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Dr Muriel Newman

Time for More Action on FASD

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Last month the New Zealand Medical Journal published a Growing Up in New Zealand study outlining the disturbing finding that almost a quarter of women continued to drink alcohol during their first three months of pregnancy, despite knowing they were pregnant.

As a result of making that irresponsible choice to drink while pregnant, their children may be born with irreversible brain damage and other serious disabilities that make it impossible to lead a ‘normal’ life. 

When a pregnant woman drinks alcohol, it is quickly absorbed into her bloodstream, crossing the placenta, and reaching the baby. Since the foetus breaks down alcohol more slowly, higher concentrations in the blood are retained for longer, which can permanently damage not only the growing baby, but the placenta as well.

By the third week of pregnancy, alcohol consumption can have affected the development of the baby’s heart and central nervous system – by the end of the first two months, all of the baby’s major organs, the digestive, urinary and circulatory systems, along with the eyes, nose and mouth, and by 12 weeks, the skeleton and limbs.

Alcohol can also have a profound impact on the baby’s brain throughout the whole pregnancy as, when it metabolises, it releases substances that disrupt the proper establishment of healthy neural networks.

The lifelong physical, behavioural, mental and intellectual disabilities that can result from the exposure of a foetus to alcohol are known as Fetal Alcohol Spectrum Disorder (FASD). As well as abnormal facial features, small head size, shorter-than-average height, low body weight, vision or hearing impairment, and problems with the heart, kidneys, or bones, such children can have poor memory and coordination, attention difficulties, learning disabilities, speech and language delays, low IQ, poor judgment skills, as well as severe hyperactivity and behavioural issues.

While the links between birth defects and alcohol consumption during pregnancy were identified by scientists nearly 50 years ago, not only does New Zealand still have no FASD prevalence data, but according to the Ministry of Health, the true situation is likely to be worse than reported, since many women will not admit their drinking habits, and many, who don’t know they’re pregnant, continue consuming alcohol.

Overall, in spite of the clear advice from the Ministry of Health that women who are pregnant or are planning to get pregnant should not drink alcohol, the evidence suggests that one in two New Zealand pregnancies are alcohol exposed, with unplanned pregnancies at the greatest risk.

Internationally it’s estimated that up to 5 percent of people suffer from FASD. With around 60,000 live births a year, that means a staggering 3,000 New Zealand children could be born with FASD every year.

The effects of alcohol on a foetus can be fatal. A 2011 study by the US National Institute of Health revealed that heavy drinking in early pregnancy increases the risk of spontaneous abortion fivefold, and drinking any amount of alcohol during pregnancy increases the risk of stillbirth by 40 percent.

Alcohol also increases the risk of babies being born prematurely, and it contributes to Sudden Infant Death Syndrome, with such babies more than three times as likely to have had exposure to binge drinking prenatally.

In general, baby deaths during the first year that are associated with FASD are due mainly to malformations of the central nervous system, congenital cardiac abnormalities, sepsis, kidney malformations, and cancer. 

US research shows that in later life the attempted suicide rate for FASD sufferers is an astounding 22 percent, compared to the general population rate of 3 percent. This is most likely the result of behavioural issues and not “fitting in” to mainstream society. It is similar to estimates that young people with FASD are 19 times more likely to get into trouble with the law than others.

At a 2017 forum in Whangarei on the links between FASD and the justice system, Judge Catherine Crawford of West Australia, explained: “Children adversely affected by neuro-disability, resulting from alcohol exposure during pregnancy, are at an increased risk of committing crime or being a victim of crime. Such outcomes are doomed to be repeated when there is systematic failure to identify and appropriately accommodate their disability into adulthood.”

She spent a day in the local Youth Court, and reported that six of the 19 young defendants had been diagnosed with FASD. The actual incidence is likely to have been much higher.

Writing in the  Youth Court newsletter in 2017 on FASD and the youth justice system, Kesia Sherwood of Otago University’s Faculty of Law, recommended prioritising the development of a comprehensive diagnostic service for FASD throughout New Zealand, since a diagnosis represents the first step towards early intervention. 

