How to Treat Pregnant Drug Addicts? Your Thoughts

Readers debate a recent Atlantic feature on women locked up for using drugs while pregnant. Does prison do more harm than good? What are the alternatives?

Social workers comfort a pregnant crack addict (Fenando Donasci / Reuters)

The Atlantic’s Olga Khazan recently reported on the increased use of incarceration to punish women who used hardcore drugs while pregnant:

Hospital workers and cops are disturbed by what they believe to be withdrawal symptoms, such as sleeplessness, crying, and agitation, that some drug-exposed newborns exhibit. “These babies are born into the world addicted to methamphetamine,” says Elena Cannon, an investigator with the prosecuting attorney’s office in Mena, Arkansas. “It’s not a very good way to come into the world.”

A growing body of evidence, though, suggests that in-utero exposure to illegal drugs does not hobble children for life in the way that some state officials fear. Many advocates, doctors, and other experts say jailing new mothers for using drugs during pregnancy is counterproductive—and might exacerbate the harms suffered by both the women and their children.

Levi Williams lays down a line:

I'm all for decriminalizing drugs and rolling back long sentences for non-violent drug offenders, but this is ridiculous. Introducing drugs to your baby's system should absolutely be a criminal offense.

Another commenter, nothingtobedone, isn’t concerned about punishment as much as protecting the unborn child: “Lock her up until the baby is born.” Terri_in_LA replies sarcastically, “Yes—jail would be a great place to ensure she receives prenatal and mental health care, and isn't exposed to disease or violence.” Ian Marsden jumps in:

The best approach is to remove these children from their abusive, unthinking parents; treat them and have them adopted by more right-thinking families that are unburdened with the need to make self-destructive choices and drag their progeny down the same sewer that they have selected for themselves.

Buzzby19491 responds with a key point from Olga’s piece:

Would you remove children from parents who consume alcohol, smoke cigarettes, or take prescription pain killers? Those, not the illegal drugs, are the greatest prenatal threat.

KateBowler is sympathetic toward the moms:

Prosecuting the mentally ill (a.k.a. addicts) doesn't work, as this article demonstrates. The women are not intentionally trying to harm their fetuses. They are sick and need medical help. And providing that help is the best (and only) way to help these fetuses!

Here’s a video profile of one pregnant woman sent to rehab after several arrests for meth use:

GeorgeSalt sighs, “Incarceration is America's solution to everything,” a comment that got the most up-votes from readers. A notable contrast to the U.S. is Portugal, which decriminalized all drugs in 2001, and the country has seen a 50 percent reduction in intravenous drug use. Commenter golden_valley vents over the American approach:

We are wedded to the idea that addiction is something that is easily overcome through will power or religion and if that doesn't work, then just throw somebody in jail. No one really wants to fix the underlying problem because that would entail recognizing that will power alone isn't enough and that we need to expend money over a long period of time to actually end the addiction.

Sticking the baby into the foster care system just means it will be bounced from home to home, which might produce problems for the baby in the future. But oh well, the mother will be punished, perhaps still addicted, but punished nonetheless. The problem remains unsolved but the criminal justice system has "done something" and the rest of us get to feel that righteousness has prevailed.

By the way, are there studies about fathers' drug use and the impact it may or may not have on the physical status and development of any children he fathers? Just curious.

Not many studies, unfortunately. In the mid-1960s, pharmacologist Gladys Friedler injected a bunch of male rats with morphine and mated them with healthy, drug-free females, resulting in offspring that were “underweight and chronic late bloomers, missing all their developmental landmarks.” But Friedler over the decades faced institutional reluctant to pursue such research, a history detailed in Cynthia Daniels’s book Exposing Men: The Science and Politics of Male Reproduction. Daniels, a Rutgers professor, emails her view:

Researchers have found it difficult to get funding to do this kind of work, in my opinion due to the gendered nature of the research.  We are certain that the male-mediated effects are real, from unfortunate experiences such as Agent Orange and other environmental disasters.  We also know that toxins and recreational drugs use can cause damage to the genetic material in sperm, and that drugs can travel through seminal fluid.  We do not fully understand the mechanisms, although it is likely epigenetic.

One of the few prominent studies on the paternal factor is from 1991, covered by The New York Times as “Cocaine-Using Fathers Linked to Birth Defects.” The lead researcher of that study, Ricardo Yazigi, was interviewed by Vice last year—nearly a quarter century later—and didn’t have much to add:

I asked Dr. Yazigi why we don't have more information on coke's effects, and he responded that human tests aren't pure "because most of the time there's coexistence of the use of cocaine along with alcohol and cigarettes and other drugs, so the single cocaine users are almost a rarity." Also, he reminded me that you can't force a group of people to do cocaine and then reproduce. You know, ethically.

