Official Report 1118KB pdf
The final item of business is a members’ business debate on motion S6M-18639, in the name of Rona Mackay, on international fetal alcohol spectrum disorder day and the need for awareness. The debate will be concluded without any question being put. I invite members who wish to participate to press their request-to-speak buttons.
Motion debated,
That the Parliament notes that 9 September 2025 is International FASD Day; understands that FASD, or Fetal Alcohol Spectrum Disorder, is a preventable neurodevelopmental condition with lifelong cognitive, emotional and behavioural challenges, which occurs when prenatal alcohol exposure affects the developing brain and body; acknowledges reports that 4% of the population are affected, and each person with FASD is affected differently, often requiring lifelong support in education and post school settings to optimise their life experience; understands that, while the guideline in Scotland for pregnant women, or women trying to conceive is, “no alcohol, no risk”, 46% of pregnancies in the UK are unplanned so without better awareness, people may continue their pre-conception lifestyle until they have a positive pregnancy test; recognises the importance of prevention, early diagnosis and intervention; notes that unrecognised FASD can lead to people ending up in vulnerable situations, particularly given reports that many professionals do not fully understand the symptoms and effects of FASD; understands that populations of concern include people in contact with the criminal justice system, care experienced people, people who are homeless, and people with substance misuse issues; notes the view that training for health and social care professionals in identifying possible FASD is vital; considers that the use of Alcohol Brief Interventions for pregnant women is a useful tool in reducing the risk of FASD; notes the view that alcohol producers should be mandated to provide clear written pregnancy warnings on their products, and understands that there is an estimated economic benefit of £1.4 million for each case of FASD that is avoided.
18:08
It is my pleasure to bring this important debate on fetal alcohol spectrum disorder, known as FASD, to the chamber again, and I thank members from across the chamber for supporting my motion. I look forward to hearing everyone’s contributions, because we need to talk about the issue and, crucially, raise awareness of the condition, which is a significant public health matter in Scotland and globally.
FASD is a lifelong condition for which there is no cure, but—this is why we must raise awareness—it is entirely preventable. I say at the outset that I have no wish to blame or shame women: this is a plea to clinicians and to those in power—yes, politicians—that we must bring this underdiagnosed and devastating condition into mainstream public awareness. It is thought that around 4 per cent of the population are affected, and each person with FASD is affected differently, often requiring lifelong support and education in post-school settings to optimise their life experience.
FASD is a family of complex conditions arising from exposure to alcohol at any stage of pregnancy. It affects the child’s physical and mental health and capacity to learn, which continues into adulthood and is the most common, but unrecognised, neurodevelopmental condition in Scotland. It has been estimated that between 3 and 5 per cent of Scotland’s young people are living with FASD, but a recent study in the west of Scotland found that as many as 40 per cent of babies showed signs of exposure to alcohol in their second trimester, suggesting a higher prevalence than was previously thought to be the case. The Scottish Government estimated that in 2019, at least 172,000 children, young people and adults had FASD.
Of equal weight to prevention are early diagnosis and support for people with FASD, which are crucial to avoid a range of issues that are commonly encountered such as mental health problems, unemployment, disrupted school experiences, imprisonment and in-patient psychiatric care. Care-experienced people and homeless people are disproportionately affected. However, as with all conditions, the severity of symptoms varies. Some people are moderately affected and are able to live relatively normal lives with support and recognition of their condition.
At this point, I will introduce Dr Jonathan Sher to the debate. Dr Sher is a renowned international expert on FASD, a former deputy director of the Queen’s Nursing Institute Scotland and a founding partner of Scotland’s coalition for healthier pregnancies, better lives. In my opinion—at the great risk of embarrassing him—Dr Sher has done more to educate people and raise awareness of the condition than anyone on the planet. He believes that the primary prevention of FASD, along with efforts to diagnose and assist those who are harmed by FASD, should become equal priorities throughout Scotland.
The savings on the prevention side would easily more than cover the endless costs of failing to prevent FASD. A Canadian study reported that analysis indicated additional costs of $1.4 million—that is more than £1 million—to public bodies for each person with FASD. We must, therefore, identify solutions and take meaningful actions, and not just perennially identify and analyse problems.
