Persistent crisis of fetal alcohol spectrum disorder in South Africa: Time for decisive action

Fetal Alcohol Spectrum Disorder (FASD) represents a critical public health challenge in South Africa (SA), where the prevalence is among the highest worldwide. This commentary highlights the urgent need for coordinated, multifaceted approaches to address FASD, with prevalence rates as high as 310 per 1,000 individuals, particularly in rural communities. Factors contributing to this high prevalence include historical practices like the "dop system," pervasive poverty, limited healthcare access, and social norms around alcohol use. The consequences of FASD are profound, leading to lifelong impairments and significant economic impacts. Alcohol-related harms cost SA around 65–104 billion Rand annually. Despite the magnitude of the issue, SA lacks a comprehensive national strategy, resulting in fragmented services and care gaps. To mitigate this crisis, a combination of prevention, early diagnosis, and community-based interventions is essential. Suggested strategies include public awareness campaigns, integration of FASD prevention into primary healthcare, enhanced diagnostic services, and community empowerment initiatives. A national response involving government agencies, healthcare providers, educational institutions, community organizations, and private sector stakeholders is imperative. With sustained commitment, South Africa can substantially reduce the burden of FASD, ensuring a healthier future for its communities. • South Africa reports the world’s highest prevalence rates of FASD. • Prenatal alcohol exposure leads to severe physical and cognitive impairments. • FASD creates significant economic and social burdens in South Africa. • Prevention is limited by scarce funding, and fragmented national policies. • Nationwide and multi-sectoral action is urgently needed to combat FASD.