Perinatal Care for Women Who Are Addicted:Implications for Empowerment

Perinatal drug abuse is the use of alcohol and other drugs among women who are pregnant. The National Institute on Drug Abuse estimates that 5.5 percent of the women in the United States have used illicit drugs while pregnant, including cocaine, marijuana, heroin, and psychotherapeutic drugs that were not prescribed by a physician. More than 18 percent used alcohol during their pregnancy, and 20.4 percent smoked cigarettes (Marwick, 1998). Literature reports the increased use of drugs during pregnancy (Lieb & Sterk-Elifson. 1995), using therapeutic communities (Stevens & Arbiter, 1995) and neighborhood context (Perloff & Jaffee, 1999) for addressing perinatal drug abuse; access barriers for low-income ethnic minority women who are addicted and pregnant (Cook, Selig, Wedge, & Gohn-Baube, 1999); the importance of effective policy making (Harrison, 1991); referrals to child protection services (Azzi-Lessing & Olsen, 1996); and other responses to perinatal drug abuse (Azzi-Lessing & Olsen; Irwin, 1995; Lieb & Sterk-Elifson; Marwick, 1998). Women who abuse drugs while pregnant face severe consequences, which include becoming stigmatized as immoral and deficient caregivers (Carter, 1997; Kearny, Murphy, & Rosenbaum, 1994; Lieb & Sterk-Elifson, 1995). A behavioral outcome of societal attitudes toward perinatal drug abuse is the degree to which the drug-taking behavior of pregnant women is criminalized (Lieb & Strek-Elifson). Criminalization refers to using legal approaches, such as incarceration, for medical problems of clients rather than referring them for treatment (Keigher, 1999). Community response to the increasing number of women who give birth to infants addicted to crack cocaine, for example, has been to prosecute women for perinatal drug abuse (Lieb & Sterk-Elifson). Similarly, the number of mentally ill inmates in jails and prisons is estimated as being twice that in state hospitals (Keigher). Individuals in helping professions also display stigmatic attitudes toward perinatal drug abuse. Disparaging interactions with women in some perinatal care facilities (Irwin, 1995), for example, include rude and judgmental comments to clients and violation of their confidentiality. Uncomfortable relationships with health care providers and fear of reprisal on the part of pregnant women who are addicted make women four times less likely to receive adequate care (Carten, 1996; Cook et al., 1999), thereby creating health risks for women who are addicted, their unborn fetuses, and their other children. In this article I discuss contemporary responses to perinatal drug abuse, including ways in which the behavior of women who abuse drugs is criminalized or subjected to legal interventions. Vignettes from an ethnographic study of 120 women who used heroin, crack cocaine, and methamphetamine while pregnant (Irwin, 1995) depict the attitudes and behaviors of health care providers, society at large, and women themselves toward maternal drug abuse. This article demonstrates how poor women and women of color encounter legal interventions--such as prosecution or reports to city or state child protective services (CPS)--more frequently for using drugs during pregnancy than their more affluent, white counterparts. Because criminalizing perinatal drug abuse presents substantial risks to the health of women and children, empowering (Gutierrez, DeLois, & GlenMaye, 1995) strategies are suggested for redefining perinatal drug abuse less as a legal issue and more as a health concern. The strategies are consistent with eleme nts of the national health plan of the U.S. Department of Health and Human Services (DHHS), such as creating access to health care and minimizing risks to maternal, infant, and child health (DHHS, 2000). SOCIETAL ATTITUDES TOWARD PERINATAL DRUG ABUSE Over the past 100 years, there has been an overall shift in obstetric medicine to a focus on fetal protection (Harrison, 1991). …