South Africa has the highest prevalence of Foetal Alcohol Spectrum Disorder (FASD) in the world, with roughly one in ten children living with the condition. In some South African communities, particularly in the Western Cape and Northern Cape, prevalence is even higher, nearly one in three and one in five, respectively.
Yet South Africa does not have a dedicated and coordinated national policy addressing FASD and its long-term consequences. Researchers argue that the country's response remains fragmented across health, education and social services, limiting prevention as well as support for people living with FASD.
The consequences of FASD last a lifetime, at a cost to families and our public healthcare sector. For instance, children with Foetal Alcohol Syndrome (FAS) or partial FAS, two severe diagnoses within the broader umbrella of disorders caused by alcohol exposure in the womb, require more healthcare visits and are at higher risk of stunting, intellectual disabilities and congenital heart defects.
In the Western Cape alone, a 2011 study estimated that FAS and partial FAS imposed an annual societal healthcare cost of approximately R597 million, using 2009 prices and exchange rates. Adjusted for inflation, that would be well over R1 billion today.
Yet every September, around FASD Awareness Day, public health messages about the disorders focus on the behaviour of pregnant women rather than the systems around them. Instead, we should be focusing on prevention and championing strategies that form part of a coordinated, national response.
“Information alone is not a prevention strategy,” says Kashifa Ancer, Project Lead for Rethink Your Drink. “We also have to ask what shapes behaviour around nutrition and alcohol use. Prevention cannot rest on individual choices alone. We need to look at the environments women live in and whether the systems around them make healthier choices possible.” This question sits at the centre of The First Home, an immersive experience hosted by Rethink Your Drink at Cape Town's Homecoming Centre on 9 September 2026.
Bringing together art, history, lived experience and policy, the exhibition asks visitors to look beyond individual behaviour and consider the environments that influence alcohol harm.
“Children don’t choose the environments into which they are born,” says Ancer. “If we want different outcomes for children, we have to be courageous enough to change what surrounds them.”
Rethink Your Drink works closely with Hold My Hand – a public campaign promoting the goals of the cabinet approved National Strategy to Accelerate Action for Children (NSAAC), urging a whole-of-society approach to protecting children and adolescents from all forms of abuse, violence, injury and harmful substances, which includes alcohol harms.
South Africa has learnt this lesson before
South Africa's response to HIV provides an important lesson in how public health prevention can evolve. Preventing mother-to-child transmission of HIV did not depend solely on telling individual women how to avoid transmission. A programme was built around women and their babies, combining HIV testing and counselling, antiretroviral treatment, maternal healthcare, infant testing and continued care and support.
The country recorded a 50% reduction in mother-to-child HIV transmission between 2008 and 2010, according to UNAIDS. National evaluations subsequently found that early transmission at four to eight weeks had fallen to 3.5% in 2010 and 2.7% in 2011.
The national approach to preventing vertical transmission continues to recognise prevention as a family and health systems issue, built around reproductive healthcare, treatment and care for women and their children.
“South Africa’s HIV response showed us that prevention improves when systems change, not simply when individuals are told to change,” says Ancer.
We can use these public health lessons in a coordinated, national approach to addressing FASD, alongside stronger alcohol regulation. The regulatory landscape must be tightened to reduce the availability of cheap liquor, increase the price of alcohol and restrict alcohol advertising, sponsorship and promotion.
The First Home takes place at the Homecoming Centre, Cape Town, on 9 September 2026, in recognition of International FASD Awareness Day. Tickets are available on Quicket.
www.rethinkyourdrink.co.za
Rethink Your Drink is an alcohol harms reduction campaign by the DG Murray Trust
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