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Missing Out on Mother's Day

Addicted women who are (or are about to be) moms can pose serious risks to their children. But so can current punitive policies that purport to address the problem. What's the best solution?

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Should kids stay with an addicted mom? photo via

By Maia Szalavitz

05/07/12

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Mother’s Day is to infertile women what Valentine’s Day is to singles: a day from hell. It’s not so great for children who’ve lost their mothers, either. But it may be most painful for a group of mothers who are among our most despised and stigmatized: addicted pregnant women.

Some people offer them payments to get sterilized, seeing their blood line—as well as their blood—as “dirty.” Politicians want to lock them up for “chemically endangering” their children, regardless of the fact that this may actually do more harm to the babies than the drugs. Still others demand that we take these mothers’ infants away at birth, seeing any drug use during pregnancy as a sign that future child abuse or neglect is inevitable.

None of the people who push these measures appears to understand the actual lives of alcoholic and addicted women who continue using during pregnancy. Indeed, the fact that these advocates of punishment pay virtually no attention to Fetal Alcohol Spectrum Disorder (FASD), which is the no. 1 known cause of congenital intellectual disability, suggests that public policy related to drug use during pregnancy isn’t truly concerned with child protection.

If the idea was to keep the largest number of children safe from chemical damage—and the belief was that drug-testing women and incarcerating them if they came up positive for alcohol would help—we would have mandatory alcohol testing for all pregnant women and would jail those found with a high BAC.

If we want to help the children of addicted pregnant women, we have to help the women. And if we want to help them, we need to understand them, not judge them.

Some 40,000 children are born each year with FASD, which causes irreversible brain damage and often severe disability that lasts a lifetime—at an estimated cost of $6 billion annually.

In contrast, only around 14,000 infants suffer from some sort of opioid withdrawal annually—and a similar number are believed to be born with exposure to cocaine (To complicate matters, many drug-exposed infants are exposed to multiple drugs, including alcohol, so there is a great deal of overlap in these numbers.)

However—despite media scare-mongering—there is little evidence that cocaine or opioid exposure causes significant and lasting damage. That doesn’t mean these drugs are safe to use during pregnancy, of course, but the studies find that amount of damage done seems comparable to that related to cigarette smoking. Given that entire generations of Americans were born with up to 50% of mothers smoking during pregnancy, the future for these babies is far more hopeful than that for children born with FASD.

Why then do we see the opioid or cocaine addicted women as evil—while giving those who use the more dangerous alcohol and the equally dangerous tobacco a free pass?

A new study by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that 21.8% of pregnant white women currently smoke cigarettes, compared to 14.2% of black women and 6.5% of Latinas. As for alcohol use, black women nose out white women, 12.8% vs. 12.2%, while Latinas lag at 7.4%. The rate of illicit drug use is 7.7% for black women, 4.4% for white women and 3.1% for Latinas.

But when the researchers looked at which women were reported to authorities for drug use, the numbers weren’t at all comparable. Blacks were reported at a rate no less than 10 times higher than whites—and poor women were more likely to be reported than wealthy ones.

Not surprisingly, in states with laws mandating child abuse investigations or custody loss following positive tests or those that incarcerate women who test positive, women who are prosecuted or investigated are overwhelmingly poor and minority. There are even cases where marijuana use leads to custody loss.

If illegal drug use was 100% associated with child abuse—and if incarceration of addicted parents or loss of custody improved the lives of the children involved—these laws might be justified (if enforced in a less biased manner). However, research shows that incarcerating pregnant women for positive tests actually deters prenatal care—not alcohol or other drug use—and prenatal care is actually the best way to protect drug-exposed babies.

Regarding child custody, there’s evidence that in “borderline” cases—where the decision to take a child is not obvious and investigators differ about whether to do so, such as cases of maternal addiction without documented abuse or neglect—children are far more likely to thrive if kept with their parents rather than placed in foster care. Those placed in foster care in such instances are more likely to grow up to have teen pregnancies and be involved in crime and less likely to be employed than those kept with their parent or parents.

Basically, if we want to help the children of addicted pregnant women, we have to help the women themselves. And if we want to help them, we need to understand them, not judge them or subject them to racist policies.

The first thing to know is that pregnancy tends to dramatically reduce substance use among women. One study of cocaine users, for example, found that those who had children were twice as likely to have quit than those who had not become pregnant. Even pregnant rats are less attracted to cocaine than virgin females.

The women who don’t quit tend to have the most severe problems. The vast majority have a mental illness, commonly major depression. They also tend to have harrowing histories of trauma—around two-thirds have been exposed to multiple childhood traumas. Moreover, a high proportion are still being exposed to traumatic stress, like domestic violence.

When I interviewed women who had smoked crack cocaine during pregnancy for my book Recovery Options, their stories were among the most painful I heard. Most had been repeatedly sexually abused and had lengthy stories of being neglected and maltreated. Many had witnessed extreme violence—like stabbings and shootings—and had lost loved ones to it, often when they were very young. Long before we got to the recovery part of their stories, I often wanted to smoke crack myself because even vicariously, their life experiences were hard to bear.

With support, however, these mothers often do recover—and are able to nurture their babies in ways that will not transmit the trauma to another generation. With support, they can get prenatal care and addiction treatment, particularly methadone or buprenorphine for opioids (which is safer than abstinence during pregnancy because withdrawal can harm the developing baby). Unfortunately, while there are some pioneering centers that specialize in treating addicted pregnant women and new mothers in recovery, many programs are not equipped to deal with their specialized medical needs before they give birth or to provide childcare while the mothers receive treatment afterward.

But punitive measures like immediate custody removal or incarceration harm mother/infant bonding and deter prenatal care. They might make some of us feel good by offering revenge against “bad mothers”—but they don’t protect children.

As we celebrate Mother’s Day—and may you not be among the groups who are immiserated by it—let’s give a thought to these mothers and their children who need our help, not our scorn.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). 

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