Back to the issue of pregnant drug users, long-time Atlantic commenter Erik Vanderhoff shares his story:

My first job out of college was working as a shift supervisor at a children's emergency shelter for kids removed from their parents. One of the kids was a 15-year-old girl who was about five or six months pregnant. One night, she and another girl ran away from the facility. They returned a few hours later high on meth. An hour or so later, the girl began complaining of pain in her belly. One of the women on staff and I immediately took her to the hospital. A couple of hours later, the doctors induced labor to remove the dead child from her womb.

Her only response upon returning to the shelter? A cold "The damn baby died.” The female staffer quit the next day. I lasted a couple more months. Now I work with people with developmental disabilities, including those born drug-positive, with fetal alcohol syndrome, and so forth. Their in-utero exposure causes profound cognitive and behavioral impairments. Neural damage cannot be fixed, only partially compensated in early development to stimulate the highly plastic growing brain.

Drug addiction is a profoundly narcissistic act. Drug use while pregnant cripples your child, causing it and its caregivers a lifetime of pain and cost.

But here’s a sympathetic profile of a mother in South Florida struggling to recover from her oxycodone addiction while pregnant:

Hugh Everett, who says he is “currently contributing financially to the care of a child who was the victim of an addicted mother,” suggests a radical solution:

These addicted mothers with multiple children are certainly entitled to help if they want to improve their lives, but they need to be on court-ordered Norplant until they start demonstrating some responsibility.

Of course the government can’t and shouldn’t forcibly implant a woman with long-term birth control, but some judges have compelled women to undergo implantation in lieu of prison time. StellaBarbone counters that thinking:

Court-ordered Implanon (Norplant no longer exists) wouldn't be necessary if effective contraception were available to all women. For example, a five-year pilot program in Colorado to provide low-income teens with intrauterine devices (IUDS) and other implants reduced the teen pregnancy rate by 40 percent. But the all-male committee in the Republican Senate declared pregnancy prevention with IUDs a form of "abortion" and ended the program.

That happened just recently, on April 29, and it showed some odd priorities from the conservative Republicans who struck down the bill. The IUD program was responsible for a 35 percent drop in abortions—something social conservatives should cheer—and saved the state $42.5 million in healthcare costs—something fiscal conservatives should cheer. Hugh Everett replies to StellaBarbone:

You are well aware that Planned Parenthood makes contraceptives available to indigent women who can’t afford the (very) low-cost options from Walmart. You and the author of this article are trying to make the ridiculous argument that the federal government or the state government are at fault, when the real problem here is complete lack of personal responsibility.

In these cases, where lives are clearly at risk, it is the responsibility of the courts to take control of the situation and compel treatment and contraception, with the alternative being serious prison time. And there are currently many women in prison for feeding drugs to their babies while in utero. I support early release of these women in exchange for sterilization procedures.

There is no more egregious example of outright criminal child abuse than a woman with seven children who continues birthing crack babies.

On that note, dreymatthew points to a really interesting story:

A year or so ago, I listened to a Radiolab podcast about a wonderful couple who sought to adopt a baby girl and was introduced to one born to a drug-addicted mother. The couple agreed to take her anyway, and over the course of the next three years, the drug-addicted birth mother had three more drug-exposed babies. The adoptive couple took all of them in too.

They were featured on Radiolab because the adoptive couple created a non-profit organization that offered drug-addicted women $200 cash in exchange for long-term birth control (such as Norplant), an IUD, or sterilization. Before everyone jumps on the race and eugenics bandwagon, a few facts: The adoptive couple are a mixed-race couple, where the husband is Black, and the mother is white. Also, to date, the program has helped over 5,000 addicts and alcoholics avoid having more children they couldn't take care of, and 60% of them were white.

Considering how very few of these children end up with loving, stable adoptive families like the one featured on the podcast, the solution above seems beyond brilliant. I can't imagine the wonderful direction this country could go in, on a social level as well as an economic level, if our government offered free, easily accessible birth control, including long-term solutions like IUDs and Norplant, to anyone that wanted it. It beats incarcerating these women for drug use, and it beats a whole population of unwanted and uncared-for children growing up rootless and purposeless, only to repeat the cycle.

KateBowler complicates the debate further:

What about women who drank/used drugs before they KNEW they were pregnant? What about women who drank very little while pregnant, with their doctor's blessing? What about women who, after discussing the risks with their doctor, makes the decision to remain on a prescription medication that has a very small risk of harming her fetus while she's pregnant?

I fall into the latter category. There’s a history of significant mental illness in my family and I've taken antidepressants daily since early childhood. After discussion with my husband and doctors, I chose to stay on my meds, knowing it increased the odds my baby might develop autism by 1-2 percent. My mom, off her meds, committed suicide in the throes of postpartum depression when my baby sister was all of four months old. Feel free to judge me for my decision to stay on my meds, but it’s my body and my call.

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