Alcohol Harm

Debate between Bill Esterson and Kelvin Hopkins

Thursday 2nd February 2017 Westminster Hall

[Bill Esterson]

Yes, that is right. My right hon. Friend has described his experience before, and I am sure that he will say more later. Many people are affected by being children of alcoholics; I think that the issue is directly related and a similar concern and challenge. Poverty and inequality are clearly linked to the damage done by misuse of alcohol, and I am afraid that the group on which I am concentrating is one of the most affected in our society.

We heard in our inquiry about the lack of support. There is only one specialist clinic in this country to diagnose FASD—it is in Surrey, and is led brilliantly by Dr Raja Mukherjee, who gave evidence to our inquiry—but that simply is not good enough. If 35,000 children are affected every year, we need a lot more than one clinic to help diagnose them, because diagnosis is needed in order to ensure that support is available.

[Kelvin Hopkins]

I applaud everything that my hon. Friend is saying in his speech. It was reported at one stage during our deliberations on the report that some medical staff literally do not know about FASD, even now. That is appalling.

[Bill Esterson]

That is right. The symptoms are misunderstood and significantly misdiagnosed, and too many professionals dismiss them. I have seen entirely contradictory diagnoses—doctors have described FASD symptoms perfectly well and then said that the child does not have it, due to the kind of misunderstanding that my hon. Friend just mentioned. We must improve understanding among health professionals. We must improve awareness, information and education among professionals, not just in health but in education.

In our inquiry, we also heard that children often cope at nursery, reception and key stage 1, and well into key stage 2, and it is only much later—from about year 6 onwards, as the expectation of independence grows in the school system—that the real problems start to emerge. Children who are damaged in this way find it difficult to cope in the school system, but because they have not been diagnosed early—because there has been no awareness or understanding, and they have got that far in the school system—it is assumed that FASD is not the problem, and that it might be due to what is going on at home or other external reasons, when the true cause is a disability. Again, we need greater support, awareness, understanding and training for education professionals as well as those in health and elsewhere.

What is needed? The Government should consider the following objectives. One objective should be to reduce the number of children exposed to alcohol during pregnancy. The Lancet’s report goes into great depth: international research suggests that just under 10% of the world’s population of women drink during pregnancy, but in this country, the figure is 41%, more than four times the international average. A similar figure was presented last year in the evidence of the FASD Trust, which serves as the secretariat for the all-party group and for which I am very grateful. That level of drinking during pregnancy suggests that the incidence of FASD may be four times higher in the UK than in the rest of the world. If we follow that logic, the World Health Organisation’s international figure is 1%, so in this country it may be 4% or 5%—that is where the figure of 35,000 babies comes from.

As well as an objective to reduce exposure to alcohol during pregnancy, the Government should introduce an objective to increase support and understanding in schools, in the health and care sector, in criminal justice and in wider society. How should they go about that? During our inquiry, we heard that the phrase should be used is

“no alcohol in pregnancy is best for baby and you”.

That fits the description of the strategy that we should adopt in this country. I welcome the fact that the chief medical officer revised the guidelines after we published our report—perhaps not entirely because of it, but I am sure we contributed. That was a big step forward. The guidelines now say that women who are pregnant or are trying to conceive should not drink alcohol at all. That is right, but by no means does it go far enough, because people do not know the guidelines—I am afraid that the increase in alcohol consumption suggests that, sadly, that is all too true.

As part of our strategy, we have to increase awareness, not only among professionals but among the wider population, of the support needed for women before pregnancy. In north America, which my hon. Friend the Member for Luton North mentioned, information is displayed in all the health facilities, education facilities and even airports—I have seen big signs in Canadian airports that say “Don’t drink if you’re pregnant or trying to conceive”.

[Kelvin Hopkins]

Another factor in America that I did not mention, because people draw back from it, is that people who are under the age of 21 cannot drink alcohol, and anyone who supplies alcohol to somebody under 21 can be sent to prison. That actually happened to a young Englishwoman who was on holiday in Florida: she provided alcohol to her younger sister and was sent to prison for corrupting a minor. It is taken very seriously indeed.

[Bill Esterson]

I am sure that the Minister has heard my hon. Friend’s comments. I agree that we must raise awareness among girls—and among boys too, because it is really important that boys and men play their part in influencing their partners in abstaining from drinking.

Awareness among professionals of how to prevent drinking during pregnancy has to be part of our strategy, but so does the support that is needed afterwards. Drinking during pregnancy will still happen, however much we are able to reduce it. Very sadly, some of the worst damage happens straight after conception; if someone has a drink before they know they are pregnant, it is too late to do anything about that drink. Support is essential throughout society, and it begins with awareness.

