September 19, 2017

Katherine King , Ellie Hamrick and Neil Hamrick explain how pregnant women are targeted by policies that vilify them for drug use and punish them for being poor.

IN 2014, 24-year-old Brittney Hudson was pregnant, but she couldn't seek out prenatal care, and she couldn't even go to the hospital when it came time to deliver her baby. She gave birth in the backseat of a friend's car.

Why? Hudson's home state of Tennessee had recently passed a bill allowing women to be criminally prosecuted for "fetal assault" if their baby was harmed by drug use.

"I was afraid I was going to have my baby, and they were going to take her. I wanted a chance to be a mom," Hudson told Mother Jones.

Despite Hudson's best efforts, she was reported to police a week after her baby girl was born. Hudson was arrested, charged with assault and jailed.

While Tennessee's law has since been repealed, the criminalization of pregnant women is a trend across the U.S.

Lynn M. Paltrow and Dr. Jeanne Flavin have documented arrests of pregnant women going back to the 1970s and have noticed an alarming trend. Between 1973 and 2005, there were approximately 13 arrests and forced interventions against pregnant women per year. Between 2006 and 2016, that number rose to an average of 70 arrests and interventions per year.

A pregnant woman languishes in a bare prison cell

Laws regarding drug usage by pregnant women vary enormously state to state and often leave huge amounts of legal gray area.

Eighteen states have laws that specifically categorize drug use during pregnancy as child abuse. Yet women have been prosecuted for drug use during pregnancy in 45 states. Fifteen states require health care workers to report suspected cases of substance use by pregnant women.

Until it was struck down by a federal judge in May, a Wisconsin law even allowed for pregnant women to be detained against their will for the duration of their pregnancies if suspected of substance use, with the fetus receiving its own court-appointed lawyer.

UNDER CAPITALISM, the idea that women's primary role in society is to be vessels for fetuses and caregivers for children reinforces a situation where raising the next generation of workers is the job of individuals or individual families, with little or no help from society at large.

In this way, women raise future workers for capitalists for free, as well as doing the bulk of the household work that allows themselves and their spouses or partners to return to work day after day. Accordingly, women's rights and well-being are sometimes artificially pitted against the interests of their fetuses and children.

The anti-choice movement, in its drive to eliminate women's reproductive rights in the name of "life," has reinforced the narrative that fetuses need to be protected from their mothers. Mothers also are seen as ultimately responsible for their children's health and well-being in ways that fathers are not.

There is enormous pressure on women to be "good mothers." Those who fail to meet all societal expectations are seen as "bad mothers"--and they can be punished with incarceration or with having their children taken away from them.

Women are systematically denied the resources they need in order to provide a safe and healthy environment for their children, and then they are blamed and labeled bad mothers because their children do not have everything they need and deserve. This is especially true for women of color.

The discourse of bad motherhood shifts the blame for children's unmet needs from systems of exploitation and oppression--such as capitalism and racism--to their mothers, who are also victims of the same systems of oppression. For instance, mothers are seen as neglectful if their children don't have proper clothing--even if their families can't afford to provide coats and gloves.

The feminization of poverty, the gutting of social welfare programs and the expansion of the prison system have exacerbated this problem. Women increasingly are criminalized for being bad mothers, and then their very criminalization serves as proof of their bad motherhood.

AS NICOLE Colson reported at SocialistWorker.org, new mothers are particularly affected when their babies suffer medical consequences of their addictions.

The number of babies born addicted to opioids increased by an estimated 500 percent between 2003 and 2012. Despite these growing numbers, hospitals in rural areas most affected by the opioid crisis often lack sufficient equipment to treat babies in neonatal intensive care units (NICUs).

While the pain of these mothers and their new babies is undoubtedly real, panic over drug-addicted babies exacerbates the criminalization of pregnant women and mothers. Once again, mothers and their fetuses or children are artificially pitted against each other, with the mother playing the role of perpetrator, and the fetus or child her innocent victim.

Women dealing with addictions are assumed to be incompetent mothers, despite research to the contrary that shows that drug users are perfectly capable of having loving, supportive, positive and healthy relationships with their children.

But the moral panic we hear from the media and politicians isn't based in science.

Joelle Puccio is a NICU nurse and the Chair of the Perinatal Substance Use Working Group for the National Perinatal Association. "Other than temporary, treatable neonatal withdrawal syndrome, there is actually no good evidence that maternal drug use causes any harm to the fetus, baby or child," Puccio said.

Sexist assumptions about maternal harm are subtly built into some original research on babies and children whose mothers used opioids while pregnant, Puccio said. She noted that the path from original scientific publications, to reports based on those publications, to media representations of scientific findings is "like a game of telephone," with perceptions of maternal harm amplified at every step.

Dr. Perilou Goddard, a professor of Psychological Science at Northern Kentucky University and expert in drug policy, agrees. She notes that "the much greater harm to fetuses, infants and children comes from the constellation of hurdles associated with poverty," not drug use.

