Alcohol and pregnancy do not mix!