Conception to Age 2: The First 1001 Days

Fiona Bruce Excerpts

Thursday 17th December 2015 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I must apologise to the Minister. I have a long-standing engagement in my constituency this evening, and I would be grateful to him if he released me to attend it. I will not therefore be able to listen to his winding-up speech.

I want to concentrate on the first part of the 1001 days—the period between conception and birth. A report was published earlier this year by a team from leading UK and US universities who had studied pregnant women in rural Gambia and the children to whom they gave birth. It is clear that the children conceived in the dry season, when there was not an abundance of leafy green vegetables, were seven times more likely to die in young adulthood than those conceived in the wet season, when their mothers’ diet was so much better. The research team said that later in life the impact could be seen in a lack of ability to fight viral infections and in their chances of surviving cancers such as leukaemia and lung cancer. That report shows the clear impact of what the mother ingests on her system and that of the unborn child.

Something that we ought to be much clearer about in this country, but that we sadly are not, is the effect of alcohol consumed by the mother during those first precious days of a child’s life in the womb. The National Society for the Prevention of Cruelty to Children estimates that about 7,000 babies born in the UK each year suffer the effects of alcohol drunk during pregnancy.

I pay tribute to the hon. Member for Sefton Central (Bill Esterson), who is chair of the all-party parliamentary group for foetal alcohol spectrum disorder, of which I am the vice-chair. This week, we published a report on the picture of FASD in the UK today, following an inquiry that ran throughout the autumn. We held a number of hearings with families and young people who have been affected by FASD, as well as with members of the medical professions and other interested organisations. The report is so substantial and so deeply concerning that, although you have been good enough to call me before the chair of the all-party group, Madam Deputy Speaker, it might have been more appropriate if we had been called the other way around. None the less, the report has such a lot of substance that I hope what I say will complement, rather than duplicate, what he will say.

The evidence that we gathered was severely alarming in respect of both the far wider impact of FASD compared with what is understood in this country and the lack of clinical and other support available to families who are affected. We learned that a mother need not consume large amounts of alcohol during her pregnancy to be affected, because individual women’s constitutions respond differently to alcohol consumption.

The impact on the unborn child, which can last for the rest of their life, can be profound. FASD causes organic brain damage in an unborn child. We were told that it causes heart defects, dental issues, eyesight problems, bladder difficulties, walking difficulties, cognitive challenges and memory and behavioural difficulties. Often it means that babies are premature. We heard about the emotional impact on those affected by FASD as they develop into young people and move into adulthood: they can withdraw from society, become unpredictable and even become suicidal. That places great stress on parents and carers, many of whom experience periods of isolation and ill health. The inquiry heard that it is likely that a much higher proportion of children are born with FASD than is currently recognised. Those children will have a variety of difficulties in childhood and in later life.

The tragedy is that, theoretically, FASD is 100% preventable if all pregnant women are given clear advice on the risks of alcohol intake to their unborn child. We were told that the best advice for young women is not to drink if they are considering becoming pregnant, since there are effects even at the earliest stage.

Equally tragic is the fact that in the UK there have been decades of mixed messages regarding the right level of alcohol intake during pregnancy. I remember that from when I had my children, which is well over 20 years ago. The all-party group was advised that a clear message should be given by Government Departments that, just as smoking during pregnancy affected the unborn child and should be avoided, so too did alcohol and it too should be avoided.

For the UK not to be sending that message is not only tragic for the families concerned; it goes against international best practice, which is to advocate that alcohol be avoided if a woman is pregnant, thinks she might be pregnant or is trying to conceive. In Canada, children as young as primary school age are taught that. Pregnant women in Denmark, France, Israel, Norway, Mexico, Australia, Ireland, New Zealand, Spain and the Netherlands are advised to abstain completely from alcohol. Since 1981, the USA has advocated that

“no alcohol is safest for baby and you.”

