Pregnant women who drink alcohol put their unborn children at greater risk than they think, writes Mia Malan.
Pregnant women who drink alcohol put their unborn children at greater risk than they think, writes Anna Crafford
Sanna Winston (37) had her first glass of wine — forced down her throat from a rusted enamel cup — when she was five years old.
“My stepmother used to drink a lot and my dad didn’t like that. She started making me drink full cups of wine too. She used to say: ‘If you tell your father I have been drinking, I will tell him that you drank as well, and then we will both get a hiding from him.’ So I kept quiet.”
Today Sanna has four children of her own — including an eight-year-old daughter, Francisca.
She lives on a wine farm near the Boland town of Wellington. Nearby are verdant vineyards and gunmetal grey mountains.
But Sanna lives in utmost poverty. With no income of her own, she has moved in with a much younger farm worker, whom she now somewhat disparagingly calls her “boyfriend”.
It’s not a happy union. But, as Sanna says: “My kids need a place to stay”.
“My boyfriend assaults me and gives me a hiding and then locks me out of the house. My child says: ‘He can’t hit me because he’s not my father.’ But the fact is that this young man provides for us, so we have to listen to him.”
The one constant in Sanna’s tumultuous life has been abuse. Her body is covered with the terrible evidence. Blue-black bruises throb across her face and head; welts from past knife wounds wind like worms in the flesh under her skin.
“All the people here ask me, ‘Sanna, why does your face look so bad?’ Then I reply: ‘I fell.’ They just shake their heads. They know I’m lying to them. But I can’t make my boyfriend’s name bad. He’s taking care of me,” she says.
A few years ago Sanna’s husband died in a pool of blood on the same wine farm where she now lives.
“He died drunk,” she whispers.
Sanna’s husband, too, mistreated her. But she’s always ready with an excuse for the men in her life.
“At least he never lifted his hands to me, gave me a black eye or hit me in the face. All he did was stab me with the messie [small knife] from time to time …”
But Sanna’s attempts at diluting the horrific truth are futile — even when she uses alcohol to drown the pain, a survival skill she learned from her stepmother, father, aunts, uncles and all her partners.
“If someone makes me angry or sad, I don’t know what to do, so I run to the bottle. I pour a drink and think about my problems — I’m soft and cry easily. Then, with the tears in my eyes, I drink and think,” she says.
Nearby, her daughter, Francisca, is talking to friends. Sanna stares at the girl. Tears swell in her eyes.
“I was drinking a lot when I was pregnant with Francisca. So bad that I lay on the ground drunk. Now I can see that her head is damaged.” Sanna sobs.
Francisca is suspected of suffering from foetal alcohol syndrome, or, more scientifically, foetal alcohol spectrum disorder (FASD).
She struggles at school. She can’t seem to get past grade two. She’s easily distracted, has a bad memory and is shorter than the other children in her class, even though she’s older than them.
Experts say children severely affected by FASD typically have low IQs. Physical aberrations include small heads and eyes that are narrow and set wide apart.
Such children sometimes shake uncontrollably.
“I feel very bad about what I’ve done to Francisca,” Sanna says. “If I didn’t drink with her in my stomach, she would have been a normal child today and might have gone far in life.”
But, at the time of her pregnancy, Sanna had no idea of what alcohol could do to her baby. For the first few months she didn’t even know she was pregnant.
It’s a scenario that Sharon Messina of the Women on Farms Project in Stellenbosch knows all too well.
“It’s not easy for the women to just forget about the alcohol. They want to stop drinking, but there are no support systems within their families and their communities to encourage rehabilitation. All the structures encourage and approve more drinking, because you are seen as an outsider if you don’t participate in the drinking parties,” she says.
According to Professor Dennis Viljoen from the Foundation for Alcohol Related Research (Farr) in Cape Town, FASD is the most preventable form of mental retardation worldwide.
“Alcohol disrupts the tissue formation of the foetus, particularly in the brain, to such an extent that you get severe neurological consequences,” he says.
South Africa has the highest FASD rate in the world. In Wellington 5% to 8% of all school-going children are affected.
But, says Viljoen, the highest rate of the illness on the globe is in the Northern Cape, in the town of De Aar, where 12% of grade one children suffer from FASD — almost double that of children infected with HIV in the area.