I was really disappointed that the briefing note for this debate did not make reference to foetal alcohol spectrum disorder. It made some really good points about other issues that we have discussed today, but it did not mention FASD. Given that FASD was one of the topics clearly indicated in the bid for the debate, that was really unfortunate—I shall not say anything stronger.

Foetal Alcohol Syndrome

Debate between Bill Esterson and Kelvin Hopkins

Tuesday 14th October 2014 Westminster Hall

[Bill Esterson (Sefton Central) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I hope that, like me, having done lots of research on this subject, you will have discovered how important it is and why it is so important that we are debating it this afternoon. I hope that there will be commitments from the Government on concrete action.

Last Thursday, Sir Al Aynsley-Green published on Opendemocracy.net a fantastic letter describing what goes on elsewhere to address problems caused by drinking during pregnancy. The title of his article is “If you could prevent brain damage in a child, would you?” Everybody is going to answer yes to that, but are we preventing brain damage in children? At the moment, there is a large question about whether we in this country are doing enough to prevent such brain damage.

I am going to give the Minister a bit of warning about what I am looking for from her in this debate. I should like her to reiterate the Government’s advice for pregnant women. Is that advice not to drink at all during pregnancy? Will she say what actions the Government are taking to ensure that women and their partners are fully aware of the risks and that society as a whole is aware of the risks? What is her view of and attitude to the potential for mandatory labelling of alcohol products, as in France?

I understand that, at the moment, the Government say that women should not drink at all during pregnancy, but that, at the same time, they say that women who do not want to stop drinking altogether should have only one or two units a week. Some would say that this is contradictory advice. We will return to what the advice should be and discuss whether there should be different advice and whether there is indeed a safe limit.

[Kelvin Hopkins (Luton North) (Lab)]

I congratulate my hon. Friend on securing this debate. Does he accept the recent evidence that suggests that even moderate drinking has an effect on IQ in babies and that the wise advice is that there should no drinking at all during pregnancy?

[Bill Esterson]

My hon. Friend makes a point about whether there is a safe limit, and I will discuss that. From the evidence I have looked at, my conclusion is that we cannot possibly say that there is a safe limit and that the advice should be no alcohol during pregnancy.

The National Organisation for Foetal Alcohol Syndrome UK tells us that there is no way to know for sure what impact drinking alcohol might have on an unborn baby. The same point is made by the British Pregnancy Advisory Service. According to the NOFAS, alcohol could have different effects at different times during pregnancy, and it might affect one baby but not another. We know that heavy drinking and binge drinking during pregnancy could increase the risk of foetal alcohol spectrum disorder, but, as I say, we do not know what the safe limit is. My hon. Friend makes the point that the best advice is to abstain completely. According to the NOFAS, at any stage of pregnancy a woman can benefit her baby by avoiding alcohol.

Foetal alcohol spectrum disorder is an umbrella term that covers foetal alcohol syndrome, alcohol-related neurodevelopmental disorders, alcohol-related birth defects, foetal alcohol effects and partial foetal alcohol syndrome. When a pregnant woman drinks, the alcohol in her blood passes freely through the placenta into the developing baby’s blood. Because the foetus does not have a fully developed liver, it cannot filter out the toxins from the alcohol as an adult can. Instead, the alcohol circulates in the baby’s bloodstream. It can destroy brain cells and damage the nervous system of the foetus at any point during the nine months of pregnancy. Those findings have been backed up by research done around the world.

The effects on a child can be mild or severe, ranging from reduced intellectual ability and attention deficit disorder to heart problems and even death. Many children experience serious behavioural and social difficulties that last a lifetime. Although alcohol can affect the development of cells and organs, the brain and nervous systems are particularly vulnerable. We cannot see the neurological brain damage that is caused, but there are a number of invisible characteristics in babies born with FASD, which include attention deficits; memory deficits; hyperactivity; difficulty with abstract concepts, including maths, time and money; poor problem-solving skills; difficulty learning from consequences; and confused social skills. There are also a number of possible physical effects, including smaller head circumference, linked to smaller brain size and brain damage; heart problems; limb damage; kidney damage; damage to the structure of the brain; eye problems; hearing problems; and specific facial characteristics.

Some studies suggest that 1% of live births in Europe are affected by FASD. Many children born with FASD are not diagnosed or do not receive a correct diagnosis, which makes calculating the prevalence of the condition extremely difficult. Because there is no proven safe level for alcohol consumption during pregnancy, the only risk-free approach is to avoid alcohol completely during pregnancy, when trying to conceive and when breastfeeding.

