The Eastern Cape has the highest reported rate of fetal alcohol spectrum disorder in the world.
The Eastern Cape has the highest reported rate of fetal alcohol spectrum disorder in the world. (Madelene Cronje)

One out of every ten Grade 1 learners in some parts of the province have been born with the consequences of their mothers’ drinking during pregnancy.


Many Eastern Cape women start to drink alcohol at ages as young as ten years old and the area now has the highest reported rate of fetal alcohol spectrum disorder (FASD) in the world, according to research released by the Foundation for Alcohol Related Research (FARR). Thirteen percent of Grade One learners in the Nelson Mandela Bay areas of Bethelsdorp and Helenvale have been diagnosed with FASD. 

“In many cases the day on which the women we interviewed were introduced to alcohol, was also the day on which they began drinking regularly. It shows that there is a high level of acceptance of alcohol in the community and that it is not frowned upon,” says FARR’s head, Leana Olivier.

Research has shown that up to three quarters of pregnancies in South Africa are unplanned or confirmed late which can result in women drinking alcohol without knowing that they’re pregnant. 

Previously, De Aar in the Northern Cape was thought to have the highest rates of FASD with a prevalence rate of 12.2%, based on studies conducted in 2002. 

According to the United States’ Centre for Disease Control FASD “are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy” resulting in mild to severe consequences such as stunted growth, intellectual disabilities, abnormal facial features, vision and hearing problems as well as problems with the heart, kidneys or bones.

“What this research also proves is that high rates of FASD are not only found in rural areas, impoverished communities and amongst older mothers as previously thought,” says Olivier.

“We found extremely high rates in urban areas, among young mothers and not limited to any specific socio-economic group.” 

Olivier says the “dilemma” is worsened by the fact that many of the women involved in the research were not aware of the risks posed to their babies from drinking alcohol while pregnant.

“There were moms who had never even heard about these dangers and were absolutely devastated to find out the consequences of their alcohol use on their children,” she says.

Alcohol an only resort for some
Some women however were aware of the “possible risks”, but she says, “their living circumstances are sometimes so terrible they see alcohol as the only way to survive – they use it to self-medicate and to escape their desperate conditions”.

According to FARR the research only identifies the problem and further “inter-departmental action” is required to support children affected by FASD who have specialised health, social and education needs which are often unavailable. 

The FARR study was commissioned by the Eastern Cape Liquor Board in 2013, funded by the South African Breweries, and will continue to 2017. 

The organisation has trained 182 foundation phase educators in the area on how to manage the particular needs of children with FASD in the classroom and provided 70 local social workers with “awareness and prevention training, equipping them with the necessary skills and knowledge to incorporate into their day-to-day service delivery”.

South Africa has been at the “forefront” of FASD research on the continent, even though studies have largely only been conducted in the Western, Northern and Eastern Cape provinces, but FARR has plans to extend their research to the rest of the country starting with the Free State towards the end of this year. 

“As for the rest of the continent,” Olivier says there is “almost nothing” with regards to FASD research. 

“All the figures quoted for the region rely on research done in South Africa, particularly in the Cape, so there is an urgent need to assess the problem in other countries on the continent.”

The available research on the extent of FASD is mostly from developed countries with much lower rates. For example, in Canada, there is an average prevalence of 1%, according to the World Health Organisation. 

But Olivier says that the situation for developing countries is confounded by a lack of specialised services for children affected by FASD and a “culture of drinking” coupled with “a lack of education about the consequences”. 

“In many communities excessive alcohol consumption is so normalised that it’s extremely difficult to break these barriers – to say that absolutely any drinking during pregnancy is not okay. This can be a hard message for some to take on.”