How does a policy that vilifies the illegal drug user translate into human cost? The drug news of featured dramatic predictions that from 375,000 to 650,000 "cocaine-exposed babies" each year would suffer low birth weight, neurological impairment, and fetal malformations. The annual care cost for these babies was projected as high as three billion dollars. Dire predictions were also made about the effect of maternal cocaine use on childhood development. More than fifty mothers were prosecuted, but not one was convicted on charges including drug possession with intent to deliver, child abuse, and murder.
In the frenzy of accusations, serious questions were overlooked about the validity of the information that attracted national concern in the first place: the damaging effects of cocaine on the fetus. In fact, most of what is attributed to cocaine's effect on low birth weight is also associated with poverty, inadequate prenatal care, and poor nutrition. One leading investigator notes that while the neonatal toxicity of cocaine is of course important, these other factors may well play a more important role in the damage. When cocaine-using mothers, even as late as the third trimester, receive treatment for their cocaine problem, along with good prenatal care and diet, their newborns have normal birth weights and, so far, no detectable neurological abnormalities. Also, no scientific evidence yet supports the claim that cocaine causes adverse developmental outcomes in these children. A major revaluation is now underway in the scientific community concerning the degree of cocaine's role in causing fetal damage. Leading scientists recommend a "suspension of judgment about the developmental outcome of cocaine-exposed babies until solid scientific data are available." What if cocaine does not cause the horrendous damage as portrayed? Are we going to charge women with the crime of poverty?
Closer examination reveals that not only were the potential harmful effects of cocaine magnified, but also the numbers of cocaine babies. As far as I can determine, the 375,000 cocaine-baby number originated in 1989 with one investigator's estimate of the number of pregnant women taking illegal drugs. Also, in 1989, William Bennett, in a television interview referred to "200,000-300,000 crack-addicted babies" born annually. Thereafter, press stories routinely cited 375,000 cocaine-babies costing three billion dollars annually. Despite all this news, neither the actual number of cocaine-babies nor the annual cost of meeting their needs is known. Have we again overportrayed the drug role in our zeal to do good?
As with so many other instances where drugs and drug users are blamed, the Secretary of Health and Human Services assailed drug use by pregnant women in a speech in Boston, stating that these women were committing child abuse and that, in serious cases, mothers should lose parental rights. News stories attributing the most graphic examples of damaged neonates solely to drug use raised concern about these children being written off. To compound the negative stereotype, these greatest number of pregnant cocaine users are poor, inner-city mothers.
Medical ethicists struggle to balance privacy rights of these pregnant mothers with the needs of society to protect their children. Widespread mandatory treatment for drug use during pregnancy is under active consideration. In addition, child protective laws are being modified; programs are being established with special live-in facilities for mother and child, or foster care for the children, with cocaine treatment elsewhere for the mothers.
The use of the criminal law to punish these women is widely condemned by medical professionals. The AMA has joined addiction medicine specialists in protesting this repressive and punitive approach, by pointing out that pregnant women need access to excellent prenatal care and addiction treatment, neither of which is available in many communities. Blameful attacks on the mother, litigation to punish the mother, and reflex separation of mother and child because of maternal cocaine use is not justified by the medical data. The dichotomy between legal and medical treatment of these women is another example of medicine under the influence of drug criminalization. |
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