Goddard identified trauma, food insecurity and lack of access to prenatal care as factors that cause far greater harm to babies and children than maternal drug use, echoing the sentiments of pediatricians.

"Kids who are drug-exposed in utero pretty much look like other kids who grew up in their neighborhood, so it's much more an effect of...resources, more than it is exposure," Goddard said.

RIA TSINAS works with the People's Harm Reduction Alliance and has experienced firsthand the stigma of being a drug user. When Tsinas found out she was pregnant, she quit using drugs. But her father passed away during the second trimester of her pregnancy, and she relapsed.

Tsinas was already an advocate for harm reduction programs for drug users, so she had a lot more knowledge about her rights and resources than a layperson. But Tsinas didn't fare well in the hospital, despite attending her prenatal appointments diligently, doing everything in her power to make sure she had a healthy pregnancy, and acting as a bold and informed self-advocate.

When she was 23 weeks pregnant, her water broke as a result of a condition called cervical incompetence. The hospital placed her on bed rest. But Tsinas and her partner, the father of her child, had just moved out of their apartment with plans to move to another state.

Her partner had nowhere to live, making bed rest logistically impossible. So Tsinas coordinated all her own care for her planned move to Eugene, Oregon, finding a hospital that had a high-level NICU for when her baby was born, and a treatment center for herself so she could reduce the risk of her baby being taken away.

When she was ready to move to Oregon, however, the hospital would not discharge her with antibiotics--despite an elevated risk of infection because of her condition--because she was a drug user who was leaving against their advice.

After a week in the hospital in Eugene, Tsinas developed an infection, which forced her to deliver at 25 weeks. Her daughter weighed one pound, 11 ounces at birth.

Tsinas's daughter, now a toddler, is "beautiful, smart, funny and developmentally right where she should be." But discrimination against her mother almost cost her life.

Tsinas' story highlights the absurdity of pitting the interests of a child against those of her mother. By attempting to punish Tsinas, health care workers nearly killed her daughter. And neither Tsinas nor her daughter has escaped the stigma of drug use--Tsinas reports that someone has called her daughter a "crack baby" right to her face.

Goddard compared the moral panic about babies born to mothers who use opioids to the panic around so-called "crack babies" in the 1980s and 1990s. Riddled with overt racism, media coverage of the crack cocaine epidemic viewed cocaine-using mothers as enemies of their babies, despite the fact that research shows no direct long-term effects of prenatal cocaine exposure in young children.

University of Pennsylvania law professor Dorothy Roberts has written extensively about the stigmatization and criminalization of Black pregnant women and mothers, including those who use crack cocaine. As Roberts wrote in the UCLA Law Review:

A popular mythology promoted over centuries portrays Black women as unfit to bear and raise children. The sexually licentious Jezebel, the family-demolishing Matriarch, the devious Welfare Queen, the depraved pregnant crack addict accompanied by her equally monstrous crack baby--all paint a picture of a dangerous motherhood that must be regulated and punished.

TODAY, WORKING-class and poor women, and women of color in particular, are the targets of demonization and criminalization for using drugs while pregnant.

In practice, it's often left up to individual nurses and doctors to decide when to test pregnant women and new mothers for opioid use and when to report them. So individual class and race biases can result in more poor women and women of color being tested and punished.

This becomes a vicious cycle: Health-care professionals look for addiction only in poor women and women of color, and therefore the association between addiction, poverty and non-whiteness strengthens.

But even beyond the individual bias of some medical professionals, discrimination against poor and working-class women and women of color is built into the system. According to Puccio, when a mother seeks prenatal care late, misses prenatal care appointments or shows signs of poor nutrition, these are seen as "warning signs" that trigger a drug test in the eyes of the medical institution.

But poor women and women of color often face barriers to accessing prenatal care or meeting their nutritional needs. "Making prenatal care appointments can be logistically impossible when you have multiple jobs, no access to child care or limited access to medical facilities," Puccio notes.

In the hospital, these new mothers find that they're then treated as suspects because capitalism has deprived them of the resources that wealthy women have.

Stigmatization of drug use during pregnancy and motherhood is an unfair--and counterproductive--means to the end goal of putting a stop to the opioid crisis.

Legal and social roadblocks hound mothers every step of the way during pregnancy and child-rearing, and for women who are suffering from substance addiction, these roadblocks can be especially prohibitive.

Prenatal care, a safe childbirth and a stable environment in which to raise children--all of which should be universally available to all mothers--are actively being denied to those who need them.

Capitalism, and the racism and sexism woven into it, is fueling the opioid crisis. The commonly accepted view of drug crises as towering mountains of individual choices, rather than systemic issues, prevents politicians and the general public from treating the opioid crisis as a public health issue.

Instead, it is viewed as something that can simply be locked away or shamed into oblivion. The left must push back against this dehumanizing and ineffective response.