Descripción de la Ingeniería del Proyecto

According to Olivier, (2006:1) the Mother, Child and Women‟s Health sub-directorate (MCWH) of the Department of Health in the Western Cape Province has been involved in the identification and prevention of FAS since the 1980s and various FAS research projects have consequently been undertaken in this Province. However, up to now, not many of these studies have been undertaken to develop intervention programmes to address the problems of alcohol consumption during pregnancy. May et al, (cited in Rosenthal, Christianson & Cordero, 2005:1099) highlight the importance of identifying risk factors for the prevention of FAS (as discussed in section 2.3 above). Binge drinking during pregnancy, maternal age, poor education, inadequate nutrition, genetic causes, pregnancy and poor socio-economic circumstances provide indicators for identifying women at risk and eligible for the implementation of effective interventions. May et al, (cited in Rosenthal, Christianson & Cordero, 2005:1099), further pointed out that prevention should address social improvement, proven techniques of birth control, treatment for alcohol abuse and screening for alcohol use during prenatal services.

FASD is a maternal and child health issue (MCH) that has been recognised in the South African National Policy Guidelines for the Management and Prevention of Genetic Disorders, Birth Defects and Disabilities (Rosenthal, Christianson & Cordero, 2005:1099). FASD prevention programmes could therefore be integrated with national MCH programmes for the prevention of HIV and sexually transmitted infections (STIs). Such integrated programmes could ensure wider support, planning, resources and finances. May et al, (cited in Rosenthal, Christianson & Cordero, 2005:1100) emphasise “training” as a crucial element of a prevention strategy. According to him, health care workers at all levels should be trained to screen, diagnose, prevent, and treat maternal alcohol consumption during pregnancy (Rosenthal, Christianson & Cordero, 2005:1100).

According to Marais, (2006:9), the best prevention strategy to eliminate or reduce alcohol consumption during pregnancy includes the following:

life skills training programmes designed to teach personal and social skills to help young people resist social influences to use substances,

routine screening of pregnant women for use of alcohol and other substances in various settings,

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brief interventions in prenatal settings (such as clinics) which are effective low-cost means of helping pregnant women with early-stage alcohol consumption problems, and

intensive case management for high-risk pregnant women can be effective in promoting family planning, facilitating access to substance abuse treatment, ensuring retention in treatment, reducing consumption and promoting connections to community services.

The Canadian Centre on Substance Abuse (CCSA) undertook a review of more than 500 papers to formulate the best practices on Foetal Alcohol Syndrome, Foetal Alcohol Effects and substance use during pregnancy. The project, commissioned by Health Canada, took place during 1999 and was supported by a national steering committee (Roberts & Nanson, 2000:1). The focus of the project involved two main elements; firstly, formulating best practices based on literature reviews and, secondly, an evaluation of FAS-related activities across Canada (Roberts & Nanson, 2000:1). From this review, it can be seen that “best practice” definitions for the prevention of FASD are grouped around three distinct activities:

1. awareness-raising before onset, 2. identification, and

3. dealing with the consequences of FASD.

For this review, “best practice statements” were based on the opinions of experts, practitioners, educators, consumers as well as scientific evidence. Literature and other information were classified into “some” evidence, “moderate” evidence and “good” evidence, depending on the involvement of a control group to back empirical findings (Roberts & Nanson, 2000:2). It was found that many FAS-related intervention studies have not been empirically tested, especially with the use of a pre-test post-test design with an experimental and control group. In such a study, the control group receives no intervention. This however, entails major ethical considerations (Roberts & Nanson, 2000:2).

Prevention takes place at three different levels, namely primary, secondary and tertiary levels (Roberts & Nanson, 2000:3). Primary prevention is aimed at raising awareness with the general population to promote physical and emotional health (raising public awareness, community education and alcohol control measures). Secondary prevention activities aim to address a problem before it becomes too

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severe or persistent (outreach, screening and referral of pregnant women or women of child-bearing age who are abusing alcohol). Tertiary prevention activities are aimed at women who already gave birth to a child with Foetal Alcohol Spectrum Disorder or who are suffering from FASD themselves, by providing substance abuse treatment and birth control services. Identification of FASD involves screening, referral and diagnosis of newborns, children, adolescents or adults affected by prenatal alcohol use. Intervention activities are intended to prevent or reduce the harm associated with primary and secondary disabilities (Roberts & Nanson, 2000:3).

Finkelstein (cited in Roberts & Nanson, 2000:5) explains that it is important to understand the nature and scope of a problem when planning an intervention. In this case the nature and scope would be the amount of alcohol consumption and the circumstances under which alcohol is used by women of child-bearing age, pregnant women and women who have given birth to a child affected by alcohol consumption. However, limited information is available due to a lack of screening and under- reporting of alcohol use by women in clinical interventions (Roberts & Nanson, 2000:5).

Due to the multi-faceted nature of behaviour change, interventions reflect this complexity in order to facilitate the targeted change in behaviour. The next section explores the different approaches to interventions and emphasises the complex interplay that exists between the intervention and the targeted beneficiary of such an intervention.