Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice


Weed whacking

CClick the image to open a larger version in a new window.

The last few years have seen an increase in states working to decriminalize recreational marijuana use by adults. Apparently, the U.S. Surgeon General believes that only illegal status was preventing pregnant people from puffing their nine months away, because this year he issued a strong warning against marijuana use during pregnancy.

This cartoon addresses criminalization of marijuana use rather than a generalized warning, but the fact is that laws that criminalize drug use during pregnancy and issue special penalties for it already exist and women are being charged under them. Furthermore, even in decriminalized states, mothers still face consequences for marijuana by way of the child welfare system; sanctions can include one that many mothers would rate even worse than the loss of their liberty: the loss of their child. These repercussions seem vastly disproportionate to the drug-using behavior, considering the following facts:

  • The effects of marijuana use during pregnancy are often overstated in the absence of concrete data.
  • The effects of marijuana use during pregnancy are often confounded with other substance use – including alcohol and tobacco, which are far more dangerous to the baby than any illicit drug.
  • The effects of marijuana use during pregnancy are often confounded with socio-economic status and with disparate effects by race, including uneven enforcement, uneven consequences, and uneven expectation of privacy. Indeed, the effects of intervention itself in the form of child welfare agencies cannot be classified as benign; certainly, separating babies from their mothers in the first hours of life isn’t good for either party.

Sanctions, whether threatened or real, scare pregnant people away from prenatal care. When so many things in our lives are bad for babies (job loss, environmental pollution, violence against women), this fixation with a substance whose harm hasn’t even been fully established looks like just another way to criminalize pregnancy. In addition, when marijuana use is legal, punishing users might serve as the bridge to criminalizing tobacco and alcohol use. Or consumption of runny cheese! Or hot tub use. … Or living in a neighborhood where the water has been turned off, homes have been foreclosed upon, and the factory next door belches a queasy-making smoke that the municipality assures residents is Perfectly Safe. 

If we want pregnancy to result in healthy babies and healthy mothers, perhaps we might concentrate on known dangers and support parents in ways that don’t involve a) a jail cell, or b) the threat of separation on the single most important day in a brand-new person’s life.

Suggested reading

Image credits 

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

  • Frame 1: “Reefer Madness” poster (“drug-crazed abandon!”) is from Wikimedia Commons. The image is in the public domain.
  • Frame 2: Policymaker and scientist/doctor are by Mohamed Mahmoud. RJ Truthteller is borrowed from another cartoon that states the image source.
  • Frame 4: Pregnant woman is by Thiago Borges. Health Department is by Michael Rivera; the image was cropped.
  • Frame 5: The photo is by Patricia Deal, and is in the public domain. Because this photo portrays a real person, we wish to emphasize that the pregnant woman pictured did not speak the words we put in her mouth. In no way do we wish to suggest that the circumstances suggested by those words apply to her.


1 Comment

Life begins … when?

Many have been known to ask when life begins, in an attempt to establish boundaries for policy issues connected with female reproduction. We wonder whether that question can possibly give a sufficiently definitive answer to guide us in our quest. If it can’t, we might do better to turn to some other defining scheme – such as the wishes of the mother whose body stands between the world and the baby-to-be.

life begins … when?, slide1

Explanations and Attributions

The spherical building welcoming the sperm is in real life the “Kugelmugel,” a micronation located in Vienna.

The clock radio photo, by Chrissy Wainwright, is titled “It’s Too Early!” It is shared here under a Creative Commons license.

The dugout photo demonstrating implantation is by Christian Bickel, described as “Speisekammern in Keldur” (food chamber – probably storage – in Keldur). It shows an example of an Icelandic turf house.

The photo representing red menstrual waters is by Derek Harper, entitled “Red Sea at Babbacombe.” It is shared here under a Creative Commons license.

The pink building shown in Frame 4 is, of course, the Jackson Women’s Health Organization, in Jackson Mississippi, where the awe-inspiring Dr. Willie Parker practices.

The court cases mentioned on Page 2 are quite well-known and easily found online, should you wish to read the opinions. No cases are mentioned for the criminalization of pregnancy (Frame 4), but a visit to National Advocates for Pregnant Women will tell you all you need to know.

