South Africa’s alcohol addiction and the disabled newborns paying the price

Venique Swartz with her one year old baby Nashrique, at their home in Avian Park.
FASD afflicts poorer communities where the dangers of drinking while pregnant are poorly understood. Venique Swartz says she did not drink while pregnant, but many do. - Barry Christianson

South Africa’s Western Cape is known for its dramatic coastlines and acres of wineland. But behind the blue skies and rolling hills, the province is grappling with a heartbreaking health crisis.

The area has the highest rate of foetal alcohol spectrum disorders (FASD) in the world – a group of debilitating and life-long disabilities caused when a mother drinks during pregnancy.

Whilst FASD affects about 0.7 per cent of the world’s population, in the Western Cape rates are as high as 31 per cent, and across South Africa, it’s estimated that 11 per cent of all newborns are affected each year.

Symptoms range from learning and behavioural problems, including low intelligence, lack of impulse control, and poor reasoning skills, to a more severe condition known as foetal alcohol syndrome, which leads to facial deformities, vision and hearing impairments, and severe organ damage.

Those with the worst forms of FASD have a considerably shorter lifespan than the rest of the population, rarely living beyond their mid-30s.

The economic consequences are significant, too. In the UK alone, FASD costs the taxpayer £2 billion a year in education, healthcare and productivity loss. It also places a heavy burden on the justice system; sufferers are 19 times more likely to end up in prison.

Venique Swartz with her one year old baby Nashrique, at their home in Avian Park
Avian Park is typical of the Western Cape neighbourhoods where alcohol takes its toll. - Barry Christianson

In South Africa, the economic and social impact of the condition is thought to be far greater, although no long-term studies have investigated this.

Many children with the condition struggle to finish school, live independently in adulthood, or engage in formal employment.

Avian Park on the outskirts of the farming town of Worcester – 90 minutes from Cape Town – is typical of the Western Cape neighbourhoods where alcohol takes its toll.

Heavy drinking and drugs are rife in the informal settlement of shacks. The neighbourhood is notorious for unemployment, gangsterism and shootings, and is another world from the picturesque nearby wine farms that attract European tourists.

Some residents get labouring jobs on farms or retail work, but unemployment is high. Farming is seasonal, leaving little income during the winter months.

“People drink every day. Beer, vodka, boxed wine. They drink everything. I can say 99 per cent of them drink every day,” says Rochelle Ntsimbi, a 22-year-old mother-of-one.

She herself began drinking at the age of 15 to impress her friends and her drinking got worse when her mother died soon after.

“It took me very hard. I had older sisters, but they didn’t care about me. Then I took it to high-level drinking. I was drinking a lot. I didn’t even care.

“When my mother died, I felt like I was alone, the person who was there for me was not there any more. I was like: ‘I am my own big person now, nobody can tell me anything any more’.”

Rochelle Ntsimbi with her 11 month old baby Thando at their home in Avian Park
Rochelle Ntsimbi with her 11 month old baby Thando at their home in Avian Park - Barry Christianson

She drank, partied and bunked off school.

She came to her senses when she realised she was pregnant and she stopped drinking, in part due to a local help group called FASfacts, which mentors young mothers and tries to keep them off alcohol.

Nathalene Jakobs was less fortunate. She was drinking heavily at the start of her third pregnancy, oblivious that she was carrying a child. At the time, during a weekend of partying and socialising, she drank two bottles of rum and a five-litre box of wine.

When her morning sickness kicked in and she realised she was pregnant, she stopped drinking, but it was too late. Her baby, Beronique, was only two months old when she became sick with a serious chest infection.

She said: “I went to hospital and they told me the baby had got too much alcohol and they sent me home. About a week later, the baby passed away. She just stopped breathing.”

Jakobs has recently given birth to her fifth child, a boy called Bertrum, and admits she drank during his pregnancy too, though not as heavily as before.

“It was stress. Me and my husband were arguing a lot because he didn’t have work,” she said.

Nathalene Jakobs with her four month old baby Bertram at their home in Avian Park
Nathalene Jakobs with her four month old baby Bertram at their home in Avian Park - Barry Christianson

There is currently no data on how much alcohol causes FASD, although experts agree that the more consumed, the more likely a child will be born with the disorder.

According to the WHO, even drinking as little as 30 grams – or three drinks – on more than one occasion during pregnancy is enough to cause permanent disability to your child.

Dr Leana Olivier, CEO of the Foundation for Alcohol Related Research (FARR), based in the Western Cape, attributes the severity of the issue in South Africa to a combination of factors.

