Alcohol, the Fetus and Fetal Alcohol Syndrome
An education misdirected?
A college paper by Kirk Van-Beer
(Written from the a Child and Youth Care Counsellors point of view.)
Fetal Alcohol Syndrome (FAS), is something whose mere mention implies different things to different people. It is a 'syndrome' immersed in stereotypes by the North American society in which we live, the majority of which are sadly negative. In the paper that follows, though written from a North American perspective, I will refrain from examining the specifics of these stereotypes, for to acknowledge them would only give them attention that I do not believe that they deserve in the context of this article.
This paper is about FAS and the way we, as a North American society, educate people about its known, and possible, causes. The paper is split into six sections. It begins by looking at a history of the discovery of FAS and Fetal Alcohol Effects, (FAE) and goes on to define each to avoid confusion within the paper. Having dealt with descriptions of FAS/FAE, it briefly examines four articles that offer a contrasting view to that of the mother being soley responsible for a child with it, by showing that alcohol is a teratogen on the sperm, and suggesting that this may effect the fetus. The paper then offers a suggestion as to why FAS/FAE is seen to be such a social and societal leper by comparing its public awareness to the initial awareness of Acquired Immuno Deficiency Syndrome (AIDS) in the 1970's and 80's, and suggesting that a different approach is needed to the education of the subject. The conclusion is very deliberate.
This paper does not try to give specific answers to the questions on FAS and our education of it. To do so would need a much longer and larger paper than is applicable to this assignment.. The idea of what follows is to give an overview of what we currently teach people around FAS and FAE and to show that from information that is now starting to be slowly become available, that we need to re-examine just what we are teaching. Whether or not the education that currently give people around this subject is fair and accurate remains to be seen. My hope is that this paper at least gives the reader food for thought.
A brief history:
In 1973, whilst doing research on human behavioral teratology (the study of birth defects) [Drs] Kenneth L. Jones and David W. Smith along with their colleagues in Seattle identified a specific pattern of malformations, growth deficiencies and Central Nervous System (CNS) dysfunctions that were observable in some offspring of alcoholic mothers (Jones, Smith, Ulleland & Streissguth, 1973), a pattern that two of them then named Fetal Alcohol Syndrome (FAS), (Jones & Smith, 1973). Though this had been previously brought to light some years before in clinical studies of alcoholic mothers, (Lemoine, Harousseau, Borrteyri & Menuet, 1968; Rouquette, 1957) once the two Seattle groups had had their findings published in the much read and respected medical magazine "Lancet", interest in the subject quickly, yet quietly took hold of those whom read it. By the end of that decade FAS was recognised as one of the three leading causes of mental retardation and had a prevalence that was comparable to Down Syndrome and spina bifida (Smith, 1980). Of the three, FAS was the only one known to be preventable. It was around this time that, further research recognized other characteristics within children that were not FAS, but were linked to it and in 1978, the term Fetal Alcohol Effects (Clarren & Smith) was coined.
The terms Fetal Alcohol Syndrome, and Fetal Alcohol Effects are sometimes confusingly put together in the same phrase as if they mean the same thing. They are not, and so should be clearly defined:
Fetal Alcohol Syndrome (FAS) is defined and characterized by a cluster of congenital birth defects that develop in the womb as a result of exposure to alcohol either before (Jones, 1998) or during pregnancy. These birth defects are best recognized by pre and postnatal growth deficiency of the child's, facial malformations, Central Nervous System disfunctions, and a varying degree of major organ system malformations. In effect, they are generally visibly recognisable.
Fetal Alcohol Effects (FAE), (or Alcohol Related Neurological Defects (ARND), a term now being recommended to replace FAE, (Jones, 1998) and which I will refer to for the rest of this paper) is as its name implies, structural and functional defects within the head attributed to prenatal exposure of alcohol. These defects as generally seen include a small head size and abnormalities in the brain which cause such things as poor motor skills, poor hand-eye coordination and leads to such things as learning difficulties within the classroom, and behavioral problems which include poor social interactions. This is seen in the actions of the child/youth/adult, but is not necessarily visibly recognisable. ARND is inclusive of FAS and provides a category for those whose birth defects do not fully meet the FAS case definition and who (for the most part) do not have the facial deformities, so outwardly they appear normal.