Clinicians must be trained properly on the diagnosis of FASD and ways to assist those who are affected by it. A public awareness campaign is necessary to highlight the dangers of alcohol to expectant parents and those who are planning to conceive. Of course, alcohol producers must play a part in that initiative, with clear messages on their merchandise about the dangers of drinking during pregnancy. They absolutely have a public responsibility to do that.
Inconsistent messaging on alcohol products is concerning, with around a quarter of women in the United Kingdom reportedly unaware of the current health advice. Dr Sher points out that alcohol affects everyone in different ways and that what might simply have an impact on one person could be devastating to another. It is a bit like Russian roulette: will that one drink be the one that affects your baby?
Back in the day, the message to pregnant women of my generation was, “Limit your alcohol intake—the odd glass of wine won’t do any harm as long as you’re sensible.” Dr Sher’s message is that the only way to avoid giving your baby FASD is to drink no alcohol at all. He also highlighted the fact that a large number of children who go through the children’s hearings system—I am a former panel member—may well have been affected by FASD. Support for families who are affected by FASD, and early diagnosis, can transform the prospects of young people who are affected. The use of alcohol brief interventions for pregnant women is also a useful tool in reducing the risk.
Adoption UK’s FASD hub Scotland provides invaluable telephone and online support for families who are living with FASD, and is funded by the Scottish Government. However, the problems with diagnosis persist. In a previous debate on FASD in Parliament, I noted that Adoption UK had
“reported that 55 per cent of children waited two years or longer for their ... diagnosis and that 78 per cent of parents whose children were diagnosed with FASD did not feel that healthcare professionals are knowledgeable about the condition or its various presentations.”—[Official Report, 23 September 2021; c 37.]
Adoption UK recommends improved diagnosis and support for people who are living with FASD, through the introduction of a dedicated multiyear national strategy on treatment and prevention.
The Scottish Government’s “Alcohol Framework 2018: Preventing Harm” includes a commitment to
“support the current system to be much more responsive to the needs of individuals, families and communities affected by FASD”.
I look forward to a response from the Minister for Social Care and Mental Wellbeing on how that commitment is progressing.
The Government also undertook to develop Scotland’s first national pre-conception framework, supporting the health of women of childbearing age and their families. A key element of the framework will be supporting women to access reproductive health services and avoid unplanned pregnancy.
Scotland has an unhealthy relationship with alcohol, which we are trying to address by way of minimum unit pricing and improved public awareness of the dangers of alcohol. One in four people regularly drink above the levels in the chief medical officers’ low-risk drinking guidelines. Alcohol consumption among women of childbearing age is common, and 46 per cent of pregnancies in Scotland are estimated to be unplanned.
To conclude, FASD is a condition that is entirely preventable. It requires women not to drink for the entirety of their pregnancy, including avoiding alcohol while trying to conceive. The chief medical officers’ advice is, “No alcohol, no risk,” and I do not think that that is too much to ask in order to bring a healthy baby into the world.
We move to the open debate.
18:15
I thank Rona Mackay for once again bringing this important issue to the chamber. It is an issue that does not always get the attention that it deserves, but it affects thousands of people across Scotland.
Fetal alcohol spectrum disorder, or FASD, is a lifelong condition that is caused by alcohol exposure during pregnancy. It is more common than many realise—in fact, research suggests that it may be one of the most prevalent neurodevelopmental conditions in the country—yet far too often it goes undiagnosed, misunderstood or unsupported.
It is estimated that up to 5 per cent of people in Scotland are living with FASD, which is, as we heard from Rona Mackay, a lifelong but preventable condition. That is higher than the average prevalence of autism in Scotland, and we talk about autism quite a lot. A study by the University of Glasgow suggests that the prevalence of FASD could be higher than previously thought, with 42 per cent of babies having been exposed to alcohol in pregnancy and 15 per cent showing signs of exposure to frequent high consumption.