She outlined how mothers of children affected by FASD experience an overwhelming feeling of relief, rather than shame or stigma, on finding out what is causing the “indescribable challenges” presented by their child. And she explained that while current disability laws provide support for disabled children, anyone with an IQ of over 70 is excluded. This means that many FASD sufferers, who may be “mentally disordered” and unable to cope, but have higher IQs, essentially have no support.

In her article, Kesia also identified a major problem facing society – the criminal justice system is based on people being able to learn from their mistakes and acknowledge the impact of their offending on victims and society in general, yet many FASD sufferers do not have the capacity to learn from their mistakes nor to acknowledge the consequences of their offending.

A well-known case of an FASD sufferer, who became a victim of the criminal justice system, is, of course, Teina Pora, who as a seventeen-year-old was convicted of the 1992 rape and murder of Susan Burdett. In spite of two trials, two guilty verdicts, and spending 21 years in jail, the conviction was quashed in 2015 by the Privy Council: “The combination of Pora’s frequently contradictory and often implausible confessions and the recent diagnosis of his FASD leads to only one possible conclusion and that is that the reliance on his confessions gives rise to a risk of a miscarriage of justice.”

When asked, if he was innocent why he confessed to the murder, Teina Pora said, “ I’ve never met Susan, I didn’t know her from a bar of soap… It was like getting interrogated … I just said whatever they were saying. I just said ‘yes’ and said ‘no’. I thought no was yes and yes was no back then. I just went along with it.”

Twenty-one years behind bars at a cost of over $300 a day, plus the $3.5 million given in compensation, amounts to over $5.5 million in the cost of one mis-diagnosed case of FASD.

While this is indeed an extraordinary incident, it does nevertheless expose the plight of those who are unable to cope because their mothers chose to drink alcohol while pregnant.

According to the Ministry of Health, FASD affects about 50 percent of children and young people in State care. This is similar to the situation in Canada for Indigenous children.

This week’s NZCPR Guest Commentator is Brian Giesbrecht, a retired Canadian Judge with over 30 years of experience in the provincial Court system, who has observed first-hand the devastating consequences of FASD. He explains that in Canada, at least half of the Indigenous children in State care are born with irreversible brain damage caused by mothers “who placed their own selfish drinking and drug taking ahead of their duties as parents”:

“The finding, that Indigenous child welfare wards are doing poorly as adults, will be met by cries of outrage from Indigenous advocates. Governments and agencies will be blamed. The public will be scolded. Demands will be made to reorganize and Indigenize child welfare services, increase government funding, again, and hold yet more inquiries.

“Put aside blaming the government, child welfare agencies, colonialism and residential schools, what we have is a fairly straightforward problem. Blame instead irresponsible parents drinking their children’s future away. There are no positive results to come from outraged blaming of others.

“Society’s indignant and self-righteous people continually give irresponsible parents exactly the excuse they need to keep on failing their children.”

So there we have it – in Canada, which recognised the problem of FASD almost 20 years ago, an experienced former Judge, who has heard every excuse under the sun, and has seen the dark side of every aspect of the welfare and criminal justice systems believes that parents are to blame for this serious problem and must be held accountable.

Here in New Zealand some professionals take a different view. A leading paediatrician in the area, Zoe McLaren says “we need to stop laying responsibility for FASD at the feet of the women”. She believes that women’s partners, health providers, alcohol marketers and society all carry responsibility for ensuring women do not drink alcohol while pregnant. In particular, she believes, “Health professionals and other service providers need to be supported to appropriately ask all women about alcohol use and advise women not drinking any alcohol is safest.”

With surveys showing that not all healthcare professionals have been up to the task of confronting women about the risk to their baby from alcohol, change is clearly needed.

The safety of a child should be paramount, and mothers must be made aware of the fact that this life-threatening FASD problem is preventable – as long as they understand that because everyone metabolises things differently, there is no safe threshold for drinking alcohol during pregnancy. 

