Addressing fetal alcohol sSpectrum disorder : problem intractability and the search for solutions

The scientific evidence base for Fetal Alcohol Spectrum Disorder (FASD) has rapidly advanced over the past four decades, but attempts to redress the problem have neither significantly reduced alcohol consumption by pregnant women nor addressed the lifetime consequences of FASD for individuals living with FASD or their families. This thesis seeks to explain why the problem of FASD appears so resistant to solution. FASD is characterised by complexity, ambiguity, a lack of agreement on definition and solutions, and resistance to traditional linear solutions: it is a wicked problem. Stakeholders engaging with wicked problems bring diverse frames of reference and preferred definitions of the problem and its solution. The level of contestability and who dominates determines the selected strategy, which may be authoritative, collaborative or competitive. Using a multiple method approach, this research uses archival records and qualitative data from semi-structured interviews, first to tell the story of FASD in the United States of America, Canada and Australia, and then to determine any similarities and differences in public policy approaches over the past forty years. The research finds that those who originally demanded attention to FASD expanded their group to engage those with the status and authority to influence policy solutions. In all countries, privileged medical and academic elites are endowed with technical authority, and their preferred solutions require the problem to be fragmented into measurable parts, with a focus on building an evidence base. FASD is now on governments’ formal agendas, but attempts to manage FASD have led to authoritative policy solutions. Original demands have not been addressed: instead, government policy decision-making controls the entry of the problem into the public arena. This research proposes that this is influenced by the overarching problem of alcohol harms in societies where alcohol use is socially and culturally accepted