Dr Jonathan Sher: “Weak action around FASD is an international phenomenon”

We spoke with Dr Jonathan Sher who has long been an advocate for action on FASD in Scotland, the rest of the UK and internationally. He was an Independent Consultant based in Edinburgh at the time of writing the co-authored article mentioned below. He has just been appointed as the Deputy Director of the Queen’s Nursing Institute Scotland (QNIS) and can be reached at: Jonathan.Sher@qnis.org.uk


You co-authored an article, published in the Journal of Public Health, where you listed three areas of reproductive health where the UK government is not doing enough. One of these examples was FASD. Could you summarize what isn´t done by the government?

I encourage colleagues across your network to read the free, full-text version of our new article at: https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdy131/5076112. Both the UK Government and the devolved governments in Scotland, Wales and Northern Ireland have been very slow to acknowledge and pay serious attention to Fetal Alcohol Spectrum Disorders (FASD). Avoidance has been comprehensive in terms of not adequately undertaking prevention (primary and secondary), identification/diagnosis or support/treatment.

Being an expert in this field, do you consider that inactivity mainly a UK specific problem?

Absolutely not. Weak, or only token, action around FASD is an international phenomenon. It is worth remembering two facts: a) there is a very large, solid and still-growing body of evidence that exposure to alcohol in utero creates the risk of major, lifelong harm; and, b) such evidence is not new. The major teratogenic potential of alcohol has been featured in the professional literature, internationally, for decades.

Have you seen any progress in recent years when it comes to public awareness, diagnosing capabilities, support for FASD families etc?

Happily, there has been significant progress on all of these fronts in a variety of communities and a handful of countries. This should be applauded, but meaningful action on FASD merits becoming universal. It appears that the pace of progress is increasing. Many encouraging examples are emerging (primarily across the OECD nations) and they are being shared widely through such helpful publications as the fortnightly EUFASD News.

Why do you think our countries are struggling with this, even though it is such a clear cut topic – no drinking during pregnancy. What´s the obstacle?

There are a variety of negative influences on, and obstacles to, effective FASD prevention, identification and support, rather than a single dominant one. This list includes: misleading information and common myths about alcohol and pregnancy; media coverage pitting extreme opposing positions (neither of which is accurate) against each other; the difficulty of identifying ‘invisible’ neurodevelopmental damage (as is the case for the vast majority of those with FASD); proving pre-natal alcohol exposure; the marketing and other pernicious influences of the alcohol industry; too few people who are knowledgeable and well-trained in relation to all aspects of FASD; and, too little assistance to resolve the underlying problems/stresses that lead to drinking during pregnancy. Naming, shaming, blaming and punishing women is both cruel and ineffective. It is extraordinarily rare that any woman drinks because she wants to harm her baby.

Politicians have to make choices, as there is never enough money to deal with everything. Why do you consider FASD to be a topic that shouldn’t be ignored by them?

The costs – human, financial and societal – of dealing with the consequences of FASD are dramatically higher than the costs of preventing this preventable harm. However, those costs are spread out over time and across different budgets, e.g. health, education, welfare and criminal justice systems. Politicians and policymakers will keep being able to avoid acting until the ‘dots are connected’ to show the true costs — and high prevalence — of FASD. Once these realities become widely understood, taking FASD seriously will become unavoidable. As we note in our article, ‘ignorance is not bliss’ for anyone, once FASD’s long-term impacts are taken into account.

You and your co-authors talk about “cultural factors” in your article. It is defined as beliefs, values, assumptions and social norms. These are tough things to change. How could one society manage to change these norms?

We never claimed that changing cultural factors is either quick or easy; just that it is necessary and very worthwhile. The good news is that all our societies have great examples of similar changes actually happening and achieving positive results. For example, attitudes and behaviours toward smoking have changed and improved markedly in recent years.

Sometimes, it is a matter of adapting lessons from a different success to the FASD context. Drink driving has decreased very substantially over the past two decades. One factor was the pervasive, two-sided public health message: ‘If you drink, don’t drive; and if you drive, don’t drink’. Thus far, FASD campaigns have been heavily one-sided; i.e. ‘don’t drink if pregnant, or likely/trying to become pregnant’. The other side of the equation — ‘If you’re going to keep drinking, then don’t get pregnant’ — has been largely missing. Good contraception can be nearly as effective as avoiding alcohol in preventing FASD.

The prevention messages to date have tended to be boring, scary and/or authoritarian. Not surprisingly, these three faults have resulted in only minor changes in behaviour or attitudes. There is no reason why we cannot be more accurate and honest about the risk (not certainty) of fetal alcohol harm in ways that are clever, sensitive, humorous or otherwise persuasive.

It is the FASD awareness month at the moment. What do you recommend that professionals, organisations, civil society and individuals could do to help tackle this problem?

The question contains the key to the answer. Preventing, and dealing well with, FASD should not always be ‘somebody else’s business’ or about ‘them’, rather than ”us’. There is truth in the maxim that ‘no one can do everything, but everyone can do something’. Asking ourselves what we can do (large or small) about FASD in our own spheres of influence — personal, as well as professional — is a terrific starting point. So is recalling that all men and women who ever want to become parents deeply desire the same three outcomes: a safe pregnancy, a thriving baby and a rewarding parenthood. Helping people get what they already want is the most positive starting point.

I am also impressed by the power of two-way relationships of trust and respect. That power often resides in unexpected places — not with experts and officials, but rather with those who work most often and most closely with the people facing or dealing with FASD. For instance, I have become impressed with the enormous, but often untapped, potential of community nurses in their diverse roles as health visitors, district nurses, public health nurses, sexual health nurses, school nurses, mental health nurses, midwives, prison nurses and general practice nurses — to turn the tide in raising awareness, understanding and meaningful action on FASD.