Pregnant women and drug use: Media reinforces stigma and stereotypes

In December, Reuters released a report attributing more than 110 infant deaths in the United States to the failure of doctors and child welfare systems to reliably report women showing signs of opioid use during pregnancy. Amid mounting concerns around heroin, intravenous drug use, and the spread of infectious diseases, the report—Helpless and Hooked—joins a long line of sensationalist media stories that perpetuate stigma, ignore treatments that are known to work, and imply that increased government interventions inspire "pill-popping mommas" to seek recovery and stabilize their families. 

Helpless and Hooked outlines the stories of several women— Amanda, Angelica, Courtney, Tory, and others—who struggled with drug use during their pregnancies and now, following the deaths of their infants, face serious criminal charges. Almost all of the women say they wish authorities had intervened sooner.

The death of an infant is a horrendous loss, and the stories of these women are likely reported accurately. But Reuters' 110 cases of infant mortality do not accurately represent the vast majority of babies born with prenatal exposure to psychoactive substances. 

Helpless and Hooked's graphic imagery evokes the sensationalist and thoroughly discredited “crack baby” narrative of the 1980s and 1990s. Media coverage around this "epidemic" fueled the arrests of hundreds of pregnant women and generated widespread fear that pervasive crack cocaine use would result in a generation of children with lifelong developmental problems. These fears were never realized, and today the “crack baby" panic is widely recognized to have been unfounded. Yet we continue to implement laws derived from this scare and force interventions on pregnant women who have allegedly used drugs. National Advocates for Pregnant Women (NAPW), an organization focusing on the rights of all parenting and pregnant women, has tracked more than 380 such cases since 2005.

There is no medical basis for these interventions. When controlling for economic status, access to health care, and other medical problems, including nicotine and alcohol use, there is no conclusive evidence demonstrating long-term adverse effects of prenatal exposure to opioids. Researchers who systematically followed children prenatally exposed to crack cocaine also found claims of the drug's devastating effects to be largely exaggerated, and at their worst comparable to those of alcohol and nicotine.

Stigma associated with prenatal exposure to drugs, on the other hand, has been found to negatively impact children's lives. In a 2013 open letter to the media and policymakers, 49 experts on prenatal exposure to psychoactive substances argued alarmist labels ("born addicted”) make children more likely to experience medical misdiagnosis, serious social stigma, and unnecessary separation from family. The morally charged term “addiction,” they added, cannot accurately be applied to a newborn.

Helpless and Hooked alleges legislation requiring more aggressive reporting of pregnant women showing signs of opioid use (both illegal and medically prescribed) will address the increase in opioid-related cases of prenatal exposure. But there is already a federal law requiring medical personnel to alert child protection workers to newborns showing signs of prenatal drug exposure. In addition, 38 states have enacted fetal homicide laws, which grant the “unborn child” legal status. At least 18 states also address the issue in their civil child neglect laws. As a result of these measures, hundreds—if not thousands—of children have been taken away from their mothers as the result of a single positive drug test, according to the Center for Reproductive Rights.

These laws and other punitive measures do nothing to address aggressive pharmaceutical companies, over-prescribing medical professionals, failed efforts to expand Medicaid, or the lack of adequate drug treatment for pregnant women. They have not incited a decrease in prenatal drug exposure or in drug use as a whole.

“There's little evidence to suggest that such interventions result in better outcomes," says NAPW in a response to Helpless and Hooked. "In fact, research suggests it's quite the opposite: that pregnant or parenting women who fear a positive drug screen and resulting child abuse charges will avoid prenatal care.”

At least two of the cases featured in Helpless and Hooked involve women under the care of a medication-assisted treatment (MAT) program. In addition to counseling and behavioral therapies, MAT programs incorporate a medication—most commonly buprenorphine or methadone—to aid an opioid-dependent patient in maintaining sobriety. Methadone has been called the most effective treatment for opioid addictions by both the World Health Organization and the Institute of Medicine. Considering public outcry around increases in opioid use, MAT programs have been shockingly underutilized—in large part due to misinformation, stigma, and heavy restrictions on both doctors and patients. At a time when the federal government has called for an expansion of MAT programs, Helpless and Hooked's horror stories stand to further reinforce the medical community’s hesitation to refer patients to medication-assisted care, and contribute to the many barriers patients encounter when seeking such care.

Our failure to re-examine the archaic story of drug use and motherhood means we continue to ignore the motivational, psychological, historical, political, racial, and socioeconomic factors that lead some into problematic drug use. Policy, research, and treatment have not accurately accounted for women's drug experiences, and in turn, women tend to receive less appropriate responses and resources. Sensationalist media stories depicting severe infant tremors from neonatal abstinence syndrome only reinforce the "crack baby" narrative, in which these mothers are heartless perpetrators—rather than women who have been following their doctors’ orders, or women who cannot access adequate treatment services.

Reuters’ report implies that neonatal abstinence syndrome (NAS), the term used for newborns with evidence of physiologic dependence on opioids, is fatal; but in reality, NAS can be treated and resolved through well-established protocols. The report’s graphic imagery depicts infant tremors as the direct result of prenatal drug exposure, but tremors can result from low blood sugar, infection, psychiatric medication withdrawal, or lack of oxygen to the brain at birth. Assuming these symptoms are a direct result of prenatal exposure to opioids, they are treatable and transitory.

Helpless and Hooked is just one of a handful of fallacious and morally charged stories on the increase in babies born with prenatal exposure to opioids. Although most of these stories do not evoke the crack baby narrative with such precision, they continue to spread well-intentioned but misguided information about women, drug use, and effective interventions. They assume a single drug test can predict one’s ability to parent, and they support the longstanding tradition of defining drug-using women by their gender—as mothers, future mothers, sex partners, or sex workers. We instead need media coverage that provides context for women’s drug use, acknowledges more culpable factors, and disseminates stories that accurately represent the vast majority of NAS cases. We need to be expanding access to prenatal care and drug treatment programs, instead of advocating for policies that erode reproductive rights and drug reform efforts.

The recent reemergence of sensationalist narratives around prenatal drug exposure affirms the fact that little progress has been made in the way we perceive women who use drugs since the era of the “crack baby.”