USA: The Crisis of Fetal Alcohol Syndrome
The USA is facing a crisis of fetal alcohol syndrome (FAS) with the rising level of addiction in the country. Despite this, political action to end FAS and other alcohol harms has been lacking across governments in the country.
The main fetal alcohol program at the federal mental health agency was discontinued in 2015. Since then there has been no constituency organized enough to get fetal alcohol syndrome back on the national agenda. The harm from FAS is however grave for the country causing billions of dollars, straining the criminal justice system, tearing up families — and causing disabilities that are largely preventable.
One study found in four communities in the United States, the estimated prevalence of fetal alcohol spectrum disorders (FASD) among first-graders ranged from 1.1% to 5.0%. According to a global study, the estimated global prevalence of FAS in the general population was 14·6 per 10,000 people.
According to data from the Centers for Disease Control and Prevention (CDC),
- 1 in 9 pregnant women consume alcohol and out of them one-third report binge alcohol use.
- Tens of millions of children and adults have lifelong impairment from FAS or FASD.
- The cost of health care, disabilities services, special education and related programs amounts to $4 billion a year.
Despite this alarming data, alcohol use in pregnancy and FAS has had no political backing to make it a priority, for example compared to the political attention (rightly) paid to the opioid crisis.
The forgotten crisis
Public health officials cite several reasons for why the alcohol during pregnancy and the FAS and FASD crisis is overlooked in the country.
- Intense stigma on pregnant mothers with alcohol problems,
- Alcohol being widely used,
- Lack of consensus on diagnostic criteria for FAS and FASD, and
- Under-reporting of FAS and FASD.
Currently, programs for fetal alcohol syndrome get about $30 million a year in federal funding, mostly for research. The current government’s fiscal 2021 budget proposal released this month slashes the National Institute on Alcoholism and Alcohol Abuse (NIAAA) – the main agency doing research on alcohol addiction and fetal alcohol syndrome – by 10%.
There is no major well-funded advocacy group for FAS and FASD like for other disabilities and diseases. Groups such as the National Organization on Fetal Alcohol Syndrome and FASD Communities are mostly made of up parents with children who have FAS or FASD.
The diagnostic criteria and treatment tools are outdated. In the the NIAAA, researchers are trying to develop new criteria and neurobehavioral screening tools to detect FAS, with an emphasis on early intervention. Work is being done on developing 3D ultrasounds that could detect alcohol exposure in utero, or on blood biomarkers to measure exposure. But none are ready for prime time.
The little progress achieved for FAS and FASD treatment and care comes mostly from efforts of dedicated parents with kids who have FAS or FASD, and not the government.
FAS is a serious condition which can be prevented with the right mix of population-level policy as well as information and awareness to parents and the broader public. As alcohol use disorder is growing in the United States, the federal government needs to urgently bridge gaps in prevention, treatment and care for this condition.