Since the mid 1980s, the medical profession has demonized mothers who use illicit drugs, calling them unfit parents who are harming their unborn children. Often we are informed that their children will be severely damaged, creating a new underclass who will be a drain on social services, the medical community and even the criminal justice system.
Yet the scientific evidence shows that the use of marijuana during pregnancy is essentially harmless and in some cases even beneficial, and that the use of heroin or cocaine is not an impediment to having a healthy child, if the mother can afford proper nutrition and a healthy lifestyle.
Most of the harm claimed to be caused by illegal drug use is actually caused by the extreme poverty of the women being studied.
Punishing bad moms
In the United States, legal sanctions against maternal drug use have been passed by 30 states since the mid 1980s. From 1985 to 1995 there were an estimated 200 women arrested on criminal charges for their behaviour during pregnancy ? 140 of them were women of colour.
In every case, prosecutors used legal statutes intended for other purposes and extended them to encompass pregnant women. Thus pregnant drug-users have been arrested for child abuse and neglect, child endangerment, drug possession, assault with a deadly weapon, manslaughter, homicide and even trafficking to the fetus.
In Canada, maternal drug use is not criminalized; however, many poor women who use illegal drugs come into contact with medical and social service professionals. Medical regulation, social service intervention and child apprehension serve to punish poor women in Canada who use illicit drugs.
Looking past the political rhetoric, what is the real story? Are specific drugs harmful to the developing fetus?
Some researchers claim that a fetus exposed to marijuana experiences withdrawal symptoms after birth. Exposure to marijuana is also said to cause low birth weight, prematurity, irritability, tremors and lower scores on infant developmental and assessment tests.
However, the largest studies on maternal cannabis use contradict these results. One of these was conducted in Canada in the 1980s. Over four years, 700 middle-class women who smoked marijuana during pregnancy were compared to non-using mothers. It was discovered that their pregnancies were similar in relation to miscarriage, obstetric complications and birth weight. There was some evidence of a shorter gestation period (one week) among the heaviest pot smokers.
A 1994 study in Jamaica actually demonstrated that Rastafarian women (“Roots Daughters”) who used marijuana heavily during pregnancy had healthier babies than women who were light users or non-users of marijuana during pregnancy.
Jamaican Rastafarians use marijuana for medicinal, ritual and recreational purposes. Marijuana is viewed as a sacred substance and is smoked daily and consumed as a tea to enhance health. Although most women in Jamaica refrain from smoking marijuana, the Roots Daughters smoked marijuana on a daily basis during pregnancy and breastfeeding. The Roots Daughters reported that marijuana use increased their appetites, relieved their fatigue, and decreased nausea during pregnancy.
Yet it wasn’t necessarily that the marijuana use itself produced superior children, but rather that the marijuana users tended to have a better home environment. The Roots Daughters who were defined as heavy users of marijuana were better educated, had fewer children at home, more adults living in their homes, less childcare responsibilities, higher education and greater independence than the non marijuana-using mothers in the study.
Heroin & opiates
The effects of maternal use of heroin and opium derivatives are also controversial. Health problems caused by these drugs are difficult to distinguish from the health problems caused by users’ poverty, low-social status and other unhealthy behaviours. In many cases even the health effects directly related to heroin use are actually caused by impurities in the heroin rather than the heroin itself.
Some research on maternal heroin use claims to show that heroin use causes intrauterine growth retardation, small head circumference (microcephaly), and spontaneous abortion. Higher rates for sudden infant death syndrome are also often attributed to maternal heroin use, as well as low birth weight and withdrawal symptoms.
However, the only specific effect of maternal heroin use is infant withdrawal, and any discussion of infant withdrawal is incomplete if it does not emphasize the fact that not all infants exhibit withdrawal symptoms.
The extent of infant withdrawal seems to vary depending on the ideology of the country the baby is born in. At the Women’s Reproductive Health Service in Glasgow, only 7% of 200 babies born to women who used drugs during pregnancy required treatment for withdrawal symptoms, and fewer still were admitted to a special care nursery.
