South Africa has one of the highest rates of Foetal Alcohol Spectrum Disorder (FASD) in the world, with roughly one in 10 children estimated to be living with the condition.
In some communities, the numbers are even more alarming. Prevalence is estimated at nearly one in three children in parts of the Western Cape and one in five in parts of the Northern Cape.
Yet despite the scale of the crisis, South Africa does not have a dedicated, coordinated national policy focused on preventing FASD and addressing its lifelong consequences.
A fragmented response
Researchers and public health advocates say the country’s response remains spread across the health, education and social development sectors, making it difficult to establish a comprehensive approach to prevention, early intervention and long-term support.
FASD refers to a group of conditions caused by alcohol exposure before birth. The effects can last a lifetime and may affect learning, behaviour, intellectual development and physical health.
Children diagnosed with Foetal Alcohol Syndrome (FAS) or partial FAS – among the more severe conditions within the FASD spectrum – can require more frequent healthcare and face an increased risk of stunting, intellectual disabilities and congenital heart defects.
The impact is not limited to families. It also places a significant burden on the public healthcare system.
A 2011 study estimated that FAS and partial FAS cost society approximately R597 million annually in the Western Cape alone, based on 2009 prices and exchange rates. Adjusted for inflation, that figure would exceed R1 billion today.
Beyond blaming pregnant women
With September marking FASD Awareness Month and International FASD Awareness Day, public health messaging often focuses heavily on the behaviour of pregnant women.
Rethink Your Drink Project Lead Kashifa Ancer argues that this approach is too narrow.
“Information alone is not a prevention strategy,” Ancer says.
“We also have to ask what shapes behaviour around nutrition and alcohol use. Prevention cannot rest on individual choices alone. We need to look at the environments women live in and whether the systems around them make healthier choices possible.”
That approach is at the heart of The First Home, an immersive experience hosted by Rethink Your Drink at Cape Town’s Homecoming Centre on 9 September.
The exhibition combines art, history, lived experience and policy to examine the wider environments that contribute to alcohol-related harm.
“Children don’t choose the environments into which they are born,” Ancer says. “If we want different outcomes for children, we have to be courageous enough to change what surrounds them.”
Lessons from South Africa’s HIV response
Advocates say South Africa’s experience in reducing mother-to-child transmission of HIV demonstrates what can happen when prevention is treated as a broader health-system responsibility.
The country’s HIV programme did not rely solely on educating individual women. Instead, it brought together HIV testing and counselling, antiretroviral treatment, maternal healthcare, infant testing and ongoing care and support.
According to UNAIDS, South Africa achieved a 50% reduction in mother-to-child HIV transmission between 2008 and 2010. National evaluations later found that early transmission had fallen to 3.5% at four to eight weeks in 2010 and 2.7% in 2011.
For Ancer, the lesson is clear.
“South Africa’s HIV response showed us that prevention improves when systems change, not simply when individuals are told to change,” she says.
Calls for a national FASD strategy
Rethink Your Drink argues that a similar coordinated approach should be considered for FASD, alongside stronger regulation of alcohol.
This could include measures aimed at reducing access to cheap alcohol, increasing the price of alcohol and placing tighter restrictions on alcohol advertising, sponsorships and promotions.
The organisation also works with Hold My Hand, a public campaign supporting the goals of the Cabinet-approved National Strategy to Accelerate Action for Children (NSAAC).
The strategy promotes a whole-of-society approach to protecting children and adolescents from abuse, violence, injury and harmful substances, including alcohol-related harm.
The First Home will take place at the Homecoming Centre in Cape Town on 9 September 2026, in recognition of International FASD Awareness Day.
