Vocational Technical Training (VTT) in South Africa
Mitigation of Substance Abuse in Pregnancy
Our VTT was for the purposes of sharing knowledge and research in the area of Fetal Alcohol and Neonatal Abstinence Syndrome. The use of both alcohol and drugs during pregnancy can cause immediate and long term issues to the fetus in utero and in life after birth.
Clinics
We visited both non-profit early childhood education centers and clinics working with both children born to alcohol and adolescent and adults with substance use disorders. One clinic is devoted to working with adolescents and adults with substance use disorders. Issues around sexual and reproductive health and access to contraception were discussed. While the teenage birth rate in the United States has been on the decline in recent years (in 2015 22 per 1,000 deliveries were to women 15-19yo, with 8% drop from 2014 to 2015) teenage pregnancy in South Africa has been steady over the past decade (at ~50+ per 1,000 deliveries).
Coolamon House
Our journey continued as we visited a Publicly-funded behavioral health center with expertise in opioid abuse and detoxification. Of interest there was routine detoxification of pregnant women abusing opioids. They described a 7 day program where pregnant women were either weaned completely off or transitioned to medication-assisted therapy. In the United States detox in pregnancy is not recommended due to the concern for fetal well-being and heightened concern for maternal relapse. We would like to review their protocol for detox in pregnancy and discuss maternal and neonatal outcomes following this process. If we can confirm the safety of these strategies we may be able to consider detox in pregnancy as an option for women addicted to opioids in the US.
FARR
FARR another organization focuses on substance use research, diagnosis and management and awareness/prevention. The prevalence of Fetal Alcohol Spectrum Disorder (FASD) is as high as 28% in some provinces of South Africa! While this number is staggering we suspect alcohol use during pregnancy in the Unites States is under reported. We discussed that healthcare providers in the US need to do a better job of screening and supporting women abusing alcohol and other substances in pregnancy.
FASD
FASD is again the leading preventable cause of learning disability worldwide.
Alcohol exposure in pregnancy is also associated with adverse fetal effects such as intrauterine growth restriction, congenital heart defects and cleft lip and palate.
The FARR organization has implemented some tremendous community outreach programs that can act as models for us in the US to educate women about FASD and alcohol exposure in pregnancy.
We currently don’t understand what amount of alcohol is safe or when in pregnancy alcohol use has its worst effects on the developing fetus. As a result our position is that no amount of alcohol is safe at any point in pregnancy!
For women who have heavy episodic drinking behavior or who “binge” drink abstaining or quitting may be extremely difficult and alcohol withdrawal could be deadly.
FARR has developed a specific alcohol screening tool that we are looking at implementing back in Connecticut for our pregnant population
FASFacts
The most intriguing program we saw was the FASFacts (fetal alcohol syndrome Facts). Their educational program is geared towards 6th and 7th graders. This program is absolutely phenomenal!! The messaging around self-esteem, responsibility, respect and substance use prevention through FASFacts is entertaining and informative. Through experiential learning youth are engaged and taught about FASD.
For more information, please see this article written in a South African Newspaper:
https://www.constantiabergbulletin.co.za/news/opioid-use-a-concern-while-pregnant-16592930