1. Protecting the unborn baby from alcohol European Parliament, 17 September 2013 Dr Lars Møller Programme Manager World Health Organization Regional Office for Europe

2. Published in June 2013

3. Recorded alcohol consumption in the EU including Norway and Switzerland, 1990 – 2010 (in litres pure alcohol per capita 15+).

4. Regional categorization

5. Central-Western and Western Country Group Central-Eastern and Eastern Country Group Nordic CountriesSouthern Europe

6. Country differences in recorded alcohol consumption (15+)

7. Changes in alcohol policy areas over the five years 2006 - 2011 (N=30)

8. Number of countries carrying out national awareness- raising activities during 2009-2011 (N=30)

9. Lifetime abstainers in the EU, candidate countries, Norway and Switzerland, females

10. Alcohol abstention rates in the world among women (WHO, 2011) Lifetime abstention rate among women in the world - 55.0% Lifetime abstention rates among women in WHO regions: –African Region - 65.2% –Eastern Mediterranean Region - 93.4% –European Region (53 Member States) - 24.6% –Region of the Americas - 27.4% –South-East Asia Region - 92.8% –Western Pacific region -44.5%

11. Prevalence of heavy episodic drinking among past-year female drinkers (WHO, 2011)

12. Maternal Alcohol Use during Pregnancy by Country The ranges are inclusive of any amount of alcohol consumed and at any point during pregnancy The upper estimate ≥85%: Denmark (92%); Finland (90%); Ireland (89%); SA (87%); Russia (85%) The lower estimate: <5% Israel (1.1%); Taiwan and the US (1.4%); Japan (4.6%)

13. Prevalence of FASD Data available in only 21 countries, often outdated and methodologically unreliable Prevalence estimates: –USA 1 : FAS: 2-7 per 1000 FASD: estimated 2-5% in young school children –Italy 2 : FAS: 3.4 - 7.4 per 1000 primary school children FASD: 35 per 1000 primary school children –France 3,4 : FAS: 1.3 – 4.8 per 1000 births FASD: 5.6 per 1000 births – Norway 5 : FAS: 1.2 per 1000 FASD: 1.5 per 1000 1 May et al., 2009; 2 May et al., 2006; 3 Sampson et al., 1997; 4 De Chazeron et al., 2008; 5 Elgen et al., 2007

14. Annual and lifetime cost per individual associated with FASD in Canadian studies (CND; Adjusted for inflation January 2009) ReferenceYear of study PrevalenceAgeAnnual cost (95% CI) Annual cost per individual (95% CI) Stade et al 2006 200331-21$386.6M$16,105 ($14,582-$17,627) Stade et al 2009 200730-53$5.5B ($4.2B-$6.6B) $22,260 ($20,409-$24,728) Than & Jonsson 2009 (based on Stade et al 2006) Various years, Alberta 3-9 incidence 0-72$148.4M- $428.4 $1.23M (lifetime cost per individual)

15. Results from the USA studies Annual Cost associated with FAS in the USA studies (USD; Adjusted for inflation Jan 2009)

16. Global Strategy and European action plan to Reduce the Harmful Use of Alcohol: Health Services’ Response … (b) supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings; such initiatives should include early identification and management of harmful drinking among pregnant women and women of child-bearing age; (c) improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome…; …

17. WHO Guidelines on Identification and Management of Substance Use and SUD in Pregnancy Covering use of alcohol and major classes of illicit drugs in pregnancy Development in parallel to WHO guidelines on identification and management of tobacco use in pregnancy In collaboration with UNODC and other partners First meeting of the Guidelines Development Group took place 28 February – 1 March 2013 in Washington D.C. Publication planned for 2014.

18. More rigorous epidemiological prevalence studies are needed The first step in understanding the severity and impact of FASD is to determine how many people have this condition. Policies and programs can be planned to benefit those living with FASD and to prevent more children from being born with this condition.

19. WHO Research Project on Child Development with a Focus on FASD: project milestones WHO meeting "Alcohol, Health and Development: agenda for international research". Stockholm, Sweden, 24-25 September 2009 Planning meeting for international research project on Fetal Alcohol Spectrum Disorder (FASD). Rolduc, Kerkrade, The Netherlands, 2-3 November 2010 Study protocol elaboration and securing initial funding (NIAAA): 2011- 2012 Training on FASD identification and prevalence research for researchers from Central and Eastern Europe. Minsk, Belarus, 12-15 October 2011 WHO Research Ethics Review Committee approval of the study protocol: December 2012

20. WHO Global study on FASD: Objectives Generate new knowledge on prevalence of FASD among children of 7-9 years old and prevalence of prenatal risk factor exposure (focus on alcohol) –First wave of data collection in Canada, Namibia, Poland, Ukraine, Republic of Belarus, Republic of Moldova and 1-2 other countries in Africa (to be determined in October 2013) Raise awareness of FASD and strengthen capacity for prevention and identification of FASD and promote treatment and support of affected individuals and families Support international collaboration, networking and partnerships for advancing FASD-related research globally.

21. Thank you! Contact details: LMO@euro.who.int Website: http://www.euro.who.int/alcohol http://www.euro.who.int/alcohol European information system on alcohol and health: http://who.int/gho/eisah