As a social problem and a consequence of the plethora of alcohol caused harms, fetal alcohol spectrum disorder (FASD) is characterised by complexity, ambiguity, and a lack of agreement on definition and solutions. Despite a history of applying a linear policy approach, prevention of FASD continues to be resistant to change. Multiple stakeholders engage (or try to engage) in the problem system, each with their diverse frames of reference and preferred definitions of the problem and its solution. After 40 years, many issues advocated in the late 1990s have not yet been resolved.
The technical complexities of FASD are in contrast with the problems in its social dimensions. Public policy preferences based in authoritative type solutions have emerged and this has fractured the problem of FASD into more problem parts, at least to those parts which can be quantified. There are consequences – the conundrum inherent in the diagnosis, determining the lowest threshold to cause fetal harm, the discretionary choice in respect to target groups and the search for evidence-based interventions. Eliminate the words ‘fetal’ or ‘alcohol’ and conflict can be avoided with the alcohol industry (demonstrated for example in the issue of voluntary labelling alcohol beverages) and the public coffers continue to bulge with collected tax revenues.
Meanwhile, such a focus denies the public the opportunity to bring oppositional pressure (Cobb, Ross & Ross 1976, pp. 126–138) and perpetuates the notion of FASD as a women’s problem, an Aboriginal problem, a problem focused on diagnosis and research attention to marginalised groups. It avoids the true prevalence of FASD ‘hidden’ among those diagnosed with alternatively named conditions, avoids a better understanding of the presentation of FASD across the lifespan and the pervasive use of alcohol in society. It has failed to meet the needs of individuals living with FASD and their families who carry the burden of care. Nor has sufficient attention been given to the lived experience of older adolescents and adults.
Governments rely researchers, and evidence produced from people considered qualified to know and understand the problem. Often there is an assumption that the interests of individuals living with FASD and their families are represented. The lifetime reality of FASD means poorer academic success, economic dependence, mental health diagnoses, alcohol and other drug dependencies, likely imprisonment, and homelessness. Acknowledgement of the long-term time frame needed to address prevention, and the historical, cultural, intellectual, personal and professional obstacles that exist – and including these topics as part of the conversations about FASD prevention – is critical.
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