Drugs During Pregnancy

Exposure to illicit and non-illicit drugs during pregnancy is a significant issue in the United States. Each year, approximately 757,000 pregnant women use alcohol and 820,000 smoke cigarettes. It is estimated that 221,000 pregnant women use illegal drugs at least once during their pregnancy and 1 in 5 of these women smoke crack cocaine. Additionally, 32 percent of women who use at least one illegal drug while pregnant also use both alcohol and cigarettes. Overall, 1 million children each year are estimated to have exposure to either illegal or legal drugs during gestation (Harvey 1998). During the 1980’s and 1990’s, increased public attention and social stigmatization was brought upon women who used illicit drugs while pregnant. Historically,
the women targeted by the government and the media were black, poor, and most significantly, addicted to crack cocaine (Logan 1999).
Media stories in the late 1980’s therefore provided extremely negative portrayals of children exposed to cocaine in utero. Coining the term “crack babies,” the media suggested that all babies exposed to crack cocaine prenatally would face severe and permanent disability in their lifetime (Harvey 1998). The re-evaluation of the various myths and stigmas associated with prenatal crack cocaine use, however, have led to much different conclusions than media portrayals in the 1980’s and 1990’s led people to believe (Barone 1994). Though it was believed and largely publicized in the 1980’s that children exposed to cocaine in utero are predisposed to a life of physical and mental disability, research conducted has determined that the crack baby epidemic is in fact a hyperbolized myth. Furthermore, the crack baby myth itself stems from historic societal tendencies to target drug-using mothers, which has led to legislative action being taken against female addicts in the
United States. The depiction of crack babies in the media worked to deliver messages about crack use as a whole, addicted mothers, and crack exposed children. Crack was made out to be stronger, more addictive, and more likely to lead to acts of violence, crime, and depression than any other drug the United States had seen before (Logan 1999). Without any evidence to support their claims, news reports described crack as “a plague” that was “eating away at the fabric of America,” (Paltrow 2000). Crack use was said to completely destroy the maternal instinct of the women who used it, leading crack-using mothers to be viewed as “inhumane threats to the social order,” because they willingly tortured their helpless unborn children. The crack baby was depicted as a helpless, trembling infant permanently damaged by its mothers’ careless behavior (Logan 1999). In regard to its effects, crack cocaine was said to bring more damage to fetuses than any other drug, and it was greatly emphasized that this damage would be permanent. Children exposed to crack were said to suffer from severe emotional and cognitive disabilities, even in the mildest of circumstances. Prenatal crack use was said to result in medical conditions such as cerebral hemorrhaging, intercranial lesions, prematurity, birth defects, prenatal strokes, heart attack or death, motor disorders, low birth weight, and neonatal growth retardation. Additionally, it was said to increase the risk of postnatal neurological problems, including severe sensitivity to outside stimuli, erratic mood swings, high pitched screaming, uncontrollable shaking, and a difficulty with social interaction. The images of children exposed to crack cocaine in utero often featured them “shrieking like cats” or staring wide-eyes into space for hours at a time. Ultimately, crack exposed babies were said to be doomed to have low intelligence levels, uncontrollable behavior, and criminal tendencies (Logan 1999). The re-evaluation of the various generalized myths and stigmas associated with prenatal crack cocaine use, however, have led to much different conclusions than media portrayals in the 1980’s and 1990’s led people to believe. Though prenatal crack cocaine exposure was said to have a more detrimental effect on children than other drugs, according to the media, alcohol and cigarettes have in fact been determined to have an equal or even greater negative impact on a newborn child. In addition, pregnant drug abusing women often do not seek medical treatment during their pregnancies, which causes their children to be born prematurely. It is important to note that characteristics of premature infants are often very similar to those characteristics exhibited by children exposed to crack cocaine during gestation. Another stigma associated with the crack baby is that all children prenatally exposed to crack cocaine live in inner-city environments. This myth, however, stems from cultural biases. When minority women without medical care during their pregnancy deliver their babies, doctors and nurses are more eager to test for drugs in the mother and in the infant. Middle-class women, on the other hand, often deliver their babies under the care of private physicians who are much less likely to test for drugs. As a result, minority women from inner cities are 10 times more likely to be reported to child abuse authorities than white women. The inconsistency in drug testing ultimately leads to misinterpretations of the types of people who use crack cocaine. Lastly, there is the myth that all children who are exposed to crack cocaine prenatally are affected in the same ways and require intensive school intervention. While educators have tried to develop stereotypic profiles of these children, it has been determined that a majority of the children do not appear to have severe disabilities and usually perform in the normal range on individual intelligence tests (Barone 1994). There have been various studies done on the effect of cocaine use during pregnancy that have fallen short on establishing a direct correlation been prenatal cocaine use and adverse developmental effects. For example, Delaney Black’s study, “Prenatal Cocaine Exposure and Child Behavior” aimed to evaluate past teacher reports that state that children exposed to cocaine in utero exhibit more problem behaviors. The sample in this study consisted of 27 children born to mothers who used cocaine during pregnancy and 75 children born to women who did not use drugs while pregnant. It was determined that there was not enough conclusive evidence to support a relationship between prenatal cocaine exposure and later childhood outcomes. The researchers concluded that other maternal and environmental factors played a more significant role in determining the children’s behavior (Black 1998). Additionally, a 1999 study done by LM Paltrow came to the conclusion that a cocaine-exposed child would be neurologically crippled, shake