FAS/ARND are conditions which suffer on the North American continent from a bad case of stereotyping. Having only been officially acknowledged to have existed for some twenty to twenty five years, they are seen by the majority of educators and recognised text books that are primarily caused by a mother's alcohol consumption either during or prior to pregnancy. (Streissguth, Bookstein, Sampson and Barr. p. 20) Though there are no definitive answers to just how much alcohol is needed to affect the womb, the writings that are available for the most part suggest, and in fact clearly point the finger of blame, solidly at the mother as the sole person responsible. Yet is, or was, this rush to judgement wrong?
Articles on the subject suggest what?:
In her paper "Effects on Future Generations of Paternal Exposure to Alcohol and Other Drugs", (Winter 1987/88) Gladys Friedler looks at how exposure to alcohol and other drugs effects the offspring of fathers who are exposed to one or both. In citing research done at Boston University School of Medicine, Friedler informs us that drug research on mice indicates that exposure "can induce long-term changes in the normal developmental and behaviourial patterns of subsequent offspring". (p. 128) She then goes on to inform the reader that alcohol, like opiates, is capable of profoundly altering the reproductive chemistry in males. For a paper that was written in 1987, in the context of things relating to what we know of paternal alcohol exposure, she had some interesting and far-sighted things to say on the subject. In her conclusion where she writes that more detailed research needs to be done on the subject. A thought echoed by almost everyone who was or is writing on this topic.
A researcher who is much quoted in this field is [Dr] Ernest L. Abel. In his paper "Paternal exposure to alcohol", (1992) Able offers us reference to peoples suspicions from as far back as the Talmud, that a males exposure to alcohol effected their offspring. He also tells his readers of research on the subject (and its findings) done on rats and mice done by himself and a number of researchers throughout history. He throws in an interesting twist to his findings when he writes of a confusing fact that data collected two different sets of rats exposed to the same amount and type of alcohol differed greatly.(p.141) The paper is a fascinating mixture of history and detailed descriptions of experiments ending not with a solid conclusion but with the observation that in his experiments, alcohol would seem to have had damaging effects on the male sperms deoxyribonucleic acid (DNA). (In effect the make-up of each and every person!)
In his much quoted and now increasingly referenced piece of research "Effects of paternal exposure to alcohol on offspring development" [Dr] Theodore J. Cicero (1994) suggests the possibility that the view that a mother is solely responsible for a child who is born with FAS is wrong. By pooling a vast amount of research of the effect of alcohol consumption on mammals, animals and humans, Cicero theorises that we have overlooked just what the impact of a males consumption of alcohol may have on the offspring to be born. Whilst admitting that he offers no conclusive proof, he does none the less, offer some interesting food for thought on the subject stating in his 'Conclusion' that ". . . results relative to the paternal effect of alcohol on pregnancy are still in a very early stage of development . . ." (p, 40) and suggests that more work needs to be done in this field, possibly with animals being those that are studied. He also says that we need to clearly define just what the parameters should be for studies of this kind.
In the context of getting ones message out on the thoughts of a subject to the world, the Alaskan Department of Health and Social Sciences, Division of Alcoholism and Drug Abuse (Jones, 1998) put series of pages on the Internet about FAS and ARND that are as thought provoking as they are quietly controversial. In admitting that alcohol abuse is Alaska's number one health problem, the pages look at the incidence and risk factors within the state and produce some very thought-provoking statistics. Like a person who is admitting that they have an addiction of some kind, the Internet pages have such headings as "Men Have Babies, Too", and subsections with questions such as "Does FAS ever go away or get better?". One point that is very well made and presented, is that of advising men to stop using alcohol and drugs at least three months before attempting to have children, and staying that way throughout the pregnancy or order to support the mother. It is a simply written and presented series of pages that are accessible and easily understood by all who chose to venture to this Internet site whatever their level, or lack of, education.
