The lush valleys surrounding this historic seaport city are home to vineyards that make wines famed for their undertones of green pepper, passion fruit, and freshly cut grass. They are also home to thousands of children whose mothers drank while pregnant, sentencing them to brain damage.

South Africa's cape region has the highest recorded levels of fetal alcohol syndrome (FAS) in the world.

Over the centuries, wine farmers paid black and colored workers in wine, creating a culture of binge-drinking and alcoholism. And while some healthcare professionals estimate that up to 70 percent of South Africa's hospital cases may be attributed to alcohol – from domestic abuse and traffic accidents to rape and murder – it is children born to alcoholic parents who suffer the most.

But while the country's healthcare system is busy combating AIDS, private groups, including wine companies, are making a difference in the fight against the scourge.

"I always hear 'We've got limited resources;' ach, it's a mind-set," says Leana Olivier, director of the Foundation for Alcohol Related Research in Cape Town, and a former official at South Africa's Department of Health. "The biggest resource is the human being herself. Women have the right to get information and to know that they can make choices and have strength within themselves."

The struggle over alcohol in South Africa goes back to the early 1600s, when the first Dutch colonial governor planted the first grape vine in Cape Town to provide wine for ocean-going ships rounding the Cape of Good Hope.

How drinking became a scourge

For centuries, the only choice most South African farm workers in the Cape region thought they had was: red or white. Until the practice was banned in 1980, farmers paid part of their farmworkers' wages with bottles of wine. This so-called "dop system" continued illegally as recently as 1991, when a health care survey found that 20 percent of Cape vineyards still paid their workers with wine.

The dop system may be illegal, but many farmworkers and rural South Africans continue to binge drink after pay day, either driving into town to spend their monthly wages on locally available cheap wine, sold in "paap saks" or soft aluminum foil pouches, or simply waiting for mobile "shabeens," or bars, to drive onto the farm and sell booze by the liter.

The habit of binge drinking is now ingrained in South African culture at all social levels, researchers say. In the Northern Cape town of De Aar, the rate of FAS babies is 122 per 1,000 live births, according to recent research by the Medical Research Council in Cape Town. By contrast, FAS levels in the US are between 0.1 per 1,000 and 0.67 per 1,000.

"There's a tolerance of drinking in South Africa, not only among the uneducated; it's right through our culture," says Ms. Olivier. Unfortunately, she says, there is little recognition that alcohol can be damaging to a woman's fetus.

"The aim is to change behavior, provide logical information for the mothers. If we can catch them when they become pregnant, at least we can still do something. After they become pregnant, the damage is done."

The solution seems clear-cut: Provide counseling about the dangers of drinking for women of child-bearing age through medical clinics; run public information campaigns on billboards and Television; and put warning labels on bottles of spirits.

But Sandra Marais, a senior researcher for the Medical Research Council, and professor at the University of South Africa in Cape Town, says that South Africa is far behind in recognizing the problem of fetal alcohol syndrome and doing something about it.

"If you have several brief interventions with a birth mother, usually at a health clinic, to give women information on how drinking can affect a baby's health, that is where you have to start, where you can make a difference," says Dr. Marais.

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