Without such a clear message, pregnant women in the UK are left confused and uncertain. I know from my work as the chair of the all-party group on alcohol harm that few people can accurately measure one unit of alcohol. If a message is sent out that one or two units a week is okay, it is probably easy to think, “Well, why not three or even four or more?”

One of the reasons that women are confused stems from the unclear guidelines provided by UK professional and governmental bodies. Although NICE and the Department of Health warn of the potential for alcohol to harm an unborn child, incredibly they do not go on to stipulate that women should abstain from drinking during pregnancy. The Government are currently carrying out an alcohol review, and I hope they will seriously consider that issue. By contrast, the British Medical Association advocates that no alcohol should be drunk during pregnancy. As a result of those mixed messages, not only are women confused but many midwives are uncomfortable about giving advice on alcohol. A study that questioned 200 midwives found that only 60% asked women about their drinking habits, 30% advised against binge-drinking, and only 10% were aware of FASD. As our report says:

“this is astonishing and deeply worrying, and something which must be rectified as a matter of urgency.”

More encouragingly, 93% of midwives said that they would be comfortable advising that no alcohol should be drunk during pregnancy if that was the consistent message from the Government. In the absence of such clarity, however, they are afraid to offer such advice.

Our inquiry also revealed a similar lack of in-depth knowledge about FASD across the medical profession. There is only one specialist FASD clinic in the UK, and it is wholly overstretched. That lack of in-depth knowledge means that children with FASD are often given multiple inaccurate diagnoses, such as ADHD, autism or an attachment disorder. Appropriate support mechanisms are rarely put in place, and families are left frustrated and confused. It is critical that FASD is given a higher priority within the NHS for research, diagnostic, and support services.

[Mr Graham Allen]

The hon. Lady is making a fascinating contribution. Given that the Minister is in his place, is this a good moment for her to comment on the failure to fund research into the prevalence of foetal alcohol syndrome? I am sure she is coming to that, but given that the Minister is paying great attention, perhaps this is a good moment to get that message sprayed on to the Department’s eyeballs.

[Fiona Bruce]

I thank the hon. Gentleman for that intervention. Our report states that because of inadequate research in this country, there is insufficient information to encourage those involved—including, we believe, Government representatives—to take action.

Several of our witnesses testified that there must be more appropriate training on FASD among the medical profession, and national standards must be adhered to. For example, we heard how diagnosis could take place as early as for a one-month-old child, or as late as at 10 years, or not at all. It appears to rely on which professional a child sees. Time and again we heard from families, including parents, grandparents, adoptive parents and foster carers, that they had to explain to medical staff the diagnostic nuances of FASD.

As I have said, the extent of this condition has been under-recognised by successive Governments. Research now indicates that 30% to 50% of children in foster care could be affected by FASD, and a study mentioned in our report from an audit in Peterborough, published in October 2015, showed that 75% of children referred for adoption had a history of pre-natal alcohol exposure. If those figures are extrapolated across the UK, that should have major implications for Government policy on fostering and adoption. Sadly, there are also impacts on the criminal justice system, and our inquiry heard of vulnerable young people with FASD who move into adulthood where they cannot meet societal expectations and behavioural norms. Those people are being exploited by criminal gangs and sexual predators, which is a result—certainly in part—of a lack of concern, understanding and support for them and their condition.

In conclusion, the seriousness of the problem cannot be overstated. Our report makes a number of recommendations that the hon. Member for Sefton Central may well go into in more detail. The impact on the early stages of a child’s life cannot be overstated. Even the alcohol industry has taken considerable steps to send warnings not to drink during pregnancy. Ninety-one per cent. of alcoholic drinks in bottles and cans now carry a warning.

That is not enough, however. A study by Drinkaware revealed that more than half of pregnant women in the UK receive no advice at all about drinking while pregnant. The original clinical diagnosis of FASD was made in 1973. Our inquiry showed that

“in the four decades since then, the UK as a whole has still barely acknowledged its existence.”

That must change, and the Government must take a lead.