In comparing the four articles (deliberately presented here in chronological order), the one thing that stands out is the how, as we begin to understand and learn more on the subject of prenatal exposure to alcohol, so the way the way those who write about it, seems to get more interesting and easier to read. Research on this subject appears to show that we are only just touching the edge of the ice-berg of what there is to know on the subject, and we have to find ways of getting that message out to the public. When Friedler initially published her findings in 1987/8, the idea that a mans drinking could damage their unborn offspring was still a relatively unexplored field. The work published by people such as Doctors Able and Cicero, has added to that awareness by writing in about the subject in ways that the average person can understand. The final series of articles put out by Alaska's Division of Alcoholism and Drug Abuse are the most readable and user friendly to understand of the four that I have written of here. Though FAS/ARND are rarely singled out for special mention in these articles, they are mentioned, and the fact that we are at last starting to acknowledge that alcohol does have an effect on a males sperm by being a teratogen, brings us to the question that is the reason for writing this paper: Have we missed the boat on the way we educate people, especially those wishing to have babies, on what we teach them around the effects of alcohol on the development of their offspring?
So why the confusion in what we know and understand?
Statistics indicate that alcohol consumption is on the increase. Yet our awareness of alcohol consumption, and the education of our expectant families, especially that of youth, primarily evolves around the mothers. Any kind of drug or alcohol prevention strategy needs three intertwining factors in order to work: 'Health promotion', 'Research' and the capability for 'Intervention'. Once these three factors are in place, awareness and eduction programs can be targeted to particular populations. At the moment, that 'awareness and education' is primarily aimed at females, or at least focused on reduction of alcohol use for females.
Yet, there is a growing amount of evidence that suggests that male drinking may be just as likely as female drinking to cause damage to the fetus. Why then are we not more aware of these dangers?
Though there are many theories on this, the most probable, (and no doubt controversial!) would seem to be that it is seen to be a condition that effects those on the outer edge of societal norms. An example here would be that of Acquired Immuno Deficiency Syndrome (AIDS): When AIDS first showed its face on North American shores in late 1970's and early 1980's, we had Conservative and Republican Governments in power, and our collective military prowess or might, was far more important than the welfare of those who were not wealthy or middle class. AIDS seemed to only effect homosexuals, drug users, blacks, Hispanics, and others seen to be on the outer edges of the American dream. They were not seen as Christian, white, popular, or God fearing, such was the mood of our continent at the time. They were not stars or media icons either. No-one in mainstream society looked up to them, so they were pushed gently to one side and quietly told to shut up and go away! Then, seemingly out of no-where, someone who was famous was reported to be a carrier of the virus, and then another, and another, and another! Quite suddenly, all these famous people who were a part of that 'American Dream' had AIDS! In hindsight, it seems to have happened overnight. But it didn't! People had had it for years and were too frightened of the stereotypes to go public about it. Then, for reasons such as proven facts that you didn't have to be 'gay', or a 'drug user', to be a carrier, it became okay to admit that you had it! The governments were forced by the people to acknowledge it, and those responsible for the 'American Dream' even sponsored charities to help raise money for it!
Which leads us to the question then, that if FAS and ARND have been around for as long as AIDS, why is it still seen as such a social leper and why is there not better public awareness of this either in hospitals, doctors offices, or in the media? The reason, I believe, would seem to be that it's because no one who is remotely famous has either had it themselves or admitted to having a child born with it. Until that happens public perception just will not change. For something to get noticed these days in our society, some rich media icon of a person has to stand up and take notice of it to get everyone else's attention.
Within this truthfully sad statement of fact about North American society lies the basic reason for the problems of education and miseducation around FAS and ARND. Unless the subject gets some major media attention, those who research it, will remain in the dark shadows of our medical and public perceptions. And without that public attention, those who need the educating the most on this matter, (Our youth!) may chose not to take any notice of just what alcohol can do to their offspring, so we will see a continued rise in the number of children born to young parents effected by this.
With FAS now recognised as the leading cause of mental retardation among new born children, (and still the only one of the top three known to be preventable!) the need for the education of our expectant families and youth can surely not be clearer. Whilst there are a number of excellent peer educational workshops, groups, and resources such as those put out and by the 'Alcohol and Drug Education Service of British Columbia' [Canada], (Carr, 1998) the need for both male and female youth education 'of self' is now abundantly clear. Unless we, the Child, Youth and Family Counsellors of today's society, can get the message to them through the media, and somehow make the message of these dangers worth taking notice of, it would appear that things may not move along very fast.