In contrast, the number of infants requiring “treatment” for withdrawal in the US and Canada ranges from 60 to 95% of infants prenatally exposed to drugs.
Why is there such a large variance between percentages in the UK and North America? It is because drug users are demonized in North America, while in Glasgow it is known that poor pregnancy outcomes have more to do with socioeconomic factors and the lifestyles of some drug users, rather than with the effects of the drugs themselves.
Before 1983 there were no reports of cocaine-related difficulties during pregnancy. Since then, researchers suddenly claimed to have discovered a number of health problems in babies exposed to maternal cocaine use.
These include an increase in placental abruption (when the placenta separates from the uterine wall), low birth weight, small head circumference, and increased risk of premature birth. Behaviourial problems have also been claimed, as “cocaine babies” are described as irritable and difficult to care for, with an inability to form social bonds.
However, subsequent research has challenged these early claims of life-threatening problems. Claims of placental abruption are highly controversial, and many researchers have shown that other obstetric complications are not as common as claimed.
It’s very important to note that the large majority of infants prenatally exposed to cocaine are healthy. They are not low birth weight, nor are they premature.
Examples of low birth weight and prematurity are compounded by maternal undernutrition and multiple-drug use, which usually includes cigarettes and alcohol.
While it is still controversial whether infants exposed to cocaine may experience withdrawal, certainly the specific effects seen in infants experiencing opiate withdrawal are not evident.
Many studies have found no differences between infants exposed to cocaine prenatally and nonexposed infants. However, political bias has prevented these studies from being readily available in professional journals. A 1989 analysis showed that studies which found no harm to cocaine-exposed babies were rejected by journals and conferences far more often than anti-cocaine studies.
Infants prenatally exposed to cocaine are often said to be recognizable by their behaviourial differences and their “unreachableness” in interpersonal relationships. Yet many researchers have shown that children prenatally exposed to cocaine are no different from other children with economic and socially deprived backgrounds.
There are no published studies of middle and upper-class cocaine-using mothers. Only poor women have been studied, and therefore the effects of poverty and an unhealthy lifestyle are often mistaken for the effects of cocaine.
Seized “boarder babies”
The seizure and fostering of infants who may have been exposed prenatally to illicit drugs is big business in Canada and the United States. The US foster care system is overwhelmed with “drug babies” in urban centres.
Children who are apprehended in the US are warehoused and given substandard care. In New York City, seized infants are kept in hospital wards for months, then placed in temporary shelters, such as old school buildings. Often these babies remain in hospitals and temporary shelters for many months without individual personal care. These babies are labelled “boarder babies.”
Their cribs are lined up one after another, with bars over them to keep the children from escaping from their beds once they have started to walk. The psychological and developmental damage must be immense, and many of these children are never reunited with their mothers.
Illicit drug use is only one variable that may affect pregnancy. The legal drugs alcohol and tobacco appear to be more dangerous to infants than most popular illegal drugs. More to the point, variables such as undernourishment, social status, poverty, general health, lack of shelter, and environmental factors all significantly affect pregnancy outcomes more than drug use itself.
It is well documented that when pregnant, drug using women are offered non-judgmental midwifery services and social and economic support, maternal outcomes are similar to those seen in non drug-using mothers.
Punishing pregnant women suspected of illicit drug use will not be contained to only the small population of “hard drug” users. All women and their infants will be affected with increased prying, urine testing, and unwarranted seizures. The increased medical, social service, and legal regulation of women who use drugs during pregnancy ignores and obscures deeper issues of social control, gender, class and race bias.
Maternal drug use is presented as so “dangerous” that intervention by the state is considered worthy, even when such interventions clearly cause more harm than they reduce, while undermining civil liberties in the most fundamental manner.
The Children of Neverland. Gideon Koren (1997).
Drugs Pregnancy & Childcare. The Institute for the Study of Drug Dependence (1992).
“Drug use in pregnancy.” British Journal of Hospital Medicine. Mary Hepburn (1993).
The pregnant drug addict. Catherine Siney (1995).