The country grapples with a pervasive binge-drinking culture, with 60 per cent of alcohol consumers classified as binge drinkers nationwide.

Within the Western Cape, up to 40 per cent of women of child-bearing age consume two to nine alcoholic drinks on weekends, research has shown.

“In all the studies we’ve done, when we ask what sensible drinking means, nobody knows. They say we drink until we tip over, and if I don’t drink, I’d be the only one in my circle not drinking,” said Dr Olivier.

In many townships like Avian Park, drinking whilst pregnant isn’t taboo. “Often, pregnant women don’t want to feel like the odd one out – people will be confused as to why they aren’t drinking,” explained Dr Olivier.

Experts attribute much of this behaviour to the legacy of South Africa’s now-abolished ‘dop system,’ a 200-year-old tradition in which farm workers (mainly Black or mixed-race) were paid for their work in wine.

A vehicle belonging to the organisation FASfacts parked in Avian Park
A vehicle belonging to the organisation FASfacts parked in Avian Park - Barry Christianson

Through this system, drinking became a part of daily life – and a coping mechanism to endure the harsh, often slave-like conditions on the vineyards.

The practice was outlawed in 1960 but the ban was not properly enforced until the 1990s under Nelson Mandela, leaving behind a culture of binge drinking in disadvantaged communities.

Even today in the Western Cape, where the majority of South Africa’s vineyards are located, some claim that as many as 20 per cent of farm workers are still paid partially in alcohol.

“When the dop system became illegal in the 1990s, we were supposed to get a sharp decline in the FASD rates – but that didn’t happen,” noted Dr Olivier.

“The system created a legacy of drinking, but drinking is a much larger part of our history in South Africa.”

And there is a lot of booze to go round. During the apartheid era, a ban on alcohol consumption for Black South Africans led to the rapid development of shebeens – illegal liquor outlets scattered across the country’s townships.

These shebeens still exist and are thriving, making alcohol “so freely available that sometimes it’s easier to access than fresh milk,” said Dr Olivier.

There are anywhere between 20,000 to 30,000 illegal shebeens in the Western Cape province, according to the local government. Not only does the alcohol content of wine, beer, and spirits tend to be higher than in licensed liquor stores, but it is also significantly cheaper.

The beer sold at the shebeens is often home-brewed, which makes it more potent. Sellers also add stronger substances to the beer, like spirits.

And they continue to adapt. In recent years, locals have begun to operate mobile liquor outlets, run out of the backs of cars and trucks.

Sellers drive around rural farms, where workers may lack access to transportation and will leave alcohol in the vicinity, returning later to collect payment.

Even if the worker didn’t initially want to drink, leaving the booze with them for a week often leads to consumption, says Dr Olivier.

Venique Swartz, Rochelle Nstimbi, Nathalene Jakobs
FASD recoverees Venique Swartz, Rochelle Nstimbi and Nathalene Jakobs - Barry Christianson

In a culture where alcohol is readily available, drinking also becomes a way of coping.

“Many of these women find themselves in a hopeless situation,” said Dr Olivier. “They tell us that to cope with the day, they have to drink because that helps them carry on with their lives.”

Dr Philip May, a research professor at the University of North Carolina, conducted a study that found domestic violence was far more common among mothers of children with FASD.

These women were disproportionately subjected to abuse, including physical assaults such as choking, burning, threats with weapons, and enduring beatings.

“We have a very violent society in South Africa, and what we find is that many of the women who are subjected to violence in the home may drink to escape,” agreed Dr Marelene De Vries, FASD researcher at The University of Stellenbosch.

The country’s high rate of unplanned pregnancies, currently at around 60 per cent, also plays a role: women may not know – or perhaps are in denial – that they are with child.

In one study, women from the Delft township just south of Cape Town described continuing their usual activities, such as going out with friends, partying, clubbing, and drinking, despite being pregnant, feeling a lack of connection or responsibility to their unborn children.

Others drank in the hopes their child wouldn’t survive.

Experts stress that, without proper support for both the mothers and children with FASD, the problem is not likely to go away anytime soon.

Despite multiple NGOs offering counselling and support for expectant mothers, the South African government has not introduced any widespread initiatives to tackle FASD at a national level.

As a starting point, Dr De Vries called for a ban on shebeens, better education of mothers and increased screening of alcohol intake at antenatal clinics.

She said: “We cannot expect to solve FASD by offering haphazard, unsustainable, and insufficient services.”

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