The challenges for prevention, for refugee communities and for the justice system were among the topics of discussion at the Australasian Fetal Alcohol Spectrum Disorders (FASD) conference in Brisbane yesterday.
Journalist Mardi Chapman filed these reports from the conference.
FASD compounds difficulties for refugee families
In addition to so many other challenges, refugee communities in Australia are also grappling with the consequences of alcohol-exposed pregnancies.
Alcohol misuse and dependence is a global phenomenon and the fraught process of seeking asylum in another country is as likely to exacerbate as relieve the underlying drivers of risky drinking.
Dr Raewyn Mutch, a pediatrician with the Refugee Health Service of The Princess Margaret Hospital for Children, said many refugees were using alcohol as a coping strategy against layers of trauma.
“Refugees’ history of trauma and violence, loss of home and family, and prolonged or uncertain transitions through camps and detention centres predisposes them to high rates of alcohol consumption,” she said.
She said home brew alcohol and high alcohol content drinks were readily available in refugee camps.
“Alcohol is even easier to get in Australia but their life here is still hard. Issues of acculturation and dissonance with families can further escalate consumption of alcohol and risk of alcohol exposed pregnancies.”
Dr Mutch said some refugee communities had already recognised the problem, and requested culturally appropriate resources on alcohol, pregnancy and FASD.
Under the influence of pre-pregnancy drinking
Preventing FASD will require a concerted effort to address drinking behaviours, especially binge drinking, in young women.
The Australasian Fetal Alcohol Spectrum Disorders (FASD) conference was told that pre-pregnancy drinking behavior was the strongest predictor of whether women would drink during a pregnancy.
According to results from the Australian Longitudinal Study of Women’s Health, a history of binge drinking before pregnancy doubled the odds of women consuming alcohol during pregnancy.
University of Newcastle PhD candidate Amy Anderson said women who drank at least once a week before pregnancy were also more likely to drink during pregnancy than women who drank less frequently.
“The results support earlier international findings that pre-pregnancy alcohol consumption is a consistent predictor of alcohol use in pregnancy,” she said.
The study found 82 per cent of Australian women were still drinking alcohol during their pregnancy, although the majority was drinking at low levels – less than 1-2 drinks on a drinking day and fewer than 1-2 drinking days per week.
Women who were pregnant before Australian alcohol guidelines recommended no alcohol as the only safe option were also more likely to drink during pregnancy.
Women who had ever had fertility problems and those with a Health Care Card (a proxy for low income) were less likely to drink during pregnancy.
Courting better outcomes for young people with FASD
Yet Auckland District and Youth Court Judge Tony FitzGerald argues that such a court system presumes that people have the ability to learn from the consequences of their actions.
“I question if there is any justice in not looking at new ways to reduce the re-offending by people with underlying neurodisability such as FASD,” he said.
With a special interest in the concept of therapeutic jurisprudence and a sympathetic focus on the wellbeing of offenders who may also have treatment needs, Judge Fitzgerald has built more understanding, support and coordination services into the Youth Court.
He said he has changed the way young offenders are spoken to, the structure of the courtroom, and ultimately, the degree of flexibility over sentencing.
“People with FASD are typically entering the criminal justice system at a much greater rate and once there, they are at a far greater risk of worse outcomes, especially if their FASD is not identified as an underlying cause.”
“This new approach still holds people accountable for their actions but there is an opportunity to consider the context and underlying cause of the offences.”
He said having forensic services present in the court provided easier access to screening and assessment for FASD.
“Diagnosis is crucial as is interagency coordination. FASD is a lifelong disability which requires the application of structure, support and supervision.”
Meanwhile, from the opening address by public health advocate Professor Mike Daube…