Drug-addicted and pregnant

The "crack baby epidemic" was a myth. So what do we do about the devastating policy it created?

Published January 28, 2009 6:18PM (EST)

For more than a decade now, activists, scholars and researchers have all been saying the same thing: The "crack baby" epidemic, a generation of drug-addicted babies born to drug-addicted women, is a myth -- a politically advantageous, racist one at that, with virtually no basis in science.

But it took until this week for the New York Times to catch on -- kind of -- with the publication of "Crack Babies: The Epidemic that Wasn’t." Mind you, the story does get the main scientific point right. The long-term effects of prenatal exposure to drugs on brain development and behavior are relatively small, as shown by Barry Lester, a Brown University professor of psychiatry. He heads the Maternal Life Study, the longest and largest study of its kind in the United States, and is quoted as the central expert in the NYT article.

So how is it, then, that Dr. Susan Okie, the author of the piece, goes on to promulgate the crack mom and crack baby myth? Why does she ooh and aah over the normalcy of the two young women born to the one previously drug-addicted woman she quotes in the story? If Okie genuinely accepts the findings of Lester’s research, there should be nothing "remarkable" about these "two happy normal girls" being "high-spirited but responsible," or one of the girls scoring "well above average on citywide standardized tests" ("despite their mother’s history," Okie adds).

I think Okie's response to Lester’s research is pretty typical for most people who were inundated with crack baby media in the '80s (and now with equally baseless, equally destructive "meth baby" hype). It’s so counterintuitive to everything they’ve heard that it just can’t be taken in all at once. But if we’re going to turn scientific research into public policy, if we’re going to move beyond the current cycle of demonizing and incarcerating drug-addicted pregnant women (and farming their kids out to foster care, then wondering why those children are having trouble forming close relationships or showing signs of distress), we’re going to have to strain our brains. What keeps this cycle going? How are we going to break it?

Here’s one big obstacle. Pregnant women who test positive for cocaine (or methamphetamine) are still being criminally charged with everything from child abuse (reinterpreted as fetal abuse) to delivery of drugs to a minor (through the umbilical cord or breast milk) or homicide (in the case of stillbirths, or when the baby is born, then dies). National Advocates for Pregnant Women (full disclosure: I used to work there), which organizes legal support and advocacy for these women, knows all too well that the research has not yet made significant inroads on policy. "Unfortunately, hundreds of women have been arrested, and thousands of new mothers have been reported to child welfare authorities based on junk science and medical misinformation," says staff attorney Allison Guttu.

We’re also going to have to come to terms with the views of Dorothy Roberts, a professor of law at Northwestern and the author of 1998's "Killing the Black Body: Race, Reproduction, and the Meaning of Liberty," who pointed out that most of the women tested and prosecuted for being drug addicted and pregnant are poor and black (despite numerous studies that have shown similar patterns of drug use among whites and people of color). As Wyndi Anderson, formerly of NAPW, says, "It’s both a class and race issue. There are plenty of wealthy drug-using women in this country who are treated quite nicely, not turned over to the police."

The two medical experts I spoke with (both also appeared in Okie’s piece) said that the time has come to start proactively treating addiction as a public health issue rather than reactively -- and uselessly -- punishing women with the criminal justice system.

"We need a paradigm shift," said Dr. Deborah Frank, a professor of pediatrics at Boston University School of Medicine, when I spoke with her. "Prosecution for a medical problem is ineffective, unjust and a misuse of resources that could better be spent in providing care." Dr. Harolyn Belcher, director of research at the Kennedy Krieger Institute's Family Center, agreed: "Rather than using funds on punitive incarceration approaches for individuals with drug dependence (especially women with children), resources should be used to provide these individuals and their children access to comprehensive evidence-based supportive treatment services.”

Finally we have to admit that treatment isn’t really readily available and accessible for poor pregnant women. "Women who are using do want treatment," says Anderson, "but we don't make it easy for them to get in, we don't give them advice they can use, and we don't make it possible for them to keep their children with them. We shove them towards treatment programs that are full or inaccessible, whether because they don't have cars or insurance, or they don't want to neglect their children. And that just makes them feel more hopeless."

Neither of the women in recovery I spoke with matched the myth of the addict who is too caught up in her drug use to care about her baby. Instead, both spoke about pregnancy as an optimal time to offer women treatment because the impetus to change is so strong. "When a woman who has been using drugs becomes pregnant, her every intention is not to harm the baby within her," says Tayshea Aiwohi, a previous NAPW client who now runs "clean and sober" houses for women and their children. Adds Tina Reynolds, MSW and co-founder and chairwoman of Women on the Rise Telling Herstory, "Every day I spent away from my children in the grips of my cocaine addiction was a living hell. Until the courts and family systems truly recognize that addiction is a disease, it will always be hard for women to receive the treatment they need to return to themselves, their families and their communities."

By Nancy Goldstein

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