Table 4 A proposed guideline for policy on the prevention and management of FASD.

Overall guiding principles of the policy

The panel agreed that policy to inform the prevention and management of FASD should

• Be holistic, considering the prevention, diagnosing and management of FASD.

• Consider the individuals with FASD and their caregivers.

• Involve all relevant government departments such as the departments of health, education, justice, social development, trade and industry, labour.

• Consider the needs of individuals with FASD throughout their lifespan.

• Involve the collaborative action of various professionals (social service, justice and healthcare); healthcare professionals from the doctors, midwives, nurses, to the community healthcare workers.

• Be holistic, considering the prevention, diagnosing and management of FASD.

• Adopt a human rights-based approach, which protects and promotes the rights of women, children, families and communities affected by FASD and recognises the principles of non-discrimination, participation, inclusion, equity and access.

• Adopt a public health framework, which acknowledges drinking during pregnancy and FASD are part of a complex interplay of biological, social, psychological, environmental and economic factors.

• Be culturally diverse and culturally sensitive, acknowledging the importance and strength of cultural values and norms.

• Use relevant and current evidence to inform practice and interventions to strengthen the knowledge base to effectively prevent and manage FASD.

• Establish clear referral pathways for the effectiveness of the prevention and management FASD

• Avoid victim blaming that is placing women at the centre of the FASD problem, which will not consider them as the perpetrators of the problem.

• Consider cost-effective interventions, which encourages a population-wide approach and enhances a wider coverage.

• Be family-centred, service providers must acknowledge and value the need for individuals within the family structure.

• Address social determinants of health contributing to FASD.

• Consider input from individuals with FASD and their families in developing a policy for the prevention and management of FASD.

• Promote responsible parenting, which recognises human values and enhance the development of individuals with FASD.

FASD prevention measures

Education-related prevention measures for FASD

The panel agreed that an FASD policy on education-related prevention should contain strategies to

• Increase awareness of the dangers of drinking alcoholic beverages during pregnancy in educational settings.

• Assist individuals with alcohol-use problems in educational settings to access treatment.

• Address the barriers to access treatment for alcohol-related problems in educational settings.

• Address stigma associated with alcohol abuse in educational settings.

• Improve training of teachers on FASD prevention/awareness programme.

• Facilitate the development and implementation of FASD awareness programmes in educational settings.

• Facilitate the use of peer education for FASD awareness programme in educational settings.

• Promote healthy lifestyle in schools through sport and other extra-curricular activities.

• Discourage the establishment of the liquor stores in the proximity of educational settings.

• Promote the education of young individuals about healthy pregnancy in educational settings.

• Facilitate the teaching of responsible parenthood in educational settings.

• Improve the teaching of safe sex practices in educational settings.

Health-related prevention measures for FASD

The panel agreed that an FASD policy on health-related prevention should contain strategies to

• Improve the screening of alcohol use in clinics and hospitals.

• Improve documentation on the alcohol history for women, especially pregnant women.

• Facilitate the inclusion of FASD prevention as a part of health promotion activities in clinics and hospitals.

• Improve the education of individuals and couples on the dangers of drinking alcoholic beverages during pregnancy in the pre-conception clinic.

• Improve the education of individuals and couples on the dangers of drinking alcoholic beverages during pregnancy in the reproductive clinic.

• Encourage the use of visible posters and pamphlets for FASD prevention campaigns in all clinics and hospitals.

• Improve the training of healthcare professionals on FASD prevention.

• Improve early and appropriate referral to treatment for individuals (including women) with alcohol misuse issues.

• Empower health professionals with the skills to counsel and ask questions about alcohol use in a safe and appropriate way.

• Promote the use of contraceptives to avoid unplanned pregnancy.

• Improve assistance to parents of individuals with FASD to avoid having another child with FASD.

Community/social-related prevention measures for FASD

The panel agreed that an FASD policy on community-related prevention should contain strategies to

• Improve education and public awareness of the dangers of alcohol abuse.

• Improve the education of all people in the community on the dangers of drinking alcohol during pregnancy.

