Securing a better future for Indigenous children
It’s a condition affecting communities and children worldwide. Fetal alcohol spectrum disorders (FASD) is an umbrella term that describes a range of conditions arising from prenatal exposure to alcohol, which can cause life-long damage to the brain. FASD is 100% preventable. However, the legacy of alcohol use during pregnancy - namely the number of children affected by FASD - remains largely unknown.
While FASD is seen in all populations, some Indigenous communities are struggling to cope with the number of children thought to be affected. For many families and communities caring for these children, life without adequate support becomes intolerable. The impact on Indigenous culture is particularly concerning, as many affected children lack the capacity to remember their traditional language, teachings and stories, and are unable to pass these on to future generations.
FASD is not a problem that is unique to Indigenous communities. But ... it may be this Indigenous community that shows the country - and the world - how we can deal with this condition and its tragic consequences.
Aboriginal and Torres Strait Islander Social Justice Commissioner
International studies suggest that rates of FASD are higher than those of Down’s syndrome and spina bifida, and that FASD is the most common cause of intellectual impairment. But our limited ability to diagnose FASD has meant that estimates in prevalence, particularly in Australia, are likely to be inaccurate because of under-recognition and under-reporting. What experts do know is that early diagnosis and intervention can provide support and improve quality of life.
Safe alcohol levels in pregnancy
There are no easy solutions to prevent FASD, especially as alcohol is widely used in many societies. In some countries up to 60% of women drink alcohol in pregnancy and although most will abstain or reduce their intake after realising they are pregnant, a significant proportion will continue to drink, some at high levels.
There is a lack of clarity in existing FASD research on whether there is a safe level of alcohol consumption in pregnancy, and what this level may be. This has lead to confusion for women and a dilemma for health professionals regarding the right message for their patients. What is known is that every woman responds differently to alcohol and that damage to the unborn child cannot be predicted. As a result, guidelines from the National Health and Medical Research Council of Australia recommend that not drinking alcohol is the safest option.
Changing attitudes – An Indigenous community leading the way
A small group of Indigenous women in Fitzroy Crossing – in remote north-western Australia – are finding their own approach to addressing the problem of FASD.
In 2007, their community took action to reduce the devastating impact of alcohol. Their decision to seek alcohol restrictions was a bold move that met with vocal opposition. But the success of this measure can be seen through a 50% reduction in hospital admissions, a 27% reduction in alcohol-fuelled violence, and a 14% increase in school attendance. By restricting access to alcohol and changing attitudes to alcohol consumption across the community, they have begun the fight against FASD.
Although prevention is the goal, the community has prioritised assessing and supporting children affected by FASD. As a result, Nindilingarri Cultural Health Services invited The George Institute and the University of Sydney to work with them to identify the number of affected children. The team will then work with the whole community, including parents, carers, health professionals, teachers and community members, on prevention and education programs.
The focus is on diagnosis, treatment, health service and research capacity in the community and increased awareness of the potential harms of alcohol use in pregnancy. The early stage of the study is underway, and will be followed by a comprehensive clinical assessment for all children, provided further funding is secured.
The strength of the Fitzroy Valley strategy to address FASD is that it is led by a strong Indigenous community committed to improving the lives of their children and future generations.