On the 15th of October we are observing National Fetal Alcohol Syndrome Day to raise awareness about Foetal Alcohol Spectrum Disorders (FASDs) and help prevent children from being born with irreversible damage, both physical and intellectual. It is incredibly important that we all show our support for this message and make sure that every single person is aware of the dangers of drinking during pregnancy.
We should also ask ourselves if making people aware of the dangers is enough. Unfortunately humans are not always as logical as we would like to believe we are. We are all prone to cognitive biases, which can skew our perception of reality. We are prone to confirmation bias for example, ignoring information that goes against our beliefs and only taking note of that which does.
Of particular importance for public health and behavioural interventions is what is referred to as optimism bias, or unrealistic optimism. This is why we all believe we are better drivers than average, we are less likely to get ill than average and we are more likely to win the lotto than average. Maybe we do not state this belief out loud, but it is quite easy to see in the way we act. “I know speaking on a cell phone while driving is dangerous but I will be fine I know what I am doing!” When faced with risk information we tend to think “it won’t happen to me”.
Unrealistic optimism is a significant barrier to behaviour change. When we spread the FASD prevention message in the 15th of October, are we making prospective mothers aware that it can happen to them.? This is the question that I set out to investigate.
In collaboration with the Foundation for Alcohol Related Research (FARR), I conducted a study in De Aar in the Northern Cape Province in South Africa. FARR has been implementing the Healthy Mother Healthy Baby© (HMHB©) programme in De Aar since 2007. This programme focuses on providing support to all pregnant women, regardless of drinking behaviour, but does have a focus on FASD prevention. We recruited women who had completed the HMHB© programme with FARR and were still living in the De Aar community. The participants were given a questionnaire during one on one interviews asking questions about their beliefs about the risks of drinking during pregnancy, and gauging their knowledge of FASD.
To answer the research question it was not enough to just establish whether women knew drinking during pregnancy was a risk, we also wanted to know whether they thought they were at risk as well. The questionnaire therefore asked women to estimate the risk, firstly to themselves and then to the average woman in their community. It would then be possible to compare their perception of their personal risk and of the general risk to others. Many of the women in the study did not drink alcohol, but the questions were framed regarding the risk should they drink during pregnancy. The results indicated that in our sample women were aware that they were as much at risk of the harmful effects of drinking during pregnancy as other women in their community.
The questionnaire also revealed that there is a high level of knowledge about FASD amongst participants. This is a very heartening and important finding. Although awareness of the risks is not a sufficient condition for behaviour change it is definitely a necessary one. There was also a strong correlation between knowledge of FASD and perception of personal risk, with those who had better knowledge of FASD also judging themselves more at risk of negative effects should they drink during pregnancy.
Because the participants were drawn from the HMHB© programme it is not clear to what extent these findings can be generalised to the greater De Aar community. There has been a decrease in FASD prevalence in this area, however the prevalence rate is still amongst the highest in the world, and there is still a lot of work to be done to conquer this 100% preventable disease. This study raises some important questions. Is the lack of evidence for unrealistic optimism a true reflection of the study population and the De Aar population in general? Which interventions or messages succeeded in making participants aware of their personal risk? How well does this awareness of personal risk translate into behaviour change?
This brings me back to the 15th of October. It is undeniable that helping women to abstain from drinking during pregnancy and preventing FASD is a difficult task. There are many factors that cannot be changed by information alone. The drinking behaviour happens within context, and we need to be sensitive to the fact that it is not solely the mother’s responsibility to ensure a healthy pregnancy. She needs support from her partner, family, friends and society as a whole to make the decision to stop drinking before pregnancy the only logical one.
The first step to any intervention however remains awareness of the risks of drinking during pregnancy. It is the foundation on which all other interventions need to be built. It is through observing days like National Fetal Alcohol Syndrome day on the 15th October and International FASD day on the 9th of September that we try and ensure that everyone hears the FASD prevention message:
No amount of alcohol is safe at any time during pregnancy. FASD causes permanent damage but it is 100% preventable
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