• Improve the education of individuals and couples on the dangers of drinking alcohol during pregnancy in the community.

• Encourage the use of community groups for FASD prevention (education and awareness).

• Improve the training of the community health /community-based workers and youth care/social workers on FASD prevention.

• Facilitate early intervention and assistance for individuals with alcohol-use problems in the community.

• Facilitate the creation of social programmes such as skills training and empowerment programmes for women in the community.

• Improve awareness and education on FASD in the workplace, rural and urban areas and farming communities.

• Promote the use of multimedia such as posters, adverts, pamphlets, TV, social media and road shows for FASD awareness in the communities.

• Improve enforcement of liquor laws and regulation of shebeens to control accessibility and availability of alcohol in the community.

• Improve access to treatment for people with alcohol use problems in the community.

• Improve smooth aftercare and community reintegration for people who have attended alcohol rehab.

• Promote afterschool activities in the community to prevent early exposure of adolescents to alcohol.

• Mandate labels on alcohol containers to contain information on the dangers of drinking alcoholic beverages during pregnancy.

• Mandate that liquor stores have warning signs regarding alcohol and pregnancy.

• Enable the creation of support groups for individuals with alcohol misuse issues in the community.

• Facilitate the training of the community and religious leaders on FASD prevention.

• Promote collaboration and the use of non-profit organisation (NPO) for FASD prevention.

• Utilise the community and religious leaders to increase FASD awareness among their communities.

• Promote the expansion and adoption of NPO evidence-based interventions for prevention in the community.

• Improve assistance to families to support individuals with alcohol use problems.

• Improve interventions services for mothers who have a child with FASD in the community.

FASD management measures

Education-related management measures for FASD

The panel agreed that an FASD policy on education-related management should contain strategies to

• Facilitate the development of a curriculum that accommodates individuals with FASD.

• Improve the training of teachers on classroom management for individuals with FASD.

• Promote skill schools for learners with learning disabilities (including individuals with FASD) that are not benefiting from formal education.

• Provide special assistance for individuals with FASD within mainstream schools.

• Facilitate the creation of the special schools for learners with a learning disability (including individuals with FASD) that are not benefiting from mainstream schooling.

• Facilitate the education of parents on the needs and management of individuals with FASD.

Health-related management measures for FASD

The panel agreed that an FASD policy on the health-related management should contain strategies to

• Increase capacity building re diagnosis among health professionals.

• Facilitate FASD screening for all children that are known to have been prenatally exposed to alcohol.

• Provide diagnostic services for individuals.

• Promote diagnosis for school children, adolescents and adults to reduce rates of people who are left undiagnosed or misdiagnosed.

• Promote appropriate referral pathways to services after diagnosis.

• Facilitate the creation of diagnostic centres in clinics, hospitals and communities.

• Facilitate the creation of national surveillance for FASD via reports from health professionals.

• Encourage routine consideration of FASD re the diagnosis and management of mental illness and developmental disorders.

• Provide integrated medical services for individuals with FASD.

Community/social-related management measures for FASD

The panel agreed that an FASD policy on the community-related management should contain strategies to

• Provide skills training and empowerment programmes for those who need it among individuals with FASD.

• Facilitate appropriate employment opportunities for individuals with FASD.

• Facilitate the training of community health workers/community-based workers/ youth care workers/ social workers and professionals within the judiciary system re FASD management.

• Improve the training of the biological and foster parents/caregivers regarding the management of FASD.

• Promote the empowerment of the parents/caregivers of individuals with FASD in the community.

• Promote the establishment of support systems for biological and foster parents/caregivers and individuals with FASD in the community.

• Promote the referral of parents and individuals with FASD to appropriate services.

• Provide effective counselling services for parents and individuals with FASD.

• Encourage family/community support for individuals with FASD.

• Provide support for individuals with FASD in child protection/foster care and the criminal justice system.

• Facilitate the creation of structure and supportive environment at home, school and beyond.

• Facilitate the provision of adequate information about individuals with for the adoptive parents.