{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T17:21:14Z","timestamp":1764350474577,"version":"build-2065373602"},"reference-count":62,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T00:00:00Z","timestamp":1552608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines\/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed.<\/jats:p>","DOI":"10.3390\/ijerph16060945","type":"journal-article","created":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T04:06:55Z","timestamp":1552882015000},"page":"945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Policymakers\u2019 Perspectives Towards Developing a Guideline to Inform Policy on Fetal Alcohol Spectrum Disorder: A Qualitative Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8798-1961","authenticated-orcid":false,"given":"Babatope O.","family":"Adebiyi","sequence":"first","affiliation":[{"name":"School of Public Health, University of the Western Cape, Cape Town 8001, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferdinand C.","family":"Mukumbang","sequence":"additional","affiliation":[{"name":"School of Public Health, University of the Western Cape, Cape Town 8001, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lizahn G.","family":"Cloete","sequence":"additional","affiliation":[{"name":"Division of Occupational Therapy, University of Stellenbosch, Stellenbosch 7602, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna-Marie","family":"Beytell","sequence":"additional","affiliation":[{"name":"Department of Social Work, University of the Western Cape, Cape Town 8001, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/GRF.0b013e31816fea3d","article-title":"Pregnancy and alcohol use: Evidence and recommendations for prenatal care","volume":"51","author":"Bailey","year":"2008","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1467-8578.2010.00471.x","article-title":"Fetal alcohol spectrum disorders (FASD): Raising awareness in early years settings","volume":"37","author":"Blackburn","year":"2010","journal-title":"Br. J. Spec. Educ."},{"key":"ref_3","unstructured":"WHO (2014). Global Status Report on Alcohol and Health, WHO."},{"key":"ref_4","unstructured":"Statistics South Africa (2018, January 12). Media Release: South Africa Demographic and Health Survey|Statistics South Africa, Available online: http:\/\/www.statssa.gov.za\/?p=9836."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.7196\/SAMJ.2017.v108i1.12615","article-title":"Self-reported alcohol use and binge drinking in South Africa: Evidence from the National Income Dynamics Study, 2014\u20132015","volume":"108","author":"Vellios","year":"2017","journal-title":"S. Afr. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4314\/ajpsy.v14i1.65466","article-title":"Alcohol use and problem drinking in South Africa: Findings from a national population-based survey","volume":"14","author":"Peltzer","year":"2011","journal-title":"Afr. J. Psychiatry"},{"key":"ref_7","unstructured":"Chambers, D. (2019, February 01). Binge-Drinking Is a Huge Problem in SA\u2014But We Can\u2019t Admit It|UCT News. Available online: https:\/\/www.news.uct.ac.za\/article\/-2018-01-04-binge-drinking-is-a-huge-problem-in-sa-but-we-cant-admit-it."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.7196\/SAMJ.2016.v106i6.11009","article-title":"Fetal alcohol spectrum disorders: Prevalence rates in South Africa","volume":"106","author":"Olivier","year":"2016","journal-title":"S. Afr. Med. J."},{"key":"ref_9","first-page":"877","article-title":"Fetal alcohol syndrome among grade 1 school children in Northern Cape province: Prevalence and risk factors","volume":"98","author":"Urban","year":"2008","journal-title":"S. Afr. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1111\/acer.12726","article-title":"Prevalence of fetal alcohol syndrome in a South African city with a predominantly black African population","volume":"39","author":"Urban","year":"2015","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.drugalcdep.2006.11.007","article-title":"The epidemiology of fetal alcohol syndrome and partial FAS in a South African community","volume":"88","author":"May","year":"2007","journal-title":"Drug Alcohol Depend."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/acer.12033","article-title":"Approaching the prevalence of the full spectrum of fetal alcohol spectrum disorders in a South African population-based study","volume":"37","author":"May","year":"2013","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.drugalcdep.2015.12.023","article-title":"The continuum of fetal alcohol spectrum disorders in four rural communities in South Africa: Prevalence and characteristics","volume":"159","author":"May","year":"2016","journal-title":"Drug Alcohol Depend."},{"key":"ref_14","unstructured":"Jacobs, L., Steyn, N., and Labadarios, D. (2018, January 12). \u2018Mind the Gap\u2019: Observations in the Absence of Guidelines for Alcohol Abstinence among Expectant Women in South Africa. Available online: http:\/\/repository.hsrc.ac.za\/bitstream\/handle\/20.500.11910\/3008\/7682.pdf?sequence=1."