In considering whether a child has FAS, it is also true that they can be very loving, friendly, gregarious, outgoing and trusting—all good traits—but without a sense of balance, these traits can often leave them open to being taken advantage of and abused by others. It appears that there is no cure but there are actions that can help, including early diagnosis; support for families; health monitoring; therapy and medication; support and safety at home; strong boundaries and routines, allied to flexibility from carers; simple instructions; and training and support in social skills. Above all, prevention is key. There should be better awareness so that fewer women drink in pregnancy, and that means providing more advice and support for vulnerable groups of young women. Drinking among young women has increased, so there needs to be better understanding among young women generally.

--- Later in debate ---

[Bill Esterson]

Indeed it is. Awareness of the dangers, particularly of smoking during pregnancy, is much higher. Why, when we know what we know about smoking and the damage it causes to the unborn child, would we not ensure that the same awareness is in place for alcohol?

We have known about the dangers of alcohol to the foetus for a long time. Judges 13:7 says:

“Behold, thou shalt conceive, and bear a son; and now drink no wine or strong drink”.

Aristotle wrote about the effects of women drinking during pregnancy. Sir Francis Bacon advised women not to drink during pregnancy. The gin epidemic saw a rise in birth defects in Britain in the 1700s. The infant death rate was 20% higher for alcoholic women in prison in 1899 as compared with the rest of the population. Distinct facial characteristics were noted by French researcher Dr Paul Lemoine—I apologise for the pronunciation—who studied families where mothers drank a lot in pregnancy. The term “foetal alcohol syndrome” was first used by English researchers Jones and Smith in 1973.

There has been extensive preventive and clinical work in Canada, the United States and Australia. In 2007, Lord Mitchell’s private Members’ Bill called for it to be mandatory for alcohol sellers to display warning labels. That was seven years ago, and it has not happened yet. We saw recent success when legislation on smoking in cars with children present was passed. The Minister was heavily involved, and I commend her for her work on that. Perhaps we can persuade her to do the same on the labelling of alcohol.

At the severe end of the spectrum, there are some 7,000 live births of children with foetal alcohol syndrome each year in the UK, with three or four times as many babies born with the wider foetal alcohol spectrum disorder. There is, however, a suggestion of under-diagnosis, as symptoms are similar to those resulting from such conditions as attention deficit hyperactivity disorder or autistic spectrum disorder. The neglect of children who end up in care or being adopted can also produce behaviours that are similar to those seen with foetal alcohol spectrum disorder. The combined effects of neglect and FASD can make life difficult for children in care and those around them.

Diagnosis among some groups can be difficult. As the parent of two adopted children, I have no idea whether their birth mother drank during pregnancy. As a result, behaviours consistent with foetal alcohol spectrum disorder, which my children exhibit, could be due to neglect or alcohol consumption during pregnancy or both or neither. There is no way of knowing. The point is that we have to raise awareness, because we have to reduce risk. The education and development needs of this group of children are specialised. I refer the Minister to the research and ask her to look further at what is needed and just how demanding it is to enable children with foetal alcohol spectrum disorders to achieve their potential, given their difficulties in learning and in relating to others.

In 2009, the National Organisation for Foetal Alcohol Syndrome said:

“Teachers and teaching support staff will undoubtedly meet children with FASD in their classrooms. They need to know how to respond to their learning needs effectively, enable them to maximise their potential, improve their life chances and take their places alongside their mainstream peers as citizens…FASD now accounts for the largest, non-genetic group of children presenting with learning difficulties/disabilities. The difficulties that children face in the classroom epitomise that much-used phrase ‘complex needs’…Their unusual style of learning and their extreme challenging behaviour is out of the experience of many teachers”—

and support staff—

“and, as there is significant shortfall in guidance for teachers on how to educate children with FASD in the UK, teachers find themselves ‘pedagogically bereft’.”

We have to look at how we can reduce the number of children with FASD. Advice that says that someone may want to stop could and should be harder hitting. As my hon. Friend said, drinking while pregnant will harm the baby, just as smoking does. The private Member’s Bill introduced by Lord Mitchell in 2007 called for mandatory labelling. In 2005, the French Government made it a legal requirement for alcohol to display a warning for pregnant women on the container. The French research quoted the same dangers, research and risks as I have. Crucially, alcohol, according to the French research, can affect the brain at any stage of pregnancy. There is no safe level. The advice in France is that the safest option is no alcohol during pregnancy. That comes from the alcohol project manager at the National Institute for Prevention and Health Education. It faced a lawsuit in 2004, and later that year moved to change the law. In 2005, the law was changed. In France, it now says on bottles of alcohol that the consumption of alcoholic drinks during pregnancy, even in small amounts, may have serious consequences for the child’s health. There is also the symbol of a pregnant woman drinking in a red circle with a red line through the centre. Why do we not have that here?

