Vox Meditantis

Alice Carter’s fears for her daughter Martha in The Archers have brought a hidden epidemic into the spotlight. Her worry that Martha might have fetal alcohol syndrome cuts to the heart of a profound public health crisis that affects far more families than most people realise. The truth is stark: up to 2.4 million people in the UK may be living with fetal alcohol spectrum disorders, most of them undiagnosed, unsupported, and misunderstood. This isn’t a distant problem affecting other people’s children. It’s happening in every community, every school, every GP surgery across Britain.

The Scale of Britain’s Hidden Disability

The numbers should shock us into action. Recent research suggests that between 1.8% and 3.6% of UK children have fetal alcohol spectrum disorder (FASD). To put this in perspective, that’s three to four times the rate of autism. In Scotland alone, as many as 172,000 people could be affected by the disorder. A study in Glasgow found that 42% of newborn babies showed evidence that their mothers had consumed alcohol during pregnancy, with 15% exposed to very high levels.

Yet these figures represent only the tip of the iceberg. The UK has the fourth highest level of prenatal alcohol use in the world, but until recently, we had no proper estimates of how many children were affected. While countries like the United States, Canada, and Italy have conducted comprehensive school-based screening programmes, Britain has lagged behind, leaving countless children to struggle without understanding or support.

The surveillance study tracking fetal alcohol syndrome specifically found just 3.4 cases per 100,000 live births. This figure is lower than similar studies elsewhere, not because British children are less affected, but because we’re failing to recognise and diagnose the condition. The study’s own authors acknowledged that many cases were notified and then withdrawn or excluded, revealing “a lack of consistency and certainty in diagnosing FAS” across the UK.

What We Know About the Damage

Fetal alcohol spectrum disorder results from alcohol exposure during pregnancy, when alcohol in the mother’s blood passes directly to the developing baby through the placenta. The science is unambiguous: there is no safe amount of alcohol consumption during pregnancy, and no safe time to drink. Even small amounts can cause harm.

The developing brain is particularly vulnerable. Alcohol causes neurotoxicity, disrupting the healthy formation of neural pathways and brain structures. Recent molecular research has identified how alcohol exposure affects critical developmental processes, including cell-type specification, axon guidance, and regional patterning of the brain. The damage is irreversible and lifelong.

The effects manifest across multiple domains. Children with FASD face growth restrictions both before and after birth. They may have distinctive facial features including small eyes, a thin upper lip, and a smooth ridge between nose and upper lip. But the most profound impacts are often invisible: intellectual disabilities, learning disorders, memory problems, poor judgement, and difficulties with attention and hyperactivity.

The Reality for Children and Families

What does this mean for a child like Martha Carter? Children with FASD experience the world differently. They may struggle with cause-and-effect thinking, have difficulty processing information, and face memory challenges that make learning particularly hard. They might take things that don’t belong to them, not through malice but because they don’t understand ownership concepts. They may confabulate—a condition where the brain distorts memories—which can be mistaken for lying.

The educational challenges are immense. Teachers in Poland reported feeling unprepared to support children with FAS, lacking knowledge about appropriate teaching methods. British teachers face similar challenges. Without proper diagnosis and understanding, these children are often misunderstood, punished for behaviours they cannot control, and denied the support they desperately need.

The consequences ripple through their lives. Young people with FASD face increased risks of mental health problems, involvement with youth justice services, and homelessness. They’re more likely to leave school without qualifications and struggle with employment. The estimated financial impact runs into billions, but the human cost is immeasurable.

The Diagnosis Dilemma

One of the most troubling aspects of this crisis is how many children go undiagnosed. In England, there is only one specialist FASD clinic. The condition is frequently misdiagnosed as autism or ADHD because the symptoms can appear similar. The University of Salford study found that up to half a million young people under 20 in England and Wales are “careening toward their adult years with a hidden brain-based neurodevelopmental condition, undiagnosed and not receiving proper support”.

The diagnostic process itself faces barriers. Many mothers may not disclose alcohol use during pregnancy due to shame or fear of judgement. Healthcare professionals may lack training in recognising FASD. The 4-Digit Diagnostic Code, which evaluates growth retardation, facial features, central nervous system damage, and prenatal alcohol exposure, requires specialist expertise that isn’t widely available.

Early diagnosis matters enormously. Children diagnosed and supported early show better outcomes, with appropriate interventions helping to limit the condition’s impact on their lives. Yet the median age at diagnosis in the UK surveillance study was just over five years, with some children not diagnosed until they were teenagers.

What Needs to Change

The evidence demands urgent action. We need comprehensive screening programmes in schools, similar to those conducted in other countries. Healthcare professionals require better training to recognise FASD and understand its implications. We need more specialist diagnostic services across the country, not just one clinic for the whole of England.

Education systems must adapt. Teachers need training about FASD, understanding that these children require different approaches, not different expectations. The therapeutic parenting techniques and environmental modifications that help children with FASD succeed should be standard knowledge, not specialist expertise.

Public awareness campaigns must tackle the persistent myth that small amounts of alcohol during pregnancy are harmless. The research from Poland showed that some people still believe red wine is healthy for pregnant women and their babies. Such dangerous misconceptions must be challenged with clear, unambiguous messaging: no alcohol is safe during pregnancy.

A Call for Justice

Behind every statistic is a child whose potential has been limited by preventable brain damage. Behind every family struggling with FASD is a failure of our public health system to protect the most vulnerable. The Archers storyline gives us an opportunity to turn awareness into action.

We cannot continue to allow millions of children to grow up without the support they need. We cannot accept that in 2025, a condition that is entirely preventable continues to affect families across Britain. The science is clear, the need is urgent, and the moral imperative is absolute. It’s time to give children with FASD the recognition, diagnosis, and support they deserve. Their futures—and our society’s conscience—depend on it.

Bob Lynn | © 2025 Vox Meditantis. All rights reserved.

Photo by Kelsey Chance on Unsplash