Those are not just numbers on a page; they represent lives with real challenges. People who are affected by FASD may face difficulties with memory, attention, behaviour, executive functioning, social judgment and emotional regulation. Many also live with physical health conditions that affect their heart, kidneys, eyes or hearing. Without timely support, people with FASD are at a higher risk of secondary harms, including, as we heard, mental health problems, addiction, involvement with the justice system and even premature mortality.
However, I make it clear that FASD is preventable. It is entirely caused by alcohol exposure in the womb, yet many expectant mothers do not know the full risk. In the UK, more than a quarter of women are unaware of advice to avoid alcohol during pregnancy. As we heard, that is the only way to stop FASD, and we need to encourage and educate younger women in that regard. Like Rona Mackay, when I had my baby, I was told, “Cut down—go and get a wee half of Guinness for your iron,” or something like that. However, we now know that the only way to stop FASD is to say to women that it should be “No” from the start.
I also want to highlight that FASD is often invisible. More than 90 per cent of people with FASD show no facial abnormalities, which means that diagnosis may rely on understanding brain function, behaviour and history. Many people go through life undiagnosed or misunderstood, or misdiagnosed with other conditions.
That is why awareness is so important. Awareness helps to prevent new cases by making sure that expectant mothers have clear and accessible information about the risks of drinking alcohol during pregnancy. Awareness also drives understanding, so that children and adults who are already living with FASD are met with compassion, not judgment, and receive the tailored support that they need to thrive.
To affected individuals, families and carers, I say: you are not alone—your struggles matter, and your voices deserve to be heard. To every health professional, teacher, social worker and MSP, I say that the duty before us is to act with compassion, evidence and urgency.
I know that I am coming to the end of my time, Deputy Presiding Officer. I pay tribute to the campaigners, charities and families who have worked tirelessly to break the silence around FASD. Their voices have been instrumental in driving change and reminding us all that, with the right support, people who are living with FASD can achieve so much.
Today, let us recommit to spreading awareness, supporting families and ensuring that no one who is affected by FASD feels invisible or left behind. Together, we can make sure that Scotland leads the way in tackling the issue with compassion, understanding and action.
18:19
I thank my colleague and friend Rona Mackay for again bringing this very important topic to the chamber with a debate on international FASD day and the need for awareness.
International fetal alcohol spectrum disorder day falls on the ninth day of the ninth month of each year. That, I am told, is to draw attention to the importance of going alcohol free for the whole nine months of pregnancy.
Folk might feel that that is an easy ask; surely it is as simple as “If you’re going to get pregnant, don’t drink.” However, that is not so. As the motion from Rona Mackay states,
“46% of pregnancies in the UK are unplanned so without better awareness, people may continue their pre-conception lifestyle until they have a positive pregnancy test”.
Many women are into week 4, week 5 or even later before their pregnancies are confirmed.
Prenatal alcohol exposure is a significant public health issue for Scotland, with an estimated one in seven babies born at risk of FASD. It is also estimated that between 3 and 5 per cent of people in Scotland could be living with FASD.
Fetal alcohol spectrum disorder is a term used to identify the range of physical, emotional and neurodevelopmental differences that might affect a person exposed to alcohol while still in their mother’s womb. FASD is frequently described as a neurodevelopmental condition. The term describes a collection of disorders that are a consequence of altered development of the brain and nervous system, and evidence suggests that early and accurate identification of brain differences and support needs can facilitate better outcomes for those who are affected.
Sadly, as we have heard, there is no treatment or cure for FASD, and the damage to a child’s brain and body cannot be reversed. However, an early diagnosis and support can, and often does, make a difference. Once a child has been diagnosed with the condition, a team of healthcare professionals can assess their needs and offer appropriate educational and behavioural strategies.
Without early diagnosis and appropriate support starting in childhood, FASD can lead to secondary disabilities, including reduced educational attainment and outcomes; mental health and addiction problems; involvement with the criminal justice system; and premature death from violence, accident or even suicide. Early identification is vital, as support can mean fewer mental health issues, better educational achievements and improved life chances.