It’s the same with smoking, although the health risks to a baby are better recognised. Since smoking a single marijuana joint delivers the same lung cancer risk as smoking 20 cigarettes, any woman who smokes cannabis during her pregnancy is deliberately passing carcinogenic chemicals through the placenta and into her baby. It’s the same with all other drugs – if a pregnant mother gets high, so too does her baby, with potentially permanent damaging consequences.

In other words, a loud and clear message should be sent out to women that they should not drink, smoke, or take drugs during pregnancy.

The cost of FASD to New Zealand is massive. In 2015 the Ministry of Health estimated the lifelong social and behavioural costs associated with the health system, mental health, substance abuse treatment services, welfare, the long-term care of individuals with intellectual and physical disabilities, and the criminal justice system, to be almost $700 million a year.

In addition, the annual loss of productivity from decreased participation in the workforce as a result of FASD, was assessed at up to $200 million.

If the ‘unseen costs’ associated with the social, health and financial impacts on family members, including alternative education, legal assistance, and medical assessments and interventions, the total burden of FASD on the New Zealand economy is likely to be in the region of $1 billion a year.

However, these figures are based on 2008 dollars and use the most conservative estimate of 1 percent of the population suffering from FASD. If the higher 5 percent estimate is used, the cost rises to over $5 billion a year.

Prime Minister Jacinda Ardern is well aware of the seriousness of this problem and the huge burden it places on society. In 2014, she said, “I feel quite strongly about this… We need to develop and implement an FASD plan that focuses on prevention, diagnosis, and a framework for support across health, social services and education.”

As the Prime Minister – and a new mother – she is perfectly positioned to make a real difference, especially with the first step, prevention.

In the US where avoiding alcohol has been the official recommendation since 1989, drinking during pregnancy is reported to have declined from around 21 percent to 12 percent.

While a high profile prevention programme will not reach everyone it has the potential to profoundly reduce the risk of FASD for 3,000 children a year – isn’t that a goal worth pursuing? 


Do you believe enough is being done to warn New Zealand women about the dangers of drinking alcohol while pregnant?


*Poll comments are posted below.


*All NZCPR poll results can be seen in the Archive.


