"Even with all the interventions and messages out there, we have not seen a significant decrease in alcohol use among women of childbearing age." --Dr. Jasjeet Sidhu of the National Center for Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. (Reuters News Report April 5, 2002)
You know, I think that only those of us out in the field (not left field either!) understand why. There are lots of reasons, including media messages and denial about alcohol as a drug, especially among professionals in the medical field. But if we looked at two sets of statistics and put them together, another answer seems obvious.
Statistics for rate of drinking during pregnancy in the 70's: I cannot find the scientific study that shows the results of the early studies of drinking during pregnancy 20-30 years ago, but I remember the figure was around 25%. You can figure that one-third of the babies born to the women drinking heavily were born with full FAS. You can also figure that about 10% of the babies born to the women who drank moderately had FAS. We don't know exactly how many babies were born with the invisible form of FASD with normal appearance and normal IQ. But if the rate or drinking during pregnancy 25 years ago (25%) was double what it is today (13%), and the rate of FASD today is 1 per 100, then we can guess that the rate of FASD in the last generation was probably about 2 per 100.
The next set of statistics to look at are those for these children born with FAS, many of whom went undiagnosed, and FASD, most of whom never get diagnosed, and see what happens to them as they grow to adulthood and begin having children of their own. According to Streissguth's studies, 50% of the men and 70% of the women with FASD have problems abusing alcohol and other drugs. Most of them have poor impulse control and lack good judgment, which also puts them at high risk for having unprotected sex and for drinking during pregnancy. Obviously, if their abstract reasoning is limited, and if they have trouble learning from consequences and continue to make the same mistakes and bad decisions over and over, they are not going to respond to government warnings or labels on bottles, and they are not going to recover easily in the limited treatment programs that we offer them.
I believe there are three target groups for reducing the incidence of FASD. The obvious one that everyone thinks of first is the group of women who are alcoholic drinkers, whose babies have a 35% risk of having full FAS (and an unknown risk for FASD). A less obvious group (less obvious to those outside of the FAS activist group) is the population of women who are "normal" or typical drinkers, just "social" drinkers, whose doctors tell them "It's okay to have a drink a day during pregnancy" because they erroneously believe it is only alcoholic women who give birth to babies with FAS, but whose babies are at high risk (10% is a high risk in my opinion) of having full FAS. The third group to focus on, that the medical field all but ignores, is the large group of women of childbearing age who were exposed prenatally to alcohol during the 70's and the men who are getting them pregnant, also exposed prenatally way back when their mothers were taking their place next to men at the bar. These physically mature adults who seem so normal but who lack common sense and foresight and don't comprehend the long-term effects of their sexual and drinking behavior are never mentioned in these studies. The rate of drinking during pregnancy among women with FAS is 40%.
Of the women in Striessguth's studies, 28% of those over the age of 12 had already become parents. The average IQ of these mothers with FASD was 84, but their Adaptive-Functional IQ was only 66. Only 10% of these mothers were eligible for DD services. Of their children, 30% were born with FASD, either diagnosed or suspected.
These women, and many other non-affected women who might be drinking during pregnancy, do not heed the warning signs and labels, but they do heed the commercial hype that promotes the glamour of consuming alcoholic beverages and touts the health benefits, in spite of the scientific fact that the risks of alcohol use far outweigh the benefits. And these women follow the leader, as most individuals with FASD will do, and their role models are all over TV, the movies, and everywhere they go.
Even though the rate of binge drinking during pregnancy has not decreased, I am encouraged to learn that the rate of overall drinking during pregnancy is significantly lower than it was 5 years ago. I would like to believe that this is a result of the world listening to us talk about how alcohol has devastated the lives of our children (and their parents). I am going to have to change the statistics in my presentations. I hope that the next study means I have to change my stats in my handouts and on my web page to even lower figures.