The adorable baby with doting mama were captured by Bonnie U. Gruenberg. The photo is shared here under a Creative Commons license.

The orange chair and other clipart were taken from cliparts.co.

The statue shown in Frame 4 on Page 2 is of unknown origin, although several photos of it can be found online, including here, where it is suggested the statue depicts (biblical) Rachel weeping for her children.

The police officer and the representation of the Big Bang are shared here under a Creative Commons license.

 

Updated November 2, 2017, to fix a typographical error.


Baby addicts?

baby addicts, p1 baby addicts, p2

The condition of suffering babies is something everyone can comfortably decry. Sources like the video These Babies Were Born Addicted to Drugs rush to tell us how many babies are afflicted and how worthy of condemnation are their mothers for using drugs – usually opioids – while pregnant. The babies’ symptoms – trembling, shrill cries – are described in great detail. One cannot help feeling that any woman who would subject her baby to such a fate must be a monster.

The only problem is the facts. Babies suffering from Neonatal Abstinence Symptom can and are treated. The symptoms of NAS are often conflated with those of poverty or alcohol and tobacco use. More to the point, to describe babies as addicts is incorrect. Addiction is defined as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” One cannot accuse babies or fetuses, for that matter, of drug-seeking behavior. Rather, babies whose mothers used substances while pregnant can best be described as drug-exposed or drug-dependent.

To criminalize mothers for their pregnancy outcomes based on substance use is neither just nor effective. Typically, drug possession is a chargeable offense, not drug use. However, in the case of pregnant women, drug use, as determined by drug testing of mothers or newborns, is treated as a crime. Medical providers often fail to inform by their pregnant patients that they are being tested for substances; this is more likely to be the case for those receiving publicly-funded health care. Although health care providers are not permitted to test pregnant people for the express purpose of informing law enforcement, they may nevertheless use maternal testing as a screening mechanism to determine which newborns will be tested. Many states require providers in their role of mandatory reporter to report all such cases to child welfare agencies, who are then free to refer cases for criminal charges.

Prosecuting parents for prenatal drug use is of little benefit. Incarceration is not known to improve the health of pregnant people or their babies. Indeed, while awaiting sentencing in a holding facility, these pregnant people might not receive any health care at all, much less substance treatment. Furthermore, incarceration almost invariably results in the separation of parent and child, an act with far greater negative consequences than most drug use.

Removal of children by child welfare authorities for parental drug use – including legal medical marijuana use! – is not in the best interest of children or parents. Other countries do not automatically assume that drug use renders parents unfit. Determinations of abuse and neglect should be made based on abuse and neglect.

Nor is state involvement equally visited upon the population. Disadvantaged groups, such as poor women and women of color, are more likely to be subject to reprisals based on drug use than are their wealthier white counterparts. However, the fear engendered by medical providers’ role in reporting drug use is sufficient to cause many pregnant people to avoid care altogether – hardly a public health good.

In the 1980s and 90s, media were abuzz with accounts of “crack babies,” children said to have been exposed to crack cocaine in utero. Dire predictions abounded regarding the eventual fate of these children. However, even at the time, it was known that other legal substances – such as tobacco – were much more harmful to fetuses than crack cocaine. Nevertheless, because the crack baby story fed into the War on Drugs initiative proposed by Ronald Reagan – itself a piece of social policy with scant evidence basis – and because it made for dramatic television, it led to severe consequences to many parents and children.

The insistence on condemning mothers of babies exposed to opioids may well be equally suspect. Drug addiction should be treated as a public health issue rather than as a criminal law issue, moves to reduce income inequality and racial bias will do more to aid mothers and babies than incarceration, and blaming women for their pregnancy outcomes will result in less liberty for women in all aspects of their reproductive lives.

 

 

[Photos of Farah Diaz-Tello, of National Advocates for Pregnant Women, and Cherisse A. Scott, of SisterReach, used with permission.]

[Updated 6/1/2016, 9:30pm, for grammar and stylistic changes, and again on 6/4/2016 and 9/2/2016. Updated 7/16/2016 with copyright designation.]