The high court has decided to hear a case that could determine how society views pregnant women who use drugs and their babies. The problem of drug use by pregnant women is real, but it is not a criminal problem. It is a mental health problem that can be treated. Criminalizing these women’s actions will only further the stigma they face.

By Barry Lester

The February decision of the U.S. Supreme Court to rule on whether public hospitals may test pregnant women for drug use and provide the results to police will have profound implications for the treatment of these women and for the fate of drug-exposed infants.

The high court will hear the case brought by a group of 10 women who had been subjected to such testing at a Charleston, S.C., hospital. The women contend that the hospital’s policy violated their constitutional protection against unreasonable searches. In 1992 the South Carolina policy sent Cornielia Whitner to jail for eight years because she violated that state’s child abuse and neglect laws by using cocaine while pregnant. The state argued that she should have known that drug use would hurt her fetus and result in the birth of a damaged baby. Therefore she had to be punished.

The Supreme Court’s decision will determine how our society views these women and their babies and how they are treated.

The problem of drug use by pregnant women is real. The latest report from the federal government showed that more than 320,000 pregnant women either binged on alcohol or used illicit drugs. The public’s concern for the welfare of the child is often expressed as anger at the mother. As a result, policy-makers tend to punish these women with jail sentences or removal of their children. However, the main challenge facing these infants is not that they have mothers like Ms. Whitner, but society’s view that drug use by pregnant women is criminal behavior and a criminal problem, rather than a mental health behavior and a mental health problem.

A pregnant woman’s substance abuse is a mental health problem that needs treatment and prevention like any other health problem such as hypertension or diabetes. Society disregards the similarity between cocaine use and hypertension because the inability to control one’s blood pressure is seen as an involuntary act. Dismissing the similarities between these two health problems is a symptom of the stigma associated with drug use. Research shows that treatment for drug addictions is effective. In fact, treatment works for drug addictions as well as it does for medical conditions such as hypertension and diabetes. But the stigma associated with drug use drives women away from treatment for fear of detection, incarceration and child removal. Of all people, these women and their babies need health care treatment.

The children also bear the stigma. Despite mounting research to the contrary, we still have the image of the infant exposed to cocaine as a brain-damaged baby born prematurely, trembling and screaming through withdrawal. These infants, according to popular beliefs, are destined to fail in school and in life, and become wards of society. These babies can be helped, but failure becomes a self-fulfilling prophecy: If society expects these children to fail, they will fail.

Once we overcome the stigma, we can look at treatment. Proven comprehensive and cost-effective services, under the supervision of the courts, can be provided for both mother and baby. The federal government spends more than $350 million annually on services for drug-exposed children in school. If that were spent instead on early intervention, we could prevent the children’s deficits from occurring.

But to do this, we first have to accept that substance abuse by pregnant women is similar to other health problems. We can no more abandon an addict at the first sign of relapse than we would abandon a hypertensive for forgetting to take blood pressure medication. The first step is to treat both the drug user and the societal stigma associated with drug use. Without that, the chances of recovery for the drug-addicted mother or the drug-exposed baby are unlikely to improve.

Barry Lester, professor of psychiatry and human behavior at the Brown University School of Medicine, directs the Infant Development Center at Women and Infants' Hospital. His work is funded, in part, by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program.