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/jpc.12814","article-title":"Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: The Lililwan project","volume":"51","author":"Fitzpatrick","year":"2015","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ridd.2017.04.001","article-title":"Prevalence and profile of neurodevelopment and fetal alcohol spectrum disorder (FASD) amongst Australian Aboriginal children living in remote communities","volume":"65","author":"Fitzpatrick","year":"2017","journal-title":"Res. Dev. Disabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.drugpo.2015.12.013","article-title":"Producing alcohol and other drugs as a policy \u2018problem\u2019: Acritical analysis of South Africa\u2019s \u2018National Drug Master Plan\u2019 (2013\u20132017)","volume":"30","author":"Pienaar","year":"2016","journal-title":"Int. J. Drug Policy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"530","DOI":"10.15288\/jsad.2011.72.530","article-title":"Evaluation of a service provider short course for prevention of fetal alcohol syndrome","volume":"72","author":"Jacobs","year":"2011","journal-title":"J. Stud. Alcohol Drugs"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/alcalc\/agr145","article-title":"Universal prevention is associated with lower prevalence of fetal alcohol spectrum disorders in Northern Cape, South Africa: A multicentre before-after study","volume":"47","author":"Chersich","year":"2012","journal-title":"Alcohol Alcohol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1111\/add.12081","article-title":"A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa","volume":"108","author":"Morojele","year":"2013","journal-title":"Addiction"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1755-7682-1-27","article-title":"Health challenges in Africa and the way forward","volume":"1","author":"Kirigia","year":"2008","journal-title":"Int. Arch. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/YCO.0000000000000315","article-title":"Fetal alcohol spectrum disorder in Africa","volume":"30","author":"Adnams","year":"2017","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_23","unstructured":"Rendall-Mkosi, K., London, L., Adnams, C., Morojele, N., McLoughlin, J.A., and Goldstone, C. (2008). Fetal Alcohol Spectrum Disorder in South Africa: Situational and Gap Analysis, UNICEF. Available online: https:\/\/www.unicef.org\/southafrica\/SAF_resources_fetalalcohol.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e019907","DOI":"10.1136\/bmjopen-2017-019907","article-title":"A modified Delphi study towards developing a guideline to inform policy on fetal alcohol spectrum disorders in South Africa: A study protocol","volume":"8","author":"Adebiyi","year":"2018","journal-title":"BMJ Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/S0277-9536(98)00445-6","article-title":"The \u2018dop\u2019 system, alcohol abuse and social control amongst farm workers in South Africa: A public health challenge","volume":"48","author":"London","year":"1999","journal-title":"Soc. Sci. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00787-014-0603-2","article-title":"Identifying maternal risk factors associated with Fetal Alcohol Spectrum Disorders: A systematic review","volume":"23","author":"Esper","year":"2014","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_27","unstructured":"Statistics South Africa (2017). Statistical Release."},{"key":"ref_28","unstructured":"Medical Research Council (MRC) (2018, January 12). Western Cape Mortality Profile 2011, Available online: www.westerncape.gov.za."},{"key":"ref_29","first-page":"871427","article-title":"Alcohol and other drug use during pegnancy among women attending midwife obstetric units in the Cape Metropole, South Africa","volume":"2014","author":"Jordaan","year":"2014","journal-title":"Adv. Prev. Med."},{"key":"ref_30","first-page":"724","article-title":"Childhood behavioural and developmental disorders\u2014Association with maternal alcohol consumption in Cape Town, South Africa","volume":"101","author":"Katwan","year":"2011","journal-title":"S. Afr. Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"34","DOI":"10.17159\/2310-3833\/2015\/v45no1a6","article-title":"\u2018I drink\u2019: mothers\u2019 alcohol consumption as both individualised and imposed occupation","volume":"45","author":"Cloete","year":"2015","journal-title":"S. Afr. J. Occup. Ther."},{"key":"ref_32","unstructured":"Charman, A., and Petersen, L. (2018, January 12). Comment on the Western Cape Alcohol-Related Harms Reduction Policy Green Paper Charman and Petersen, Sustainable Livelihoods Foundation. Available online: http:\/\/livelihoods.org.za\/wp-content\/uploads\/2016\/12\/SLF-Comments-on-Western-Cape-Government-Alcohol-Harms-Green-Paper.pdf."},{"key":"ref_33","unstructured":"Glenton, C., Lewin, S., Norris, S., and Norris, S. (2014). Chapter 15: Using evidence from qualitative research to develop WHO guidelines. WHO Handbook for Guideline Development, WHO."},{"key":"ref_34","unstructured":"Creswell, J., and Creswell, J. (2017). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, Sage Publications."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/1468794107085301","article-title":"Naturalistic inquiry and the saturation concept: A research note","volume":"8","author":"Bowen","year":"2008","journal-title":"Qual. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s11136-009-9540-9","article-title":"Qualitative research and content validity: Developing based on science and experience practices","volume":"18","author":"Brod","year":"2009","journal-title":"Qual. Life Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gale, N.K., Heath, G., Cameron, E., Rashid, S., and Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-117"},{"key":"ref_38","unstructured":"Miles, M., and Huberman, A. (1994). Qualitative Data Analysis: An Expanded Sourcebook, Sage. Available online: https:\/\/books.google.co.za\/books?hl=en&lr=&id=U4lU_-wJ5QEC&oi=fnd&pg=PR12&dq=Qualitative+data+analysis:+An+expanded+sourcecbook.&ots=kETI6LOSUR&sig=myBC5ImkUmJHO1z2hizEOBwQzD4."},{"key":"ref_39","unstructured":"Lincoln, Y.S., and Guba, E.G. (1985). Naturalistic Inquiry, Sage Publications. Available online: https:\/\/us.sagepub.com\/en-us\/nam\/naturalistic-inquiry\/book842."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"402","DOI":"10.7196\/SAMJ.6249","article-title":"Burden of Fetal Alcohol Syndrome in a rural West Coast area of South Africa","volume":"103","author":"Olivier","year":"2013","journal-title":"S. Afr. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.drugalcdep.2010.10.019","article-title":"The utilization of health care services by children with fetal alcohol syndrome in the Western Cape, South Africa","volume":"115","author":"Crede","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Popova, S., Lange, S., Burd, L., Urbanoski, K., and Rehm, J. (2013). Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada. BMC Public Health.","DOI":"10.1186\/1471-2458-13-570"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ijlp.2015.03.010","article-title":"Cost attributable to fetal alcohol spectrum disorder in the Canadian correctional system","volume":"41","author":"Popova","year":"2015","journal-title":"Int. J. Law Psychiatry"},{"key":"ref_45","first-page":"e91","article-title":"The burden of prenatal exposure to alcohol: Revised measurement of cost","volume":"16","author":"Stade","year":"2009","journal-title":"Can. J. Clin. Pharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e000880","DOI":"10.1136\/bmjgh-2018-000880","article-title":"Governing multisectoral action for health in low-income and middle-income countries: Unpacking the problem and rising to the challenge Handling editor Seye Abimbola","volume":"3","author":"Bennett","year":"2018","journal-title":"BMJ Glob. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e000890","DOI":"10.1136\/bmjgh-2018-000890","article-title":"Governing multisectoral action for health in low-income and middle-income countries: An agenda for the way forward","volume":"3","author":"Rasanathan","year":"2018","journal-title":"BMJ Glob. Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.ridd.2016.11.007","article-title":"Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders","volume":"60","author":"Pei","year":"2017","journal-title":"Res. Dev. Disabil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1352\/1934-9556-48.5.330","article-title":"Children and youth with fetal alcohol spectrum disorders: Summary of intervention recommendations after clinical diagnosis","volume":"48","author":"Jirikowic","year":"2010","journal-title":"Intellect. Dev. Disabil."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"May, P., De Vries, M., Marais, A.-S., Kalberg, W., Buckley, D., Adnams, C., Hasken, J., Tabachnick, B., Robinson, L., and Manning, M. (2017). Replication of high fetal alcohol spectrum disorders prevalence rates, child characteristics, and maternal risk factors in a second sample of rural communities in South Africa. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14050522"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00004703-200408000-00002","article-title":"Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects","volume":"25","author":"Streissguth","year":"2004","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1503\/cmaj.141593","article-title":"Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan","volume":"188","author":"Cook","year":"2016","journal-title":"CMAJ"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e20154256","DOI":"10.1542\/peds.2015-4256","article-title":"Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders","volume":"138","author":"Hoyme","year":"2016","journal-title":"Pediatrics"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Watkins, R.E., Elliott, E.J., Halliday, J., O\u2019Leary, C.M., D\u2019Antoine, H., Russell, E., Hayes, L., Peadon, E., Wilkins, A., and Jones, H.M. (2013). A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-13"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1111\/acer.12903","article-title":"Systematic review of fetal alcohol spectrum disorder interventions across the life span","volume":"39","author":"Reid","year":"2015","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_56","first-page":"e79","article-title":"Managing fetal alcohol spectrum disorder in the public school system: A needs assessment pilot","volume":"17","author":"Koren","year":"2010","journal-title":"Can. J. Clin. Pharmacol."},{"key":"ref_57","first-page":"1","article-title":"Prevention of fetal alcohol spectrum disorder: Current Canadian efforts and analysis of gaps","volume":"10","author":"Poole","year":"2016","journal-title":"Subst. Abuse"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Adebiyi, B.O., Mukumbang, F.C., Cloete, L.G., and Beytell, A.M. (2018). Exploring service providers\u2019 perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: A qualitative study. BMC Public Health.","DOI":"10.1186\/s12889-018-6126-x"},{"key":"ref_59","unstructured":"Public Health Agency of Canada (2018, August 08). Fetal Alcohol Spectrum Disorder (FASD): A Framework for Action, Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/reports-publications\/fetal-alcohol-spectrum-disorder-fasd-framework-action.html."},{"key":"ref_60","unstructured":"Australian Government (2019, February 02). Title: National Fetal Alcohol Spectrum Disorder Strategic Action Plan, Available online: http:\/\/www.dpmc.gov.au\/government\/commonwealth-coat-arms."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1097\/01.PHH.0000338382.36695.42","article-title":"Moving upstream: How interventions that address the social determinants of health can improve health and reduce disparities","volume":"14","author":"Williams","year":"2008","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e450","DOI":"10.17269\/cjph.105.4692","article-title":"Looking further upstream to prevent fetal alcohol spectrum disorder in Canada","volume":"105","author":"Sanders","year":"2014","journal-title":"Can. J. Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/6\/945\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:39:15Z","timestamp":1760186355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/6\/945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,15]]},"references-count":62,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,3]]}},"alternative-id":["ijerph16060945"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16060945","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2019,3,15]]}}}