In looking at ways to get that message across, we cannot wait for public opinion to make the subject popular. We need to change what we are focussing on and perhaps begin to look at gearing the education on the males contribution to the equation of a child first. After all, education aimed at females has not worked that well so far! The idea that both male and female drinking may damage a fetus is not a pleasant one to think about for an adult, yet alone our youth. For the last twenty five years the finger of blame has pointed solely and squarely at the female. With evidence now suggesting that the males alcohol consumption 'may' have an effect on fetal development, it is definitely time to take a look at the focus on who we are trying to educate here.
For a government and its people, much like a single human being, it is hard to look in the mirror and own up to the possible flaws in oneself. Twenty five years ago, North American society was biased, racist, and closeted in many ways. Yet can we, as a people, admit to ourselves and our children, that we may have made a mistake? That we may have gotten our education on alcohol, the fetus and FAS wrong? That quite possibly, the male may be as guilty as the female for the problems that happen to the development of the child within the womb?
There is an old saying about how 'prevention is better than cure'. There is no cure for FAS or ARND, yet there is prevention! The question of whether or not 'Alcohol, the fetus and FAS' is an education that we have misdirected is not one that is easily answered. Until such time as concrete evidence is shown to the contrary, there are many who will refuse to believe that the fault and the responsibility can not be anyone's other than the mothers. As 'Child, Youth and Family Counsellors', I do not believe that we have the right or power to make a judgement on the case one way or another, even if it turns out the initial education was misdirected. I do believe however, that we have a moral obligation to educate those whom we work with of 'all' the information that is out there. Then let people make their decisions on their own. After all, isn't that what good counselling is all about?
Abel, E. L. (1992). Paternal Exposure to Alcohol. In T. B. Sonderegger (Ed.), Perinatal Substance Abuse: Research Findings and Clinical Implications (pp, 132-160). London.: Hopkins.
Carr, R. A. (1998). Field-Test of a Peer Education Workbook for the Prevention of Fetal Alcohol Syndrome and Fetal Alcohol Effects. Written for British Columbia Ministry of Health (Alcohol and Drug Programs Branch), and Canada Health and Welfare (Health Promotion & Social Development Office.) Internet site access: www.islandnet.com/~rcarr/FASART.html
Cicero, T. J. (1994). Effects of Paternal Exposure to Alcohol on Offspring Development. Alcohol, Health & Research World. (Vol., 18 No. 1, 1994) pp. 37-41.
Clarren, S. K., & Smith, D. W., (1978). The fetal alcohol syndrome. New England Journal of Medicine, 298(19), 1063-1067.
Friedler, G. (1992) Effects on Future Generations of Paternal Exposure to Alcohol and other Drugs. Alcohol, Health & Research World. Winter 1987/88. pp. 126-129.
Jones, K. L., & Smith, D. W., (1973). Recognition of the Fetal Alcohol Syndrome in early infancy. Lancet, 2, 999-1001.
Jones, K. L., Smith, D. W., Ulleland, C. N., & Streissguth, A. P., (1973). Pattern of malformation in offspring of chronic alcoholic mothers. Lancet, 1, 1267-1271.
Jones, L. (1998). Fetal alcohol information. Alaskan Department of Health and Social Security: Division of Alcoholism and Drug Abuse. Internet site access: www.hss.state.ak.us/htmlstuf/alcohol/table.htm#reports
Lemoine, P., Harousseau, H., Borteyru, J. P., & Menuet, J. C., (1968). Les enfants de parents alcooliques. Anomalies observees. A propos de 127 cas. (Children of alcoholic parents: Abnormalities observed in 127 cases.) Paris, Ouest Medical, 21, 476-482.
Rouquette, J. (1957). Influence of paternal alcoholic toxicomania on the psychic development of young children. Unpublished medical thesis, University of Paris, Paris, France.
Smith, A. P., Bookstein, F. L., Sampson, P. D., & Barr, H. M., (1993). The Enduring Effects of Prenatal Alcohol Exposure on Child Development. United States of America.: University of Michigan Press.
Smith, D. W. (1980). Alcohol Effects of the fetus. In Swartz, R. H., and Taffe, S. J. (Eds), Drug and Chemical Risks to the Fetus and Newborn (pp, 73-82). New York.: Alan R. Liss, Inc.
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