A Glass Half Full? Harm Reduction among Pregnant Women Who Use Cocaine

• Published date: 01 July 2002
• Date: 01 July 2002
• Author: Jeanne Flavin
• DOI: 10.1177/002204260203200315
• Subject Matter: Article

© 2002 BY THE JOURNAL OF DRUG ISSUES

JOURNAL OF DRUG ISSUES 0022-0426/02/03 973-998

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Jeanne Flavin, Ph.D., is an associate professor of sociology at Fordham University. Her research

focuses on identifying humane responses to people who use drugs and to their families.

A GLASS HALF FULL? HARM REDUCTION AMONG

PREGNANT WOMEN WHO USE COCAINE

JEANNE FLAVIN

The current research challenges the popular assumption that pregnant women

who use drugs are either unable or unwilling to take steps to promote a healthy

pregnancy. Many qualitative studies have found that pregnant women who use

drugs may engage in harm reduction strategies. These findings were confirmed in

the present study, which uses data collected as part of the 1992 National Institute

on Drug Abuse survey of women who delivered live-born infants in DC hospitals.

These data also highlight the disadvantaged socioeconomic, emotional, and physical

position of women who use cocaine relative to other women. The findings suggest

a need for policies and responses to maternal drug use that recognize many

women’s desire to promote a healthy pregnancy as well as their diminished social

and physical circumstances.

INTRODUCTION

On March 21, 2001, the Supreme Court ruled in the South Carolina case of

Ferguson v. City of Charleston that, contrary to past practice, a public hospital

cannot test pregnant women for drug use without their consent and turn the results

over to police. Two months later, also in South Carolina, a woman was sentenced

to 12 years in prison for killing her unborn fetus by smoking crack cocaine (Firestone,

2001). Criminal justice intervention in the lives of pregnant women is not

uncommon, nor is it confined to South Carolina. In the last two decades, over 200

women in more than 30 states have been arrested and charged for their alleged drug

use or other actions during pregnancy (Swift, 2000; Center for Reproductive Law

FLAVIN

974 JOURNAL OF DRUG ISSUES

and Policy, 1996, 2000). In some of these cases, charges were dropped before trial,

but, in many others, women have been pressured into pleading guilty or accepting

plea bargains, some of which result in incarceration.1

Although the prosecutorial zeal has waned in recent years, debate over how to

address maternal drug use continues. At one end of the spectrum, pregnant women

who use drugs are viewed as self-centered individuals who can and should carry

full responsibility for their actions; at the other end, they are defined as victims of

drug addiction and social circumstance who have no agency and therefore no

responsibility for their actions. Both positions assume that drug-using women are

either unable (at best) or unwilling (at worst) to take steps to reduce the risk of

harm to self or the fetus.2 Whether inspiring policies of increased surveillance,

punishment, or mandatory treatment for the “mother’s own good” or in the interest

of the fetus, neither position seriously considers that women who use drugs may

exert some positive influence over their pregnancies. The current research challenges

the veracity of this assumption, using recent findings from qualitative studies and

survey data collected from 120 women who reported using cocaine during their

pregnancies. Specifically, I consider the backgrounds of pregnant women who use

drugs as well as the nature and extent of their efforts to promote a healthy pregnancy.

BACKGROUND

Proponents of prosecution, court intervention, increased medical surveillance,

and other measures designed to recognize “fetal rights” claim that such measures

are necessary to protect the fetus from harm (Noble, Klein, Zahnd, & Holtby, 2000;

Roth, 2000; Center for Reproductive Law and Policy, 2000).3 This claim often

assumes women who use drugs (especially cocaine) are out-of-control women who

would do anything for drugs and who are completely indifferent to any harm they

may cause to themselves or others (Humphries, 1999; Reeves & Campbell, 1994).

Partly to counter the overwhelmingly negative and vilifying media images of

indifferent crack mothers, another, largely feminist, academic literature has emerged

constructing pregnant women who use drugs as victims – not only of drug use, but

of physical and sexual abuse, an indifferent culture, and structural inequality (Center

for Reproductive Law and Policy [CRLP], 2000; Daniels, 1993; Kang, Magura,

Laudet, & Whitney, 1999; Roberts, 1999; Roth, 2000). This literature suggests that

many women self-medicate with alcohol and drugs as a means of alleviating the

pain and anxiety of lives shaped by poverty and violence. Other scholars object to

the tendency “ . . . to create a monolithic construct of ‘the pregnant addict’ whose

entire life story is one of structural victimization” (Roth, 2000, p. 27). In the last

five years, a growing body of research suggests that images of women who use

drugs as having little or no agency may be as misguided and inaccurate as the