'Mind the gap': Observations in the absence of guidelines for alcohol abstinence among expectant women

Posted by: Kim Trollip

This policy brief, drafted by Dr Liezille Jacobs, Dr Nelia Steyn and Demetre Labadarios of the PHHSI research unit, examines the alcohol consumption policies of the National Department of Health’s approach to alcohol use in South Africa. In particular, it focuses on the food-based dietary guideline (FBDG) on alcohol promulgated by the Department of Health in 2001: ‘If you drink alcohol, drink sensibly.’ This guideline was re-evaluated in 2011 and the revised FBDG recommended that there should be no alcohol guidelines at all.

The evaluation processes for both meetings comprised an ‘expert working group’ on alcohol consumption and a literature search on alcohol consumption in South Africa with particular reference to alcohol’s known adverse impacts (when abused) and benefits (when consumed as part of one’s diet) on health.

There are many adverse effects of heavy alcohol consumption reported (for instance, risk to HIV infection, malnutrition and loss of employment). This brief, however, focuses on four adverse effects of alcohol abuse in relation to the burden experienced by South Africa, namely:

  1. high alcohol consumption levels;
  2. fetal alcohol spectrum disorders (FASD);
  3. health and psychosocial concerns;and
  4. social effects of alcohol abuse.

Having taken cognisance of the reported health benefits of moderate alcohol consumption and considering that alcohol abuse in South Africa is associated with major and significant adverse impacts on health and psychosocial conditions, the decision by the Department of Health not to include alcohol guidelines in the revised FBDGs is commendable. In lieu of the guidelines, a policy recommendation would be the need to focus on the subject of maternal health with a specific policy focus to address alcohol usage during pregnancy.

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Key recommendations for easy reference

This policy recommendation should also include the role of other stakeholders, such as the alcohol and media industries, to ensure comprehensive public education on the dangers of FASD. These recommendations should be seen within the broader context of current priority policies to improve maternal and child health in the country. This policy brief supports the removal of alcohol guidelines in the FBDG and recommends the following changes to the 2001 FBDGs on alcohol consumption:

1. Positive interventions should be made, particularly at community levels, to stop the system of alcohol for wages practised in some sectors of the economy. To this end, strong local monitoring systems by the Department of Labour and the Department of Health must be put in place. As good labour practice, it is imperative that employers do not use alcohol as remuneration. This is particularly essential for the winemaking and farming sectors. The Department of Labour and related workers' associations should monitor employer compliance in all sectors to ensure complete eradication of this system.

2. The Department of Health in conjunction with the Department of Social Welfare should implement more efficient monitoring systems of FASD-affected communities with particular reference to the Western Cape, where intergenerational FASD is reported. The Department of Basic Education should also contribute through school-based surveillance and monitoring of ECD (early childhood development) and young learners to collect data on symptomatic FASD. A more integrated approach to maternal health monitoring to include alcohol use monitoring should be part of basic healthcare for women presenting for antenatal care.

3. The limited but overwhelming evidence of public perceptions on the role of alcohol in society is a subject for further research. There should also be more focus on the impact of FASD on maternal and child health.

4. The liquor industry's role in explicit alcohol advertising without appropriate messaging for pregnant women should lead to interrogation of current regulations to ensure that strong public education campaigns are supported in communities with a history of alcohol abuse. In terms of campaign messaging, it is imperative that more investment is made in multimedia campaigns to promote safe pregnancy among women vulnerable to alcohol abuse. In particular, the alcohol industry and media industries' advertising campaigns promoting alcohol should include more visible and equally well developed and presented campaigns on the dangers of alcohol for girls, young women and expectant women. Such campaigns should be informed by evidence-based behaviour change and public health education messaging from the Department of Health.

5. Based on the evidence that FASD is a growing concern in South Africa, and the silence of the current guidelines on the well-documented adverse effects of drinking among women who become or are pregnant, it is recommended that the Department of Health should:

  • create and disseminate education materials and awareness campaigns for the public and promote service provider compliance with health safety messaging;
  • improve access to and encourage effective use of contraception;
  • identify women at risk for alcoholexposed pregnancy (AEP) for interventions;
  • implement strategies (counseling, for example) to prevent AEP in high-risk settings; and
  • establish and monitor FASD surveillance programmes to prevent alcohol use among women of childbearing age.

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