Viljoen says 60% of women with FASD children have a body mass index of less than 20, which means they’re abnormally thin. “If you’re a poor, malnourished woman, alcohol will affect your baby far more than if you are a well-nourished, middle-class woman. So poverty underpins this whole situation.”
A shebeen on the farm where Sanna lives ensures she and her fellow residents always have easy and relatively cheap access to alcohol.
The establishment is operated by the farm workers themselves and they’re all allowed to drink on credit.
Messina’s colleague, Leonora Sefoor, says since the so-called “dop system” — which thrived during the apartheid years and in which some farmers paid their workers with wine — was outlawed, farm workers across the Western Cape have created their own dop systems.
“Whereas before it was the white farmers that were exploiting the workers by making sure that they were in constant debt to the farmer, it’s now the workers who are harming themselves. When workers get paid, they end up paying their alcohol debt and the whole cycle begins again,” Sefoor says. Most women on the farms remain “totally ignorant” of the harm of drinking alcohol during pregnancy, she says.
South African law demands that liquor companies must place labels on their products warning consumers of the health problems associated with alcohol consumption. But Viljoen says this measure is largely ineffective.
“Many of the people living in affected communities are illiterate,” he says, slamming the labelling of alcohol containers as “an appeasement of government’s conscience”.
Viljoen applies the same argument to government pamphlets on FASD: “It makes little sense to distribute masses of literature to people who can’t read.”
The solution to South Africa’s FASD crisis, he says, lies in intensive, state-sponsored initiatives in affected areas that “speak directly” to people. This, he says, could be achieved by employing “reformed” individuals who’ve experienced the illness “first-hand” as mentors to discourage women from drinking while pregnant.
“It lies in increasing employment rates. Education and housing need to be bolstered. Contraception should be offered to all women so that they can plan pregnancies,” Viljoen says.
But for Sanna and the other women on her farm, employment and education are mere dreams.
Messina is convinced that until social conditions in FASD-afflicted areas improve and women have less reason to abuse alcohol, the incidence of the illness will only increase.
“Some [of the women] will tell you they have stopped drinking, but this will generally be only for a while. After that initial success the abuse will continue and to get relief they’ll start drinking again. It’s mostly a vicious circle,” Messina says.
Research shows that the risks of drinking alcohol while pregnant far outweigh prenatal exposure to tobacco and illicit drugs. In fact, alcohol is even more harmful to a pregnancy than marijuana, cocaine or heroin. This is because it is classified as a teratogen, a neurotoxin that can cause developmental disabilities, even severe brain damage, whereas drugs such as cocaine do not.
No amount of alcohol consumption during pregnancy is considered safe. Frequent drinking during pregnancy can cause mental handicaps, birth defects, brain damage, emotional and behavioural problems and defects relating to the heart, face and other organs. It increases the risk of premature birth or miscarriage.
Babies born to smoking mothers generally tend to have a lower birth weight and higher rates of illness and respiratory problems. Smoking while pregnant increases the risk of sudden infant death syndrome and birth defects to the heart, brain and face.
Experts recommend consuming moderate to low amounts of caffeine while pregnant. Some experts say 300mg of caffeine a day is safe, but others say pregnant women should not consume more than 200mg a day. A 2008 study found that women who consumed more than 200mg of caffeine a day had about twice the risk of miscarriage compared with women who did not consume any. A cup of coffee contains 90mg to 150mg of caffeine, a cup of tea 30mg to 70mg and an average bar of chocolate about 30mg.
Drugs such as aspirin or ibuprofen, which are safe under normal circumstances, can cause significant harm to a foetus. — www.merck.com, www.acshealth.org,ww.ucsfhealth.org, www.netdoctor.co.uk, www.prenatal-health.suie101.com, www.thepregnancyzone.com — Qudsiya Karrim
Mia Malan is Bhekisisa's editor-in-chief and executive director. Under her leadership, Bhekisisa’s online readership increased 30 fold and its donor funding eightfold between 2013 and 2019. Malan has won more than 20 African journalism awards for her work and is a former fellow of the Reuters Institute for the Study of Journalism at Oxford University.