Global Perspectives on Fetal Alcohol Syndrome: Assessing Practices, Policies, and Campaigns in Four English-Speaking Countries.

Abstract

Abstract Maternal alcohol consumption during pregnancy places the fetus at risk for a number of neurological abnormalities and functional impairments. These deficits are 100% preventable by abstaining from alcohol use during pregnancy. Nevertheless, the worldwide prevalence of Fetal Alcohol Syndrome (FAS), the most severe outcome of prenatal alcohol consumption, is estimated at 0.97 cases per 1,000 live births (see May & Gossage, 2001). This paper examines awareness of the problem in Canada, the United States, the United Kingdom, and Australia along three dimensions: 1) the relationship between alcohol consumption rates and the incidence of FAS; 2) government action and policy creation; and 3) prevention/intervention initiatives and educational efforts. The extent of knowledge within each country affects, and is affected by, the level of research activity, the emphasis on policy creation, and the initiatives that drive educational efforts. At present, Canada and the U.S. have the highest levels of activity and a clear recognition of the problem. Activity in the U.K. and Australia is at the grass-roots level, although some promising movements toward greater public and professional awareness have begun. Alcohol is a legal and socially acceptable drug. The effects of alcohol on the user are widely known to the public. Decreased inhibition, loose muscle tone, loss of line motor coordination, reduced activity in the central nervous system, impaired reasoning, memory loss, and euphoria are just a few of the short-term effects of alcohol intoxication (Kuhn, Swartwelder, & Wilson, 1999). A potentially far more serious cost of alcohol consumption by pregnant women is much less well understood by the public. The Institute of Medicine (1996) has reported that alcohol produces the most serious neurobehavioural effects in the fetus, compared to other drugs, including heroin, cocaine, and marijuana. The consequences of prenatal alcohol exposure fall along a continuum, ranging from subtle neurodevelopmental and behavioural manifestations to Fetal Alcohol Syndrome, the most serious outcome of prenatal alcohol exposure. Recently, the term Fetal Alcohol Spectrum Disorder (FASD) was coined to encompass all the terms that describe alcohol-related defects, including FAS (Sokol, Delaney, & Nordstrom, 2003). Other terms, such as Fetal Alcohol Effects (FAE), partial FAS (pFAS), atypical FAS, alcohol-related neurodevelopmental disorder (ARND), and alcoholrelated birth defects (ARBD) describe other effects within the spectrum. For the remainder of this paper, reference will be made to FAS. Fetal Alcohol Syndrome is the single most preventable cause of birth defects (Bratton, 1995; Institute of Medicine, 1996) and is recognized by the World Health Organization (WHO, 1999) as the leading cause of environment-related birth defects and mental retardation in the Western world. It refers to a specific cluster of anomalies and developmental delays among children associated with the use of alcohol during pregnancy (Conry & Fast, 2000). Abel (1995) estimated that 4.3% of heavy drinkers give birth to a child with FAS. According to the United States Institute of Medicine (1996), a diagnosis of FAS requires a confirmed history of maternal alcohol exposure, evidence of facial dysmorphology (distinctive facial features), growth retardation, and central nervous system (CNS) dysfunction. Recent research employing magnetic resonance brain imaging techniques has revealed that FAS-related neurological deficits are uncorrelated with facial abnormalities (Bookstein, Sampson, Connor, & Striessguth, 2002). Consequently, a child without the distinctive morphological features may be as severely impaired in functional skills as someone with the full range of diagnostic criteria. Key Issues This paper examines the issues of alcohol and pregnancy, government policies, and awareness of FAS within four English-speaking countries: Canada, the United States, the United Kingdom, and Australia. …