Prevalence of FAS is high in both Galeshewe and Roodepan, and the lack of prior diagnoses indicates that awareness remains low. The maternal mortality rate was especially high in Galeshewe. The unexpectedly high burden of FAS in an urban area with predominantly Black African population mandates extension of surveillance and intervention measures in southern Africa.

Photo-elicited interviewing (PEI) can make a valuable contribution to understand the lived realities of mothers raising children with foetal alcohol spectrum disorder (FASD), when used as a methodological tool. This article offers an explanation to some of the challenges experienced by these mothers who are often marginalised by a perception of causing wilful harm. PEI was used in a Master’s thesis that described the ways in which mothers promoted the occupational engagement of their children with FASD in the Pixley Ka Seme District in Northern Cape Province, South Africa. The study served as an example of how PEI shifted the power balance between the researcher and the mothers to create a space that encouraged mothers as participants to talk openly and freely about the challenges in their daily lives. PEI promoted the agency of participants and enabled the researcher to learn from them as experts in raising their children. The images discussed during PEI opened valuable doorways to conversation, helping participants prioritise what they want to share, while images acted as reminders during the conversation. Photographs added a visual layer to the verbal data gained through semi-structured interviews, offering a deeper level of insight into the contributions mothers make towards the development of children with FASD.

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