Click to view x 120


This has been an ongoing matter for years yet seems to be on deaf ears and although Medical Operators and others advise the wrongs if they do not take notice (how far does one go if they will not listen?) perhaps a severe hit in the pocket to cover any charges may assist (why should the rest of us have to pay to clean up their stupidity). Marylin
I studied this topic 32 years ago as part of my Psych nurse training. The scientific and medical evidence was clear cut then. I remember writing a letter 20 yrs ago to the local paper. It wasn’t printed. Ignorance is bliss except for the brain damaged and the people who try and mediate or repair the damage. Nigel
I’m disheartened that the general population are undereducated about drinking while pregnant. Our personal responsibility is absolute but not if it’s obfuscated by faulty data and our nanny state health care system. Every pregnant woman’s visit to the doctor, midwife, plunket nurse, in-law is full of questions about drinking alcohol. The truth is that a glass of wine every week will not give a baby FASD, it takes copious amounts of alcohol – staggering levels that would only be taken by a woman who already had problems – not a middle class, relatively intelligent one. And what of prescription meds? Antidepressants are just as damaging to an unborn baby as a cigarette but we don’t vilify mothers for taking these. And what if expectant mothers that kill their babies via abortion? Are they better or worse than a mother who drinks? I suspect the problems with FASD are localised within small communities and ethnicities and that data would be able to be easily extracted if only we lived in a society where we could talk about it openly Randy
Did not know it was it was so bad. Why is Ardern not doing anything instead of worrying about a stupid plastic bag ban? She is a useless leftie. Monica
More can always be done, but then, how much should we be holding the hand in our over socialized state? Peter
No, but then there are some people in society that wouldn’t take heed in any case. Maddi
What it comes down to at the end of the day is very simple– it is called education. The problem is that mostly these problems exist amongst the Maori population and it is up to them to take responsibility for their actions . But what they do best is — as usual — play the blame game– and accuse the evil white colonialists to be the one and only source of their problems. The tribal elite has been paid Billions of tax payers money and they are responsible to deal with it. Obviously there need to be some more warnings to be issued to the people concerned, but this has to go hand in hand with a stern demand that it is not up to our social services to take responsibility for ever and that these settlement payments are plenty enough to cover their health issues. Michael
However most will still claim they did not understand and if they also suffer from FASD they may not, so just providing more warnings will not be enough. John
More needs to be done – eg- advice by doctors at surgery visits. Brian
Sale of alcohol in supermarkets should be banned also the advertising of alcohol in supermarket brochures. Mary
After all they are the ones who are ignoring the good advice and choosing to drink. Having said that there is always room for more and better advice for those who care to heed it. Laurel
I not sure about this but probably not as how can you get through to thicko women who drink when the are pregnant We need to have some system that punishes these women when the child is born Like make them give the child up for adoption to a couple who will give the child extra special care to make up stupidity of their mother Tough on the mother but it would sure get the message through to these ignorant and cranky women. Colin
Must be a major factor in keeping prisons and low IQ children Laurie
I don’t believe that the issue is about warning pregnant women about alcohol during pregnancy, because I believe that ALL pregnant women are already aware there is a danger. I believe the problem is that a large percentage of women are just “not going to be told what they should and should not do” during pregnancy. After all, as we have heard for so long now, it’s their body and they will do as they please. It is about taking personal responsibility, and also, as we know today, that is a thing of the past. I believe that every pregnant woman must sign an agreement that any costs relating to their child suffering FASD as a result of alcohol contamination during pregnancy will not be born by the health service. Neil
Quite a bit is being done but you have people that don’t care less about there own families, they only make a fuss when there’s something in it for them. Steven
After one failure to protect the foetus, tie the tubes Brian
I’d have to say “yes” to this poll question, because every doctors waiting room has the walls plastered with warnings of every kind. Having said that, I believe that there is a group of women in our society who have babies willy nilly with absolutely no regard to the future of their children. I’d be surprised if there were only 3000 babies a year born in NZ with foetal alcohol syndrome. The poor unfortunate babies will unhappily have a lot more adversity to face from their parents than FASD. I think that medical practitioners should have the absolute right and responsibility to insist on questioning pregnant women about their lifestyle and to make it very clear that alcohol and drug abuse of unborn children, is a significant criminal offence with serious consequences. If there is just a lot of fluffy waffling about recommendations then nothing will improve. Actions must have consequences – if not then we just have to build more asylums and prisons to accommodate societies unfortunates. Unless of course we really get tough and recommend abortion for damaged foetuses. Imagine the hullabaloo if such an effective solution was proposed. It is of course the only solution to the problem, as irresponsible baby makers are not open to sensible recommendations from anyone. Just saying … Dianna