The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) was on the Health Committee in 2012. At that time, he was quoted as saying that there should be better warnings on the dangers of alcohol. He and others in the medical profession have warned of those dangers for some time, including those posed by drinking during pregnancy. He called for greater publicising of the dangers to raise awareness. As a Minister—along with his colleagues, whom he can advise—he is in a better position to act than he was in 2012.

Last week, the British Pregnancy Advisory Service raised concerns about the impact on pregnant women of the recent publicity on this issue, of which there has been a significant amount in recent months. The BPAS said that women are considering abortions because they fear they may have harmed their unborn child before they realised they were pregnant. It stated that occasional binge drinking was unlikely to cause harm to the baby. From the research I have looked at and the evidence available to us, it is true that binge drinking may not harm a baby, if it happens on occasion, but the trouble with that advice is that there is no way of knowing which babies will be harmed. The concern raised by the BPAS should not be taken lightly. It says that media coverage has caused panic among some pregnant women. That is the last thing that anyone who takes an interest in this issue wants, but, equally, there is a danger that playing down the risks of damage from foetal alcohol spectrum disorders could lead to some women continuing to drink, thinking it is safe when it is not. The BPAS points out that half of pregnancies are unplanned, so many women do not know that they are pregnant, meaning that many women will be drinking alcohol while pregnant. I agree that women should not be alarmed as there is nothing that can be done about what has already happened. However, if greater awareness of the risks can reduce the number of women drinking while pregnant in future, which is the experience in other countries, that must be a step forward.

[Kelvin Hopkins]

My hon. Friend is making a thoughtful speech. He spoke of unplanned pregnancies. The high level of teenage pregnancies in this country is a serious problem. The number is reducing, but it is still high. Young women who may have been drinking and then become pregnant following unprotected sex and are unaware of that may carry on drinking on a regular basis and cause terrible damage to their babies.

[Bill Esterson]

That is an incredibly important point and is why what Sir Al Aynsley-Green and others have said about Canada is so important. We need to increase awareness among much younger children about the possible damage, so that at the very least young women have the facts available to them. Many other measures are needed to make young women, and young men, aware of concerns around teenage pregnancy.

In 2008, Lord Mitchell proposed that labels on alcoholic drinks should say, “Avoid alcohol if pregnant or trying to conceive.” Some will say that that will not necessarily help the women referred to by the BPAS who are not planning to become pregnant, but it will help those who are planning a pregnancy. I wonder how many other women will consider whether they should drink alcohol if they see the advice and how many men may reiterate the advice and increase awareness, which is what has happened in France. This is not just about women. Men have an important role to play in supporting women, and education of the dangers should target men as well as women. Lord Mitchell also gave the example of tobacco labelling as a good reason for making labelling a legal requirement and not a voluntary code. The damage done to children by alcohol and the damage done by smoking are both important and deserving of maximum attention. I mentioned before the Minister’s support for banning smoking in vehicles with children, so I hope that she will agree when it comes to the labelling of alcohol.

“Foetal alcohol spectrum disorder and foetal alcohol syndrome are completely preventable intellectual and developmental deficits in individuals, resulting from maternal consumption during pregnancy.”

Those are the words of the National Organisation for Foetal Alcohol Syndrome. The time has come to listen to those words and for greater action to reduce the number of children who suffer from foetal alcohol syndrome and the wider spectrum of foetal alcohol disorders to ensure that women in particular have greater awareness of the risks and to ensure that children, families, school staff and all those trying to cope with the results of FASD get more of the support that they need. Some women become pregnant and do not drink alcohol and are giving the best protection against FASD. However, some women drink while pregnant unaware of the risks, and some drink while pregnant unaware that they are pregnant. A further group chooses to drink while pregnant and aware of the risks. Different strategies are required for each group, but it is clear that reducing the number of women who drink alcohol while pregnant is the right way forward and that should be where policy is directed. I have suggested labelling, greater awareness and education at school, and I look forward to hearing the Minister’s suggestions.

As I said earlier, the Canadian federal and provincial governments are convinced that FASD is the most important preventable cause of severe childhood brain damage. The time has come for our Government to decide whether they agree with that statement and whether they will take the necessary action.