Should drinking during pregnancy be criminalised to prevent fetal alcohol spectrum disorder?

Gardner, Jillian

doi:10.7196/sajbl.2016.v9i1.468

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…The opinions expressed by these participants are consistent with the current policy discourses to re-contextualise and decolonise FASD policies and reframe the problem of FASD in a way that avoids victim-blaming [33]. This principle supports the argument that drinking during pregnancy should not be criminalised [39]. Rather, women with alcohol problems should be assisted.…”

Section: Discussionsupporting

confidence: 64%

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A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

Adebiyi

Mukumbang

Beytell

2019

BMC Health Serv Res

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BackgroundFetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa.MethodsWe applied a modified version of the World Health Organization’s approach to guideline development in three phases. In the first phase, we designed the initial guideline prototype. To do this, we conducted an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions for FASD. In phase 2, we refined the initially formulated guideline prototype through a discursive approach with seven local and international experts on FASD. Phase 3 involved refining the prototype using a modified Delphi approach. Forty-three and forty-one experts participated in rounds 1 and 2 of the Delphi approach, respectively. The acceptable consensus for each included policy statement was 85%.ResultsWe identified three aspects of the proposed guideline, which are the approaches and guiding principles, the prevention measures and the management measures. The guideline proposes that a FASD policy should consider lifespan needs, be culturally diverse, collaborative, evidence-based, multi-sectoral and address social determinants of health contributing to FASD. The essential components of FASD prevention policy consist of awareness and education of the dangers of drinking alcohol, access to treatment for alcohol problems and training of service providers. The management components include capacity building related to diagnosis, educating parents regarding the needs and management, appropriate referral pathways, training of teachers regarding classroom management and support for parents and individuals with FASD.ConclusionFASD in South Africa deserves urgent attention. Developing a specific policy to guide programmes could enhance and coordinate the efforts towards preventing and managing FASD. The guideline has the potential to assist policymakers in the development of a comprehensive and multi-sectoral policy for prevention and management of FASD, considering the consensus obtained from the experts.

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Section: Discussionsupporting

confidence: 64%

“…In developing the guideline for the prevention and management of FASD, we adapted the World Health Organization’s approach (steps) [38, 39], which we organised in three phases (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

Adebiyi

Mukumbang

Beytell

2019

BMC Health Serv Res

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“…Contrary to reporting alcohol use, report of illicit substance use or noncompliance with a treatment plan among mothers can result in rather severe legal consequences such as loss of child custody and incarceration in the U.S [17]. This is not the case with South Africa to date [18], and potential consequence of reported illicit substance use is assignment of case management by a social worker; however, stigmatization by healthcare professionals on prenatal illicit substance use [19] is potentially the reason of underreported illicit substance use in the current study. Due to low disclosure rate of illicit substance use among pregnant women, the combined verbal and urine screenings are recommended to determine the national prevalence of prenatal substance use; while, verbal screening only captures the prevalence of prenatal alcohol use.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, biochemical screenings do not necessarily demonstrate clinical efficacy nor may they be ethically acceptable due to the legal implications of prenatal substance use, at least in the U.S. [17]. Although a severely punitive approach such as loss of child custody does not happen in South Africa [18], fear of exposure to stigmatization by healthcare providers may increase under-reported substance and alcohol use among pregnant women when asked in healthcare settings [19]. A combined use of biochemical screenings with a standard self-report instrument (such as the Alcohol Smoking and Substance Involvement Screening Test; ASSIST) is encouraged for identifying substance use in pregnant women [17]; however, little international empirical evidence supports this notion so far.…”

mentioning

confidence: 99%

Validity Of Self-reported Alcohol And Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units In The Cape Metropole, South Africa

Williams¹,

Mathews²,

Jordaan³

et al. 2019

Preprint

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Background: This paper examines the validity of self-report of alcohol and other drug use in a South African cohort of pregnant women by comparing simple questioning about alcohol and other drug use (yes/no), a standardized screening tool (Alcohol, Smoking and Substance Involvement Screening Test; ASSIST, and urine analysis. Method: An observational study among women in eleven public prenatal clinics was conducted. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and substance use in dichotomous verbal screenings were asked to engage in screening using the ASSIST and urinalysis. Results: Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73-0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs 8.8% urine screening) with an overall predictive value of 50.0. Conclusion: Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy so that women can be identified and referred for appropriate interventions where needed.

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“…11,12 Discrepancies between self-reported rate of AOD use and biochemically verified use have been well documented, in which self-reported AOD use generally demonstrated low sensitivity relative to biomarkers, [13][14][15] in part due to fear of judgment. 16 Nevertheless, biochemical screenings do not necessarily demonstrate clinical efficacy nor may they be ethically acceptable due to the legal implications of prenatal substance use, at least in the U. S. 17 Although a severely punitive approach such as loss of child custody does not happen in South Africa, 18 fear of exposure to stigmatization by healthcare providers may increase under-reported AOD use among pregnant women when asked in healthcare settings. 19 A combined use of biochemical screenings with a standard self-report instrument (such as the Alcohol Smoking and Substance Involvement Screening Test; ASSIST) is encouraged for identifying substance use in pregnant women; 17 however, little international empirical evidence supports this notion so far.…”

Section: Introductionmentioning

confidence: 99%

Validation of simple dichotomous self-report on prenatal alcohol and other drug use in women attending midwife obstetric units in the Cape Metropole, South Africa

et al. 2020

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Background This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to engage in screening using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) and urinalysis. Results Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73–0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs. 8.8% urine screening) with an overall predictive value of 50.0. Conclusion Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed.

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Should drinking during pregnancy be criminalised to prevent fetal alcohol spectrum disorder?

Cited by 3 publications

References 25 publications

A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

Validity Of Self-reported Alcohol And Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units In The Cape Metropole, South Africa

Validation of simple dichotomous self-report on prenatal alcohol and other drug use in women attending midwife obstetric units in the Cape Metropole, South Africa

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