1. Fetal Alcohol Syndrome in South Africa By: Tanya Staton MPH 583

2. Fetal Alcohol Spectrum: is a term used to describe the effects that can occur if an individual prenatally is exposed to alcohol. Signs and Symptoms include: Abnormal facial characteristics Growth deficits Brain damage Kidney, lung and heart defects Poor coordination and motor skills Learning disabilities (nofas, n.d). aishamusic.wordpress.com

3. FAS facial features can be easy to distinguish.

4. “Fetal alcohol spectrum disorder is the most common birth defect in South Africa. It is by far more common than Down syndrome and neural-tube defects combined” (Graham, 2012).

5. FAS Compared United States Approximately 40,000 children are born with some form of fetal alcohol disorder (Rotherman-Borus & Tomlinson, 2014). Higher FAS rates are reported in the U.S. among Black and American Indian women, low– socioeconomic status (SES) groups and those with an alcoholic partner (May et al., 2005). FAS in US children is 0.05 to 2.0 per 1000 births (May et al, 2005). South Africa The highest rates reported globally are seen in South Africa's Western Cape Providence Region. The rate of full-blown FAS alone is staggering, and has been reported to be 46 cases per 1000 births in the Western Cape Province (May et al, 2005). The rate of FAS increased from 4.8 percent to 8.8 percent between 1997 and 2001 in the South Africa Western Cape Region (Graham, 2012).

6. Why are FAS rates so high in South Africa? Although it has been illegal since the mid-1990s there is still a continued practice of the “dop” system. This is where farmers are paid in alcohol as part of the conditions of their employment (Ojo, 2010). Women make up approximately 30 percent of the labor force and are more likely to be employed as casual laborers. “Shebeens” (informal bars) are prevalent in every township. Employing mostly women, they are the “Shebeens Queens.” Historically beer brewing became women's work in South Africa (media club South Africa, 2014).

7. Why are FAS rates so high in South Africa continued…. Fas children come from families with a history of heavy drinking abuse (Graham, 2012). Alcohol helps people cope with the gruesome social conditions and pressing poverty.

8. Due to limited resources prenatal alcohol- exposure prevention activities for women and intervention programs for children with FAS are virtually nonexistent in low-income countries.

9. What efforts can be done to improve birth outcomes in South Africa…. Discourage “dop” trade. Shut down illegal “shebeens” ~ There are approximately 200,000 illegal shebeens operating across the country (enca, 2013). Complete needs assessments that detail the availability and lack of resources in alcohol prevention and treatment services for women and intervention services for children (CDC, 2013). Develop training through key staff to educate women on the effects of drinking while pregnant.

10. Fetal Alcohol Spectrum is 100 percent preventable! Don’t drink alcohol if you are trying to become pregnant. Avoid alcohol throughout your pregnancy. Consider giving up alcohol during your childbearing years. If you have a drinking problem seek help before you try to conceive.

11. No safe type No safe time No safe amount Be alcohol-free to give your baby a healthy start.

12. References: National Organization on Fetal Alcohol Syndrome. (n.d). FASD: What Everyone Should Know. Retrieved from http://www.nofas.org/wp-content/uploads/2014/08/Fact-sheet-what-everyone-should-know_old_chart-new-chart1.pdf http://www.nofas.org/wp-content/uploads/2014/08/Fact-sheet-what-everyone-should-know_old_chart-new-chart1.pdf May, P., Gossage, P., Brooke, L., Snell, C., Marais, A., Hendricks, L., Croxford, J., Viljoen, D. (2005). Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population-Based Study. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361810/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361810/ Rotherman-Borus, M., Tomlinson, M. (2014). This Is Your Child’s Brain on Alcohol. Retrieved from http://time.com/3342053/this-is- your-childs-brain-on-alcohol/http://time.com/3342053/this-is- your-childs-brain-on-alcohol/ Ojo, O., Goedele, L., Morojele, N., Rendall-Mkosi, K., London, L., Olorunju, S., Davids, A. (2010). Factors associated with female high- risk drinking in a rural and urban South African site. Retrieved from http://www.scielo.org.za/scielo.php?pid=S0256- 95742010000300022&script=sci_arttexthttp://www.scielo.org.za/scielo.php?pid=S0256- 95742010000300022&script=sci_arttext Media Club South Africa. (2014). Long reign of the South African shebeen queen. Retrieved from http://www.mediaclubsouthafrica.com/culture/3975-long-reign-of-the-south-african-shebeen-queen#ixzz3DZt2ALKq http://www.mediaclubsouthafrica.com/culture/3975-long-reign-of-the-south-african-shebeen-queen#ixzz3DZt2ALKq Graham, E. (2012). Rising incidence of Fetal Alcohol Syndrome in South Africa. Retrieved from http://www.wsws.org/en/articles/2012/08/safr-a28.html http://www.wsws.org/en/articles/2012/08/safr-a28.html ENCA. (2013). Legalising taverns a headache. Retrieved from http://www.enca.com/south-africa/legalising-shebeens-headachehttp://www.enca.com/south-africa/legalising-shebeens-headache Center for Disese Control and Prevention. (2013). Fetal Alcohol Spectrum Disorders. Retrieved from http://www.cdc.gov/ncbddd/fasd/pastactivities-international.html http://www.cdc.gov/ncbddd/fasd/pastactivities-international.html