South Africa is facing a public-health crisis that cannot be solved by information alone.
The country has the highest prevalence of Foetal Alcohol Spectrum Disorder (FASD) in the world, with roughly one in ten children living with the condition.
In some communities, the numbers are even more alarming.
In parts of the Western Cape, prevalence is nearly one in three. In the Northern Cape, it is nearly one in five.
Yet despite the scale of the problem, South Africa does not have a dedicated, coordinated national policy addressing FASD and its long-term consequences.
The result is a response spread across health, education and social services, with researchers arguing that this fragmentation limits both prevention and support for people living with FASD.
The cost of a problem that lasts a lifetime
FASD is not simply an issue that ends with pregnancy.
Its consequences can follow a person throughout life, placing pressure on families as well as the public healthcare system.
Among the more severe diagnoses within the broader spectrum are Foetal Alcohol Syndrome (FAS) and partial FAS.
Children living with these conditions require more healthcare visits and face increased risks of stunting, intellectual disabilities and congenital heart defects.
The financial consequences are significant too.
A 2011 study in the Western Cape estimated that FAS and partial FAS imposed an annual societal healthcare cost of approximately R597 million, using 2009 prices and exchange rates.
Adjusted for inflation, that figure would be well over R1 billion today.
That makes the question of prevention bigger than individual choices.
It becomes a question of what systems are doing to prevent harm before it happens.
When awareness is not enough
Every September, around FASD Awareness Day, public-health messaging often focuses on the behaviour of pregnant women.
But advocates argue that this approach does not go far enough.
“Information alone is not a prevention strategy,” says Kashifa Ancer, Project Lead for Rethink Your Drink.
The issue, she argues, also requires an examination of the environments in which women live and whether the systems around them make healthier choices possible.
That shift in perspective sits at the heart of The First Home, an immersive experience hosted by Rethink Your Drink at Cape Town’s Homecoming Centre on 9 September 2026.
The experience brings together art, history, lived experience and policy to encourage visitors to look beyond individual behaviour and consider the environments that influence alcohol harm.
Changing the environment around children
The conversation becomes even more urgent when the focus moves from pregnancy to the children who ultimately live with the consequences.
As Ancer puts it, children do not choose the environments into which they are born.
If South Africa wants different outcomes for children, the argument is that it must be willing to change the environments surrounding them.
Rethink Your Drink works closely with Hold My Hand, a public campaign promoting the goals of the Cabinet-approved National Strategy to Accelerate Action for Children (NSAAC).
The strategy calls for a whole-of-society approach to protecting children and adolescents from abuse, violence, injury and harmful substances, including alcohol harms.
The FASD conversation therefore sits within a much larger question about how South Africa protects children and supports healthier environments.
South Africa has faced a similar public-health challenge before
There is already a powerful example of how South Africa can move from individual messaging towards a coordinated public-health response.
The country’s response to HIV offers an important lesson.
Preventing mother-to-child transmission of HIV did not rely solely on telling individual women how to avoid transmission.
Instead, a broader programme was developed around women and their babies.
It brought together HIV testing and counselling, antiretroviral treatment, maternal healthcare, infant testing, continued care and support.
According to UNAIDS, South Africa recorded a 50% reduction in mother-to-child HIV transmission between 2008 and 2010.
National evaluations subsequently found that early transmission at four to eight weeks had fallen to 3.5% in 2010 and 2.7% in 2011.
The national approach continues to recognise prevention of vertical transmission as a family and health-systems issue, built around reproductive healthcare, treatment and care for women and their children.
For Ancer, the lesson is clear.
“Prevention improves when systems change, not simply when individuals are told to change.”
A national response must go further
The argument being put forward is not that individual responsibility has no place.
It is that individual choices cannot carry the entire burden of prevention.
A coordinated national response to FASD would need to draw on the lessons of other public-health programmes while addressing the wider environment in which alcohol-related harm occurs.
That includes stronger alcohol regulation.
The proposed direction includes measures to reduce the availability of cheap liquor, increase the price of alcohol, and restrict alcohol advertising, sponsorship and promotion.
The aim is to move the conversation from simply telling people what not to do towards creating conditions that make healthier choices more possible.
From awareness to action
South Africa’s FASD figures demand more than another annual reminder.
When roughly one in ten children is living with FASD, and prevalence in some communities reaches nearly one in three, the issue cannot be viewed only through the lens of individual behaviour.
The health consequences are long-term.
The financial costs are substantial.
And the systems responsible for prevention, healthcare, education and social support remain fragmented.
The challenge now is to connect those pieces.
The First Home offers one space for that conversation, bringing art, history, lived experience and policy together in Cape Town on 9 September 2026.
But the bigger conversation extends beyond one exhibition or one awareness day.
If South Africa wants to reduce FASD and improve outcomes for children, the case being made by Rethink Your Drink and its partners is that prevention must become a coordinated national responsibility.
Because information can raise awareness.
But changing systems is what can turn awareness into prevention.