We also need to address the drinking culture, including drinking patterns, because this is not only about how much people drink, but about the way in which they drink. As with any alcohol-related issue, the risks to the fetus are typically influenced by three aspects of the pattern of alcohol consumption: the quantity of alcohol consumed; frequency, or how often the mother drinks; and the timing of drinking in relation to pregnancy.
The most damaging pattern of drinking for the fetus is heavy episodic drinking, known in the UK as binge drinking. Folk can get a bit of a shock when they find out how small an amount of alcohol can be considered as binge drinking. The UK guideline for weekly alcohol consumption is 14 units for folk who are not pregnant, and a binge is defined as drinking a certain number of units on a single occasion—six units for women and eight units for men. That sounds simple, but what is a unit? Is it a drink, a glass, a bottle or a can?
In fact, a binge, which is the riskiest type of drinking for the fetus, amounts to just two large glasses of wine. That is not an unusual amount for women of reproductive age to drink on a night out or during dinner at someone’s home. It must also be taken into account that alcohol measures poured at home are often two or three times larger than pub measures—that is something that folk should ponder on.
In conclusion, I hope that today’s debate has brought the issue to the forefront of folks’ minds and that it goes some way towards getting the message across. The message that I would like to get out there is this: “Don’t risk it. If you are even thinking that you would like to become pregnant soon, just don’t drink.”
18:24
I thank Rona Mackay for bringing the debate to the chamber once again and allowing Parliament to recognise fetal alcohol spectrum disorder. As she will know, I have participated in these debates because the issue is close to my heart, and I really appreciate her bringing it to the chamber.
It is important that we continue to highlight FASD’s impact on Scotland’s communities and raise awareness of the long-lasting impact that exposure to alcohol during pregnancy can have. As other members have highlighted, fetal alcohol spectrum disorder affects 4 per cent of Scotland’s population, which is a startling figure, given that—as others have said—it is preventable. The UK chief medical officer recommends that the safest approach for people who are pregnant or are planning a pregnancy is not to drink alcohol at all. That will keep the risk to the baby to a minimum.
Of course, it is important that people understand the risk of drinking during pregnancy, but a point that I would make, and which Rona Mackay made, too, is that we, as elected politicians, must take our responsibility in this regard seriously. We live in a Scotland that normalises alcohol; in fact, excessive alcohol culture is almost normal, up to the point where it becomes a problem. Therefore, we must, as Ms Mackay has said, understand this issue as a public health situation, and we must have more debates about population-wide measures to reduce alcohol-related harm.
Research indicates that individual women are often not aware of the advice not to drink alcohol during pregnancy, so clearly more can be done with regard to public health messages that can improve awareness, especially given that, as colleagues have said, 46 per cent of pregnancies in the UK are unplanned. I would hope that putting out that messaging early to young women could be useful.
The Government’s “Women’s Health Plan” commits to providing accessible information and advice on pre-pregnancy care, which is welcome. In the medium term, there is a plan to develop a framework for pre-pregnancy care to raise awareness and understanding of the importance of optimising health before pregnancy. That might be an area on which we could work with the Minister for Public Health and Women’s Health to ensure that we get accurate information and that we can talk about the use of alcohol in pregnancy.
Do you think that it would help get the message across if we started speaking about the issue in schools, and teaching younger folk what would happen if they were to drink during pregnancy?
It would help, too, if the member could speak through the chair.
I thank the member for making that important point. Interestingly, I have been involved in a discussion on young women’s health, and I think that young people would appreciate our talking about these things much more openly, so that the information is out there and that they can make up their own minds about what they are going to do.
Healthcare professionals do a fantastic job out there, but we know that they find it quite difficult to discuss alcohol consumption, particularly when a woman attends healthcare services for pregnancy-related issues. For those who work in maternity services, raising awareness of the dangers of drinking is not part of their area of expertise. We know that they find it difficult, so there are perhaps some things that we could do to help them, such as exploring women’s drinking habits.
We could also have a look at whether alcohol brief interventions might be a valuable tool, and how widely it is used by maternity services and midwives. Again, that might be something that we could work on across the health portfolio as part of the considerable work that needs to be done to reduce the prevalence of FASD.
