September 9th has been globally acknowledged as Fetal Alcohol Spectrum Disorder (FASD) Awareness Day since Bonnie Buxton Brian Philcox and Teresa Kellerman first dreamed of this event more than twenty years ago. The ninth day of the ninth month has been chosen to represent the nine months of pregnancy. Over time the FASD Day theme has extended to the whole month of September to acknowledge the leading cause of preventable disability in the world.
Frequently, at this time, journalists contact NOFASD Australia seeking information about FASD. They are ever hopeful that we will be able to advise them about the “safe” number of drinks which can be consumed during pregnancy, so they can gleefully report this to their public. They also want to know exactly how many people in Australia are affected by FASD; often with a barely disguised opinion that it is an uncommon disability and happens mainly to women who are severely alcohol dependent.
To establish a safe number of alcoholic drinks during pregnancy would require thousands of women in all stages of pregnancy to consume measured quantities of alcohol followed by at least a ten-year monitoring of their children to confirm the presence or absence of FASD. Morally and ethically such research will never be undertaken.
To find out how many Australians have FASD would require a complete diagnostic screening for every Australian. An expensive and almost impossible logistical task. A representative sample study could be undertaken, and indeed has been completed in the USA and Canada. These international prevalence figures inform the Australian estimate of a FASD prevalence of at least 4% amongst the general population.
Any research which is undertaken inevitably points to far greater numbers of people being affected by FASD than was previously thought. Like tobacco smoking, research evidence over time indicates increasing cause for alarm about the harms to health caused by alcohol, in particular the risk of harm to children before they are born.
Animal research indicates that even small amounts of alcohol result in the risk of a FASD outcome. In short, all the recognised global research on alcohol and pregnancy indicates that any amount of alcohol potentially harms a child in-utero. We have no way of predicting the outcome, or preventing it, other than ensuring that women have the opportunity to experience healthy, well-informed, supported, alcohol-free pregnancy in a community which knows and understands alcohol risks.
Despite these hard facts, popular information sharing circulates myths about FASD which are not true but are often widely supported:
- “The placenta protects the fetus from toxins”
- “Only women diagnosed as ‘alcoholic’ have children with FASD”
- “Only women from low socio-economic communities have children with FASD”
- “Some types of alcohol are safe”
- “During the first trimester it is safe to drink alcohol”
- “During the third trimester it is safe to drink alcohol”
– All not true.
Other myths include the belief that FASD is an ‘Aboriginal problem’ when the reverse is true. Aboriginal people have led the way in recognising the harm caused by alcohol and many communities have rallied powerfully to address the issue.
The most brutal myth of all is that nothing can be done once FASD is present because the disability remains for life. This encourages comments like “why diagnose and cause shame to the family?” Is there any reaction more cruel, callous and dismissive of the universal declaration of human rights?
FASD cannot be cured but the evidence is rock solid that early diagnosis and intervention improves outcomes dramatically. Recognition of brain injury makes a great difference to the support and understanding an affected individual receives. Early identification reduces and prevents secondary conditions.
However, the favourite myth, shared widely, is “person x drank right through her pregnancy and the baby is fine”. A bigger variation on this theme is the observation that alcohol has always been present in societies and if it was harmful in pregnancy this would have been “known” earlier. Indeed, it was known earlier; historical records indicate that hundreds of years ago alcohol was recognised as harmful when consumed in pregnancy. In addition, there have always been people who were developmentally delayed or who struggled to learn and fit in. There have always been people who are easily led by others, anxious to please and unable to make good decisions. There have always been people with memory problems, compromised physical health, sleep disorders and any number of the nearly 400 conditions that have been experienced by people diagnosed with FASD.
At the time of birth FASD is almost impossible to detect, more than 80% of affected individuals have no physical signs of the disorder. This means that, as the child grows, the disorder is often mistaken for bad behaviour, poor parenting or a variety of other disabilities. Most children diagnosed with FASD have been previously diagnosed, incorrectly, with other disabilities including Autism Spectrum Disorder and ADHD. Therefore, a sigh of relief that a baby has not been affected by alcohol exposure based on the immediate birth outcome is premature.
As a nation, Australia is poised to implement pregnancy warning labels on all alcohol containers. In the light of this important step, and the research evidence, isn’t it also time to ensure that only the best advice and support is given to women who could be pregnant, would like to be pregnant or who are actually pregnant?
The message is clear, absolute and final: An unborn child should not be exposed to alcohol, from the moment of conception. It is time to move on from myths about alcohol in pregnancy and solve the problems which prevent alcohol-free pregnancies.
We don’t know how many car trips can be taken safely without a seatbelt – we just buckle up.
Written by Louise Gray, Chief Executive Officer of NOFASD Australia
Follow this link to read more about International FASD Awareness Day.
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