uncontrollably, and be irreversibly damaged for life. However, it was later found that poverty had a greater impact than cocaine on the child’s developing brain (Paltrow 2000). In Wendy Chavkin’s analysis of DA Frank’s study on the “Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure,” she concludes that the data Frank gathers in regard to the negative developmental consequences of cocaine in utero cannot be distinguished from the adverse effects that other drugs or environmental factors may have. Additionally, she states that it is difficult to solely attribute negative developmental effects to cocaine use because if a person is using cocaine during pregnancy, it is very likely they are also using other illegal drugs, drinking alcohol, and smoking cigarettes (Chavkin 2009). The effects of illicit drug use are ultimately much less clear than established research conducted on alcohol use. It is difficult to estimate the consequences of maternal drug use because of a number of outside factors that can influence maternal outcomes; this incudes nicotine and alcohol exposure, quality of prenatal care, exposure to violence, socioeconomic conditions, maternal nutrition, health conditions in general, and exposure to sexually transmitted diseases. Also, parenting styles, the quality of care during early childhood, violence exposure, and continued parental drug use into childhood are significant environmental aspects that can influence the outcomes of a child (National Institute on Drug Abuse). While associations have been found between illicit drug use and cognitive and behavioral problems in some studies, it is difficult to establish whether these associations are the result of a child’s postnatal environment or the result of the drug (Preece 2011). Ultimately, research conducted on the crack baby epidemic and the difficulty in determining any direct correlations shows that the predictions about the detrimental effects of cocaine exposure in utero were extremely exaggerated (Frank 2001). The concept of motherhood and the history that lies behind it is extremely important in regard to the controversy surrounding prenatal drug use and the construction of the crack baby epidemic. The end of the Industrial Revolution in America marked a change in the role of women and children in society. Children went from acting as economic contributors to the family to being perceived as dependent members of the family in need of care and protection. As a result of their selfless nature and perceived lack of intelligence, women were thought of as the most fitting to assume the role of caring for the household and their children. Child rearing and the production of children consequently became women’s primary duty. As women were principally responsible for the upbringing of their children, they were also first to blame for social problems such as the high unemployment, lack of housing, and poor working conditions that resulted from the Industrial Revolution. Rather than improving the social and medical services offered to citizens of the United States, people resorted to blaming mothers, as it was easier and cheaper (Boyd 1999). This attitude toward women and mothers carried on into the 1980’s and 1990’s. As a result of the “war on drugs” declared by President Richard Nixon in 1971, society started to pay more attention to prenatal drug exposure which increased the attention directed toward women who were using illegal drugs during pregnancy (Gomez 1997). The media created extremely negative images of drug-using pregnant women, depicting them as deviant (Boyd 1999). Additionally, because they chose to primarily commit themselves to substances rather than their offspring, the media portrayed women who used illicit drugs during pregnancy as failures in assuming their roles as mothers. Drug-using women were determined to be incapable of making decisions and were looked upon for posing a serious risk to their children (Logan 1999). Illicit drug use during pregnancy was described as a direct form of child maltreatment, as mothers that remained addicted to drugs after the birth of their child could create disruptive, chaotic, and abusive home environments for their children. In regard to the connection between drug use and child abuse, Chicago, Illinois hospital records from 1985 to 1990 revealed that over the course of 5 years, 512 infants had been exposed to illicit drugs and allegations of abuse had been reported for 102 of the infants (Boyd 1999). Many states have worked to create child abuse laws that extend to maternal drug use as a result of the negative attention directed toward drug using mothers (Boyd 1999). The media’s harsh reports toward pregnant women who used drugs led to the government’s desire to treat prenatal drug use as a criminal issue (Gomez 1997). Legislators in the 1980’s created countless numbers of proposals for bills that addressed creating criminal penalties for drug using pregnant women (Paltrow 2000). However, due to the successful lobbying of the American Civil Liberties Union and women’s organizations, no states were able to pass laws that recognize prenatal drug use as an independent crime. Therefore, since the end of the 1980’s, policymakers have debated the proper way to deal with the issue of women’s illicit drug use during pregnancy. They ultimately decided the best way was to innovatively use criminal laws that already exist and to charge women under the categories of child abuse, neglect, vehicular homicide, failure to provide child support, and drug trafficking, and many more (Logan 1999). In 2014, however, Tennessee became the only state to specifically criminalize prenatal drug use (Guttmacher Institute 2016). In recent years, several states have expanded their civil child-welfare requirements to include prenatal substance abuse, so that prenatal drug exposure can lead to the termination of parental rights as a result of child abuse and neglect.
Additionally, some states have put in place civil commitment for women who use drugs while pregnant, which includes the forced admission of women into an inpatient treatment program. Various states also now require medical professionals to report or test for prenatal drug use, which can later be used as evidence in child-welfare accounts. Moreover, some states have been working on making drug treatment more available for pregnant women, which is supported by federal funds that require that pregnant women obtain priority access to these programs (Guttmacher Institute 2016). In regard to those that still believe cocaine use specifically has a negative impact on maternal behavior, controversial charities such as Children Requiring a Caring Kommunity (C.R.A.C.K) have raised money to give mothers with a history of illicit drug use financial incentives to accept sterilization procedures. (Frank
2001).