Protecting unborn babies from alcohol-related harm

Aboriginal women in Australia are taking the lead

March 2014

Alcohol and drug abuse during pregnancy can harm babies. It can also cause miscarriage, preterm birth, and stillbirth. If an unborn baby is exposed to alcohol it can be affected for life. Fetal alcohol spectrum disorders (FASD) is the umbrella term for impairments of the growth and development of the brain and the central nervous system caused by drinking alcohol during pregnancy. Aboriginal women in Australia have shown how communities can take action to protect their women and babies from alcohol-related harm in pregnancy.

The remote Fitzroy Valley in the Kimberly region of the north of Western Australia is renowned for its ancient reefs, huge boab trees, strong culture, and vivid art. The region is also home to about 4 500 Aboriginal people who are spread across 45 communities.

As in many disadvantaged communities around the world, alcohol abuse was common half a decade ago. The high consumption of alcohol resulted in high numbers of alcohol-related deaths and suicides, and widespread violence and crime.

Alcohol’s impact on the future

Prof Elliott examining an Aboriginal boy
WHO/J.Fitzpatrick

The most disturbing effect of the alcohol abuse, however, was the impact on future generations. In 2007, the Aboriginal communities in Kimberly recognized that many babies suffered from disorders associated with high rates of alcohol use during pregnancy. Signs of Fetal Alcohol Spectrum Disorders (FASD) may include physical deformities, mental retardation, learning disabilities, and behavioural problems with irreversible and lifelong effects on children’s development.

The high numbers of babies exposed to alcohol in pregnancy triggered Aboriginal women to sound the alarm and take action to protect their communities from alcohol abuse and alcohol use in pregnancy.

“FASD is a tragedy that somehow transcends other aspects of grief and trauma,” explains June Oscar, an Aboriginal leader and head of the Marninwarntikura Women’s Resource Centre in Fitzroy Crossing, the main town of Fitzroy Valley. “Here is innocent young life, the future of our people and all that goes with it – our culture, our language, deep knowledge of our creation and the laws of our country – being born into this world with brains and nervous systems that are so impaired that life for that person, from birth to death, is cruelly diminished.”

Limiting alcohol

Under June’s leadership, the Aboriginal communities successfully urged liquor licensing authorities to restrict the take-away sale of all alcoholic beverages but low strength beer in Fitzroy Crossing. After the restrictions were introduced domestic violence in the Aboriginal communities fell by 43% and alcohol-related presentations to hospital more than halved. The restrictions have since been extended indefinitely and taken up by some other rural communities.

An Aboriginal woman (left) educates women in the Wangkatjungka community about the harms of alcohol use during pregnancy
WHO/E. Elliott

Partnership addressing Fetal Alcohol Spectrum Disorder

Maureen Carter from Nindilingarri Cultural Health Services joined June and other community leaders to establish a partnership with clinicians and researchers from the University of Sydney Medical School and George Institute for Global Health to diagnose, treat and prevent FASD. In 2009, they agreed to conduct the first population-based study of FASD prevalence in Australia, the Lililwan Project.

The Lililwan Project looks at the scope of FASD and aims to provide each affected child with a personalized FASD management plan involving also their families, doctors and teachers. The project also educates the communities about the risks of drinking alcohol during pregnancy and about the challenges faced by children with FASD and their families. Multi-disciplinary teams of health workers travel and work together so that comprehensive care can be provided to children with FASD.

“The Lililwan Project is an example of the power of collaboration – between Aboriginal and non-Aboriginal people, clinicians and researchers, governments and philanthropists – to tackle a difficult and sensitive problem and to make a difference to children and families“, says Professor Elizabeth Elliott, an Australian paediatrician and a Chief Investigator for the Lililwan Project. Prof Elliott was also a member of the group of experts convened by WHO to develop the "Guidelines for the identification and management of substance use and substance use disorders in pregnancy". These guidelines are aimed at preventing and managing alcohol and drug use during pregnancy and reducing the associated risks for unborn children worldwide.

“Aboriginal people must take control. We can change what is happening in our communities,” emphasizes June Oscar. “When you read the next media piece of the suffering occurring in communities like ours, don’t think of us as victims. Rather, support us to be the architects of our future - a future in which every child has the right to be born healthy and to fulfil their potential.”

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