Health experts are warning Te Tai Tokerau's hazardous drinking culture is having disastrous long-term impacts on generations of whānau and needs urgent attention.
'I drank with you, and you turned out okay' is a common myth that Ngā Tai Ora - Public Health Northland community wellbeing adviser Dave Hookway-Kopa said is believed by many mothers regarding drinking alcohol while pregnant.
"Unfortunately, we know today this is often not the case."
Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurological disability and the result of brain damage suffered before birth, caused directly by drinking alcohol while pregnant.
It is also entirely preventable.
Hookway-Kopa, who worked as an FASD educator and advocate for 14 years in Te Tai Tokerau, said mothers drinking alcohol during pregnancy continued to be an issue for the region.
He said in smaller communities like those found in Northland, alcohol use by young women had increased considerably.
"Observations of such behaviour in social settings while pregnant are common in the stories shared in the wānanga I facilitate," he said.
According to Hookway-Kopa, the underlying reasons for increased drinking among young women varied, but in most cases were related to New Zealand's hazardous heavy drinking culture, costing an estimated $7.85 billion in harm every year.
Hookway-Kopa said around one in 10 children born in Te Tai Tokerau were adversely affected by prenatal alcohol exposure - and in some parts of the region, the incidence was likely much higher.
"Since only around one in 20 children show the physical signs of harmful prenatal alcohol exposure, FASD remains largely a hidden disorder."
Local community workers, school principals and teachers, and other health professionals say, however, there is a 'hidden tsunami' of children coming through the system, suspected of having problems related to their prenatal alcohol exposure.
"Through educating and increasing people's understanding of FASD, many 'lightbulb' moments happen for people when they realise their whānaunga are affected," Hookway-Kopa said.
Common traits in people with FASD include immaturity, gullibility and a lack of common sense.
Although drinking during pregnancy most commonly affects the brain, other parts of the body can also be affected.
The impacts of FASD can be seen in motor skills, memory, attention span, communication, social skills, overall physical health and even hearing and vision problems.
"For Northland whānau, problems show up in poor school results, reading difficulties and, more commonly, behavioural problems," Hookway-Kopa said.
"FASD explains many of the challenges they have observed."
Hookway-Kopa believed all members of a family had a role to play in eliminating drinking during pregnancy and all healthcare professionals should advise the safest option was to not drink alcohol while pregnant.
Shelley Tweedie is a Far North community midwife and said she saw the effects of Northland's drinking culture first-hand.
She said the misplaced judgment on the behaviour must be traded in for community-led solutions.
"Just about every social situation tends to include alcohol, so it's common to meet women who've drunk before they knew they were pregnant, and there's nothing they can do except not drink moving forward," Tweedie said.
"Another reason why the problem is so pervasive is because of the historical distrust of healthcare professionals.
"They [health professionals] tend to think they have this superior, evidence-based knowledge, but that doesn't matter when people don't trust them."
The expert consensus about New Zealanders living with FASD is that most cases are largely undiagnosed and lacking the support required to live well.
Dr Ailsa Tuck, a community paediatrician in Whangārei, confirmed FASD was hugely under-recognised across Northland communities.
"Too often we see tamariki who have not had their neuro disability recognised," Tuck said.
"This can mean a significant mismatch between our expectations of that young person and what they can achieve without adequate scaffolding.
"Often these young people and their whānau can have a breakdown in their schooling, their homes and caregiving and relationships."
According to the country's leading expert on FASD, many healthcare providers were not familiar with the term, despite around 50 per cent of all pregnancies being exposed to alcohol and as many as 1800 babies born with FASD each year.
Internationally recognised FASD expert, clinical neuropsychologist Dr Valerie McGinn, believed New Zealand had a pervasive societal problem with alcohol consumption, which could be contributing to why many paediatricians wouldn't diagnose FASD.
"Alcohol is an addiction, and denial is a part of addiction," McGinn said.
"It's not any particular socio-economic status either, it's ingrained in our culture and that needs to change.
"This is not an individual woman's problem, it's a societal problem. These women have only been doing what's accepted."
McGinn said the solution had to come from the whole community and the Government needed to hand resources over to Māori, so iwi-based services could be delivered in the community through their networks.
According to McGinn, Canada and Australia were leading the way and Aotearoa New Zealand needed to follow suit.
She said FASD must be recognised as a standalone disability and be eligible for disability support services.
"I can't work out why a Government would ignore a problem that is so expensive...the right funding and support would make a huge impact on improving outcomes," she said.
"I put the blame on the Government - they regulate the industry and provide health and education services."
Is the Crown failing Māori on alcohol?
A claim made to the Waitangi Tribunal last month has asked whether the Crown is failing Māori on alcohol.
The claim highlighted 'the open secret' Māori are disproportionately affected by FASD, and that alcohol has been a major contributor to harm and inequities post-colonisation.
The claim's focus was the legislative failings of the Sale and Supply of Alcohol Act 2012 and the prejudice subsequently suffered by Māori as a result of those failings.
Information obtained from the Ministry of Health shows that from 2018 to 2021 more than 30,000 liquor licence applications were made - and only 87 consulted Māori.
There is currently no requirement in the act to include Māori on the list of those who must receive a copy of an application for a licence that has been lodged. The claim alleges the legislation fails to ensure Māori have the opportunity to inquire into applications.
Lead claimant Raawiri Ratuu, tiamana whakahaere (executive chairman) of Kookiri ki Taamakimakaurau Trust, submitted that successive governments had avoided
responsibility to protect Māori from the harmful effects of waipīro (alcohol) despite a 2010 Law Commission report finding alcohol contributes to the broad health and social issues affecting Māori.
"You do not have to look far to see the stranglehold waipīro has on many Māori," Ratuu said.
"The Crown has already conceded that they have failed Māori by neglecting to measure the prevalence of Fetal Alcohol Spectrum Disorder (FASD).
"This means our communities are suffering, but we have no real data on how to address the issues caused by waipīro."