I believe that women who drink when they know they are pregnant should be brought before the Courts. They are knowingly harming another person and possibly injuring them for life. Are they any different from Ben Stokes who allegedly beat up two other people? Tony
The article was all new news to me Warren
Why isn’t alcohol classified as a drug? – because it actually is one! Ted
What would work to reduce the incidents of fast, would be to offer $1000 to these druggies having kids to get sterilised. I know the wacky left would be having a nearcardiac episode at the thought, but look how much that would save the social services of this nation. Sam
If women continue to drink alcohol during pregnancy they are not fit to have families. John
It appears not. Such warnings are paramount but will such warnings be heeded by some individuals. That’s the worry. Barbara
The main driver of this problem is to much government intervention. That has led us to believe that personal responsibility is a thing of the past. Sure, put warning labels on bottles, even a picture of Teina, with the statement; my mothers drinking cost me 21 years of my life; might help, but at the end of the day, only PERSONAL RESPONSIBILITY will solve the problem.. A.G.R.
More effort needs to be made , to make ALL women aware of the effect. especially Maori and all the lower socially ecconomic women. Don
Getting pregnant is a responsibility and how stupid if the mother to be if she ignores the the pregnancy and continues doing things that will hurt the fetus. In this day and age there is ample advice, books, TV, organizations which suggest and provide. Think first, no worry later, and healthy babies. Elizabeth
Show videos of damaged children. Many people think it wont happen to them. Sheena
This problem is almost completely under the radar. More action must be taken as alcohol is so widely used and abused. Graeme
If there was as much exposure of this as there has been of the choice for Maori to join the Maori Roll that would go some way to keep the message out there. Something must be done. Bryan
An iceberg revealing moment. As a society we need to penalize those who knowingly choose to ignore or refuse to act upon medical advice. Robert
FASD statistics are frightening. Mark
You can always do more but surely everyone knows not to drink or smoke whilst pregnant. Keith
Try getting through to the one’s most vulnerable .It will be hard John
If enough was being done the problem would not exist! Paul
No need to spend a zillion dollars on this, the message has been out for many years. Medical professionals just need to be more insistent in stressing the dangers to patients Graham
It may well be an exercise In futility but we must find a way to get the message across. Lee
I never see any advertisements or warnings online or TV. Gerlinde
As far as education for FASD goes, it has obviously not yet reached the lowest common denominator YET. Geoff
Women in NZ already know everything, and have more benefits & rights than normal people. Pierre
Most people know that alcohol and drugs are extremely dangerous to a developing baby I knew that 60 years ago so what’s wrong with women today I guess they just don’t care Peter
When I was pregnant 40 years ago and when my daughter was pregnant 10 and six years ago we were bombarded with No Alcohol, No Smoking messages. Loud and clear. If you don’t listen, it is pointless is shout the message any louder. Ann
They are simply NOT LISTENING! Andy
A major health problem which the Govt et al are not addressing with anything like the seriousness demanded Russell
The responsibility for drinking while pregnant is fairly on the mother. If you drink and drive you are an idiot. If you drink while pregnant the chances are your child will be impared Jeff
There has to be some self responsibility. Sue
As it is common sense it should not be necessary,but Common Sense is far from universal. David
Getting the message through to Maori and other Polynesians would go a long way to solving the racial inequality ‘problem’. Let Chester Borrows know. Terry
Perhaps there should be more education from parents and perhaps in schools. Warning signs could be placed in bars etc. Frank
Its not rocket science, preganacy and alcohol and drugs don’t mix Robert
I have yet to see any publicity material. A comment or two on TV news has registered. Graeme
And to stay off drugs as well! Ross
Hammer the message home Kevin
Not enough is being done to warn people in general about the potential dangers of drinking alcohol – period. Medical research is progressively revealing the health dangers of consuming even moderate amounts of alcohol. Not everything we like is necessarily good for us. Graham
If the answer is no then what happened to personal responsibility. pdm
It will be a hard thing to police with the less educated people or those that know best Colin
The worst offenders will still continue to drink and breed. So sad for the offspring Bruce
The message has been out there for decades, sadly there is nothing that can be done with terminally stupid people who won%u2019t listen to advice. Max
The evidence is there, definitely not enough being done David
No – but as a male – who am I to say! Many males and females over indulge in alcohol from early ages creating a habit some (or many) have difficulty later in life pulling back from. Too many think drinking alcohol is ‘cool’ making it difficult to get the dangers of drinking across – very sad! Stuart
The figures speak for themselves – 3,000 children being born with such a condition is appalling. Much, much more needs to be done. Ted
Why hasn’t the Ministry of Health and governments prioritised this? It is beyond belief! Stuart
More certainly needs to be done in getting the message out. The cost of doing nothing is unacceptable. Jason
Responsibility for this dreadful situation lies to a great extent with medical professionals. They need to stress to women of child-bearing age the risk of brain damage for their baby if they drink while pregnant.  Mary
I don’t understand why I haven’t been aware of all of this before. Why don’t people talk about it as the major problem that it clearly is? Christopher