Rethink Your Drink is bringing together art, lived experience and policy to challenge how South Africa prevents FASD and build support for a more coordinated response.
The organisation will host The First Home at Cape Town’s Homecoming Centre on 9 September, using an immersive experience to explore how the environments surrounding women and children can influence alcohol-related harm.
Rather than placing responsibility for Foetal Alcohol Spectrum Disorder prevention primarily on pregnant women, the initiative asks what healthcare systems, communities, alcohol regulation and the broader social environment can do differently.
“Information alone is not a prevention strategy,” said Kashifa Ancer, Project Lead for Rethink Your Drink.
“We also have to ask what shapes behaviour around nutrition and alcohol use. Prevention cannot rest on individual choices alone. We need to look at the environments women live in and whether the systems around them make healthier choices possible.”
The First Home brings together art, history, lived experience and policy to encourage visitors to think about FASD prevention as a wider social responsibility.
The approach is particularly relevant in South Africa, which has the highest reported prevalence of FASD globally. Approximately one in ten children is estimated to live with the condition, while prevalence is significantly higher in some communities in the Western and Northern Cape.
Yet South Africa does not have a dedicated, coordinated national policy addressing FASD and its long-term consequences.
Researchers have argued that the country’s response remains fragmented across health, education and social services, limiting both prevention and the support available to people living with FASD.
Rethink Your Drink believes addressing those gaps requires moving beyond awareness campaigns and creating conditions that make prevention possible.
“Children don’t choose the environments into which they are born,” Ancer said. “If we want different outcomes for children, we have to be courageous enough to change what surrounds them.”
The organisation works closely with Hold My Hand, a public campaign promoting the goals of the Cabinet-approved National Strategy to Accelerate Action for Children.
The strategy promotes a whole-of-society approach to protecting children and adolescents from abuse, violence, injury and harmful substances, including alcohol-related harm.
The potential social and economic benefits of stronger prevention extend beyond individual families.
Children with Foetal Alcohol Syndrome or partial FAS, two severe diagnoses within the broader spectrum of disorders associated with prenatal alcohol exposure, can require more healthcare services and face increased risks of stunting, intellectual disabilities and congenital heart defects.
A 2011 study estimated that FAS and partial FAS imposed an annual societal healthcare cost of approximately R597 million in the Western Cape alone, using 2009 prices and exchange rates. Adjusted for inflation, that would amount to well over R1 billion today.
For Rethink Your Drink, South Africa already has experience demonstrating how a systemic approach can transform preventable health outcomes.
The country’s response to mother-to-child HIV transmission developed beyond simply asking women to change individual behaviour.
A broader system was built around mothers and babies, incorporating HIV testing and counselling, antiretroviral treatment, maternal healthcare, infant testing and continued care and support.
South Africa subsequently recorded a 50% reduction in mother-to-child HIV transmission between 2008 and 2010. National evaluations found that early transmission at four to eight weeks declined to 3.5% in 2010 and 2.7% in 2011.
“South Africa’s HIV response showed us that prevention improves when systems change, not simply when individuals are told to change,” Ancer said.
Rethink Your Drink believes lessons from that response can help shape a more coordinated national approach to FASD prevention.
This would mean combining individual and community support with stronger healthcare and social systems, while also examining the environment in which alcohol is marketed, sold and consumed.
The organisation argues that stronger alcohol regulation should form part of that response, including measures aimed at reducing the availability of cheap liquor, increasing the price of alcohol and restricting alcohol advertising, sponsorship and promotion.
The scale of the challenge reinforces the need for prevention. South Africa’s high FASD prevalence means interventions have the potential to influence not only health outcomes but education, family wellbeing, social services and longer-term public expenditure.
Through The First Home, Rethink Your Drink is placing that broader conversation before the public: preventing FASD should not rest on one woman making one decision.
Instead, the initiative is advocating for communities, healthcare services, policymakers and the alcohol regulatory environment to become part of a coordinated prevention system that gives women and children a stronger first home.
