Women drug program in pregnancies

Women drug program in pregnancies

Women drug program in pregnancies

Introduction

Context is always important for social policy, but in the case of drug abuse during pregnancy, context is important in several different ways. First, policy is, by definition, dependent on social context. As was clear from our historical review, the social context for prenatal drug exposure changed dramatically in the mid-1980's with the crack epidemic. Social consternation with the high level of use by pregnant women centered on consequences for the children and then shifted to the fetus. Once the fetus became the central protagonist there was a significant shift in social perception. The concept of harming the fetus by using drugs during pregnancy resulted in sanctions by both the criminal justice system and the child protective system.

Second, existing policies have been made in a climate of scientific uncertainly about the effects of prenatal drug exposure. Policies looking for a "quick fix" have taken a linear approach by focusing on the single risk factor of prenatal drug exposure as the explanation for the outcomes of these children. However, as we will show later, there is a wide variation in the developmental outcome of these children, and the determinants of development in these children are multifaceted and complex. Drug effects must be understood in the context in which the child develops. Parenting and other environmental factors in addition to drugs are responsible for the outcome of these children. Poverty (which can be a proxy for an inadequate environment) affects IQ without drugs.

Third, context is also important because social policy in this area brings up many ethical dilemmas. In the "real world," drug-using pregnant women are mostly poor and minority. The social policy context for these women includes dramatic reductions in services and access to legal recourse. In the real world, child rearing is also affected by context, including culture. Drug-using mothers may want "the best" for their children, but what they mean by "best" will be influenced by their context, experience and belief systems and may differ from what the experts mean by "best." And "best" needs to be weighted against the alternative.

Fourth, to say that policy is dependent on social context also means that policy is shaped by public perception and attitudes. One of the consequences of shattering the placental barrier, triggered primarily in response to the use of cocaine by pregnant women in the 1980s, has been two parallel sets of attitudes towards drug use during pregnancy resulting in two parallel sets of policy responses. One approach is to view drug abuse as a mental health/medical illness. Advocates of this approach recommend policy that emphasizes treatment and prevention including reproductive health care, therapy for past abuse and for parent child relationships. The other approach is punitive and views drug-using women as criminals and as irresponsible ("how could they do this to their babies?"). This approach translates into sanctions within both the criminal justice system and the child protection ...