Mentors helped Veronic Blom stop using alcohol and crystal meth when she was pregnant with her youngest son. Photograph: Kate Hodal for the Guardian
In a dusty township in South Africa’s sun-drenched wine country, Charay Afrika says only one thing helped numb her through a turbulent relationship and two pregnancies: alcohol.
She drank all day, every day, throughout her full-term pregnancies – unaware of the effect alcohol could have on her children.
Afrika was still at school when she met her first boyfriend, a man who would go on to beat her and rob her at gunpoint multiple times before she finally escaped him. “He’d beat me and lock me in the house with no food and then disappear for days,” Afrika, 28, says quietly. “I once had to drug him with sleeping pills so that I could call the neighbours and beg for help to sneak out. But he found me again and robbed me at gunpoint, and the whole thing started all over again. I drank as a way of escaping it all. I drank the whole time. I didn’t stop.”
Now eight years old and at school in Roodewal township, her eldest child has learning difficulties and behavioural problems – telltale signs of foetal alcohol syndrome (FAS), a condition under the broader umbrella of foetal alcohol spectrum disorder (FASD), which can manifest in birth defects such as brain damage, physical and mental impairments and stunted growth. It is directly caused by the mother’s drinking during pregnancy.
FAS affects more children in South Africa than anywhere else in the world: prevalent in 111 per 1,000 children, a rate 14 times higher than the global average of 7.7 per 1,000, according to the American Medical Association journal JAMA Pediatrics. But even this estimate may be lower than the true figure, say social workers in the Western Cape, as FAS is often a “hidden disability” that can affect a child in a number of ways, not all immediately obvious to parents or doctors.
“It’s a development issue,” says Sudene Jeftha, a social worker with FASfacts, an NGO based in Worcester. “You can’t necessarily see it when the child is born, only later when the child isn’t talking or crawling or walking like other children.”
The condition is endemic in the Western and Northern Cape, where high levels of unemployment, alcohol and substance abuse and teen pregnancies are intrinsic to daily life. In high-risk rural areas, up to 72% of school-age children are believed to suffer from FAS. Experts point to the 200-year-old dop system, in which Afrikaner farmers pay black and mixed-race workers in wine, or dop, as the primary cause of the regions’ high prevalence of alcoholism. Although the system was outlawed long ago, as many as 20% of vineyards are estimated to still pay their workers in wine, and binge-drinking in the Western Cape is a major health concern.
There is no concerted national health effort to tackle the issue, nor have there been any government studies to measure the socioeconomic impacts. But in a country where as many as six million people are thought to be affected by FASD and an additional three million are thought to have had foetal alcohol exposure, comparisons with other nations come in handy. In the UK, research has shown that it costs £2.9m to raise a child with FASacross their lifespan, while a Canadian study found that FAS youths were 19 times more likely to end up in jail than their peers.
A number of NGOs, including FASfacts, now run courses in at-risk communities to spread awareness of the condition, as well as “mentor mother” programmes, which rely on local mothers going door-to-door to speak to pregnant women about drinking. FASfacts, founded in 2002 by François Grobbelaar (an Afrikaner whose father used to pay his farmworkers in dop), claims this approach has helped reduce the number of pregnant women who drink by as much as 84%.
Veronic Blom, 33, drank and used tik (crystal meth) throughout her first two pregnancies. She was approached by one of FASfacts’ mentor mothers and stopped using both during her third pregnancy. Blom is now a mentor mother herself. “I smoked heavily – heavily – for the whole nine months of the pregnancy,” she says of her second child, now aged two. Making a rectangle with her thumb and forefinger, she indicates the size of a full gram of meth. “I’d smoke the full packet and smoke the whole day. I can only thank God he wasn’t born with any problems with his face.”
From the corrugated-iron shack in the Esselen Park township she shares with her two youngest children, Blom says the programme has changed her for the better. “I’m very talkative and I like to give back and speak to other mothers,” she says. “I usually tell them my own story so they know they don’t have to use their stories as an excuse: they can do better. The women are mostly keen to do better, but teenage pregnancy here is very common, you know, women selling their bodies to buy drugs or food.”
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