Objective: To understand the impact of Fetal Alcohol Spectrum Disorder (FASD) on the individual, their family/whānau, community and society within the Aotearoa New Zealand (ANZ) context. . Background: An alcohol consumption culture has developed over many years in ANZ. This has resulted in emotional and financial costs, not only to the individual, but their family/whānau, communities and to society as a whole. This cost can extend to the unborn child when a woman consumes alcohol while pregnant resulting in permanent damage to their Central Nervous System (CNS). This damage is irreversible and to date there is no successful pharmaceutical intervention. Up until 40 years ago, FASD was not recognised, so those affected would either go misdiagnosed or undiagnosed. Interventions were not put in place to support the individual, family/whānau and other societal groups. Subsequently, research and recognition of FASD has developed, but much of this knowledge is not well utilised for the support of those with or caring for those with FASD. Methods: To address the research objective a narrative literature review was undertaken. Bronfenbrenner’s Ecological Systems Theory provided a framework for synthesis of the literature. Five themes were extracted from the literature and were used to frame the discussion. These themes were: (1) a drinking culture which has developed over time; (2) risk factors for the unborn child; (3) the importance of early diagnosis and intervention for a child with FASD; (4) A multidisciplinary approach to assessment and diagnosis across the life span for those with FASD; and finally (5) ANZ policy implications. Discussion: The child who has FASD symptoms being referred for an assessment and diagnosis, along with an individualised intervention plan being implemented, will provide the best opportunity for the child to flourish. Undiagnosed or wrongly diagnosed young people with FASD symptoms are likely to develop secondary conditions. This will have long term consequences for not only the individual, but their family/whānau, community and ANZ society. This literature review has critiqued the FASD action plan released by the Ministry of Health (MoH) in 2016 using international literature resulting in recommendations for future research in the ANZ context.

Summary of Conclusions and Recommendations: The drinking culture of ANZ has developed since colonisation. Alcohol consumption has cost not only the individual and their families, but communities and ANZ society as a whole although the MoH (2016) has released the FASD Action Plan 2016-2019 with a budget attached to implement the plan, gaps have been identified. These gaps include: the financing of screening, referral, assessment, and diagnosis; along with developing and implementing intervention strategies with all who are affected by FASD. These individualised interventions would help avoid people affected by FASD developing secondary conditions which cost society in the long term. Within the context of ANZ and Treaty obligations, a significant gap identified is the need to consult with Māori in developing policy and programmes that are culturally appropriate for Māori.