I would say more, but other members have already said it. I will just end by saying that, if we work together, we can make a difference. This is a cross-party issue, and I know that other members in the chamber really want to see a change in this area. Let us hope that, if we are all back here again next year discussing the issue, there are some real improvements that we can talk about.
I invite Tom Arthur to respond to the debate.
18:29
I thank my colleague Rona Mackay for securing this important debate, and my colleagues Jackie Dunbar, Annie Wells and Carol Mochan for their important contributions. I assure everyone that the Scottish Government is committed to preventing the harm caused by alcohol consumption during pregnancy, and to supporting those impacted by fetal alcohol spectrum disorder.
As has been outlined over the course of the debate, FASD is a lifelong neurodivergent condition that can affect every area of a person’s life. That is why the Scottish Government is determined to ensure that people with FASD have the opportunity to live life on their own terms, properly supported when they need to be.
We are working to ensure that our policy on FASD is joined up across various areas of Government, including alcohol education and maternal and pre-conception health, to name but a few. We are taking forward a number of important pieces of work that are relevant to future prevention and support for people with FASD in Scotland.
As some members will be aware, we published in 2018 an alcohol framework that set out a commitment to increasing awareness of FASD and supporting improved diagnosis. We are currently developing a refreshed alcohol and drugs strategic plan that responds to the alcohol and drugs crisis, and we aim to publish that new strategic plan in early 2026, ahead of the conclusion of the national mission on drugs.
The clear message from our chief medical officer on alcohol during pregnancy remains “No alcohol, no risk”. That message is also featured in the “Ready, Steady, Baby!” guidance and on NHS Inform, where there is information on why women should avoid alcohol when they are pregnant or are trying to conceive.
The Scottish Government recognises the importance of pre-conception care to aid pregnancy planning and preparation, which can significantly reduce avoidable harm, including from alcohol. I am pleased to say that we are taking action through delivery partners, communities and families to enable all children to develop to their full potential, including before and during pregnancy. That work is part of our commitment to acting on early child development through our transformational change programme.
Additionally, our recently published population health framework sets out plans for tackling the root causes of poor health and reducing the life expectancy gap between the poorest and most affluent areas across Scotland, including initial action to reduce health-harming risks during pre-conception and in pregnancy.
Related to that, Scotland’s “Women’s Health Plan”, which was published in August 2021, sets out actions that aim to address women’s health inequalities by raising awareness of women’s health, improving access to healthcare for women across their lives, and reducing inequalities in health outcomes for women and girls. We are now working on the next phase of the plan, which is expected to be published in January next year.
We know how important it is to provide education and training that are specific to FASD, as well as support to families and individuals with FASD. Over the past four years, we have provided almost £2 million, including £620,000 this year, to improve understanding of and support for FASD.
We fund the FASD hub through Adoption UK to support people affected by FASD as well as their families. The hub provides peer support, training and advice, including an advice line that is open to all parents and carers in Scotland who are parenting a child or young person with a history of prenatal alcohol exposure and one-to-one support.
We also fund the fetal alcohol advisory support and training—or FAAST—team at the University of Edinburgh. The team provides consultation and training to professionals, including tiered training programmes that give them the tools that they need to recognise, support and diagnose people who are affected by FASD.
We are aware of significant increases in the number of neurodivergent people, including those with FASD, seeking a diagnosis and requiring support. Although that creates challenges for a range of services, we recognise how important a diagnosis and support can be to someone’s wellbeing. I assure members that the Scottish Government is working closely with national health service boards and local authorities to improve services and support for neurodivergent people, and we have set up a new children and young persons neurodevelopmental task force to drive forward those improvements, as well as providing an additional £500,000 this year to enhance the support available to children and families.
The Scottish Government remains committed to preventing FASD, and to supporting those with FASD to live their best lives. We will continue to work across Government and with partners to increase awareness of FASD, enhance prevention measures, and support the delivery of those measures to those who are affected by FASD.
I again thank members for their contributions, and Rona Mackay for securing the debate.
That concludes the debate.
Meeting closed at 18:35.Previous
Decision Time