Despite clear scientific evidence that there is no safe amount of alcohol during pregnancy, Foetal Alcohol Spectrum Disorder (FASD) remains a persistent public health challenge in South Africa.
But why, if it is entirely preventable, are children still being born with it in every province across the country, asks Mokebe Thulo, CEO of the non-profit group Aware.org.za (Association for Alcohol Responsibility and Education).
FASD is often associated with rural or peri-urban communities, but the issue is far more widespread. Beyond medical risk, many women face complex realities including poverty, social pressures, misinformation about alcohol use during pregnancy, and healthcare systems that are often under strain.
In efforts to stem the problem and to strengthen prevention efforts, Aware.org is working with 20 000 pregnant women and healthcare professionals in public clinics to encourage early, non-judgmental conversations about alcohol use during pregnancy.
The question of why the problem is so widespread is one worth pondering. Not because the answer is complicated – and certainly not because the solution is simple, but because of what it demands of us.
There is no safe amount of alcohol during pregnancy. The science is unambiguous, the evidence has accumulated over years of research, and the required intervention is clear. So why does FASD persist?
At Aware.org, it’s a question with which we regularly grapple. FASD is often framed as a rural or peri-urban issue, but the reality is far broader. Across South Africa, many women arrive at pregnancy carrying far more than medical risk. They carry the weight of poverty, isolation, harmful cultural myths and norms, and healthcare systems that are often under-resourced and struggling to meet complex social and behavioural challenges.
In late 2025, Aware.org convened a national FASD Roundtable during World FASD Month in September. What quickly became clear in those discussions was that FASD is not only a public health issue but a societal challenge linked to patterns of alcohol use, social norms, and the broader environment in which pregnancy and alcohol intersect.
Across the sector, conversations about FASD are becoming more urgent. What is increasingly clear is that awareness alone will not shift the trajectory. Prevention must be embedded in the places where women access care and support.
For many women, that place is the public health clinic. Yet conversations about alcohol use during pregnancy are still inconsistent and are not always part of the routine care. In many settings, whether these conversations happen might depend on the time available to healthcare workers, the competing pressures within the busy clinics, limited awareness about FASD, and the absence of consistent screening practices that include asking whether a pregnant woman drinks or continues to drink alcohol.
It can also depend on the comfort levels of both practitioners and patients when navigating what are often sensitive and personal discussions about alcohol use.
This is where prevention needs to evolve. This year, AWARE.org will begin working with 20 000 pregnant women in public clinics and healthcare professionals to advance FASD education and early prevention conversations.
The goal is simple but critical: to ensure that women, their partners and families receive practical and non-judgmental information and if necessary, support, at the point it matters most.
Women who have participated in our FASD programme consistently report positive outcomes. Insights from our NextGen Mothers programme, delivered by Aware.org’s implementation partner School of Hard Knocks, show that around 95% of participants report improved emotional well-being, while a further 90% demonstrate increased knowledge of alcohol use during pregnancy.
These outcomes matter because they illustrate that when people feel supported rather than stigmatised, they can make different decisions.
With that said, the systemic gaps remain a reality to surmount, and they are specific. Despite the scale of the issue, FASD screening is still not consistently integrated into all antenatal care in South Africa. These gaps mean families often navigate the long-term consequences of FASD long after opportunities for prevention have passed.
We know FASD is preventable. We have the research to tackle it. What is still needed is the collective courage to act sooner, using what we already know, in our clinics, private care settings, classrooms, communities, and, most importantly, in the conversations we start today.
Our latest Annual Report highlights progress, challenges, and efforts to enhance FASD prevention in South Africa, detailing our programmes, partnerships, and community impact. Read the full report here.
See more from MedicalBrief archives:
Plea for more funding – not prison – to tackle Foetal Alcohol Syndrome
South Africa’s top’s world misery list in foetal alcohol syndrome
Effect on infants from mothers’ multiple substance use in pregnancy – SA study
Low level alcohol use during pregnancy can impact on child brain development