Pregnant drug users: Scapegoats of reagan/bush and clinton-era economics.

• Date: 22 December 2001
• Author: Murphy, Sheigla,Sales, Paloma
• Published date: 22 December 2001
• Author: Murphy, Sheigla

Introduction

IN THIS ARTICLE WE PRESENT ANALYSES FROM TWO NATIONAL INSTITUTE ON DRUG Abuse-funded studies: "An Ethnographic Study of Pregnancy and Drug Use" (Rosenbaum and Murphy, 1991-1994) and "An Ethnography of Victimization, Pregnancy, and Drug Use" (Murphy, 1995-1998). Our goal is to explicate the ways in which pregnant drug users in the San Francisco Bay Area experienced, coped with, and protected themselves from increasing stigmatization, abuse, and punishment while enduring a period of fiscal retrenchment of government assistance programs.

Beginning in the 1980s, the trend was for social welfare programs to move from federally mandated and funded programs developed in the 1960s to state-by-state directed programs funded through federal block-grant mechanisms. These policies were advanced during the Reagan/Bush administrations and continued during the Clinton era. Due to shrinking budgets at the state level, numerous social service programs shifted to public subsidization supervised by local governments and finally to privatization or the purchase of privately produced services. Historically, the downsizing of human service program provision tends to occur as programs move from federal to state to local supervision (Feldstein, 1988).

For pregnant drug users with limited means, these funding decisions created barriers and denied access to cost-effective services that would enable them to improve their lives. As a result, they were forced to find alternative resources and to construct survival strategies. The women we interviewed reported that drug use helped them overcome some adversities in their daily lives. It was sometimes a source of income and usually a source of solace and recreation. Although drug use helped interviewees survive on a day-to-day basis, in the long term, women faced severe consequences. In a political context of social welfare reform, our interviewees' ability to care for themselves and their children was extremely compromised. Our collection of data over a seven-year period enabled us to chart interviewees' perspectives and experiences within changing social and policy climates. In the following, we detail the ways in which pregnant drug users became ideological targets in the U.S. war on drugs. The media and politi cians promulgated pernicious images of drug-using mothers having babies simply to qualify for government handouts that would enable them to buy drugs and then neglect and abuse these children (Campbell, 2000; Humphries, 1999). These images contributed to the passage of legislation and funding allocations that resulted in the wholesale reduction of social welfare services to all poor women and children. The war on drugs has always been a war on the poor, particularly people of color (Maher, 1992; Murphy and Rosenbaum, 1999). By 2001, drug use and drug users were clearly playing a very important role in defining poverty among women and children as an individual behavioral problem, rather than the result of systematic, structural economic inequities.

Methods

An Ethnographic Study of Pregnancy and Drugs: "An Ethnographic Study of Pregnancy and Drugs," conducted between 1991 and 1994, was a study of drug use during pregnancy in the San Francisco Bay Area (Rosenbaum and Murphy, 1991-1994). We employed fieldwork, depth-interviewing, and closed-ended questions as the primary data-gathering tools. We interviewed 120 pregnant or postpartum adult women who were using heroin, methamphetamine, or cocaine singly or in combination for a minimum of 25 days during their current or most recent pregnancy. Women who were enrolled in drug treatment for more than five days within a four-week period were not included in the study. Those women who were in treatment for less than five days had to have returned to drug use for five or more days since their last day of treatment. These criteria allowed us to interview women who had brief encounters with drug treatment and had subsequently returned to drug use. Therefore, we were able to explore women's reasons for leaving treatment.

To fully explore AIDS risks, attitudes, and behaviors, half (20) of the women interviewed in each of the three stages of pregnancy (discovery, five months to delivery, and six months postpartum) were intravenous drug users (IDUs). IDUs were defined as women who had injected heroin, cocaine, or methamphetamine at least once a week during the six months before discovering their pregnancy. These inclusion criteria permitted us to examine the changes in drug administration before and after the onset of pregnancy. Non-injection drug users were defined as any woman who had not injected drugs in the previous two years. Each of our subgroups, IDU and non-IDU in each stage of pregnancy, consisted of 20 subjects. Our past research demonstrated that a minimum of 20 interviews is necessary to discover meaningful patterns and to produce a robust theoretical framework.

In the course of the life history interviews, the interviewer and study participant explored the introduction and initiation to each drug used, social environments of use, pressures to use or not to use, the relationship of pregnancy to patterns of use, and barriers to treatment. The other areas of inquiry included methods of ingesting drugs, violence, involvement in criminal activities and high-risk AIDS behavior (including needle sharing and sexual practices), the level of involvement in prenatal care, living arrangements, and sources of income.

The ethnic breakdown of the sample was 53% African American (n = 64), 34% white (n = 41), seven percent Latinas (n = 9), with the remaining six percent being Asian, Native American, or Pacific Islander. Eighty-eight percent of the women relied on public assistance to support themselves and their children. Approximately 40% were homeless at the time of interview and another 20% lived in publicly subsidized housing projects in neighborhoods characterized by high levels of drug sales, drug use, and violent crime.

An Ethnography of Victimization, Pregnancy, and Drug Use: Our second study, "An Ethnography of Victimization, Pregnancy, and Drug Use" was conducted between 1995 and 1998. It was an exploratory depth-interview study of pregnant drug users who experienced one or more victimizations (physical, sexual, and/or emotional) while pregnant (Murphy, 1995-1998). This project developed from findings in the previous study of pregnancy and drug use, which indicated pregnant drug users experienced an extremely high incidence of violence. Of the 120 women we had interviewed in the previous study, 78 (65%) were, or had been, in abusive relationships. We began this project by using ethnographic fieldwork methods to locate and recruit women who were pregnant or recently pregnant and had used marijuana, crack/cocaine, heroin/opiates, and/or methamphetamine singly or in combination. During the first phase of the study, we collected information concerning demographics, family, drug use, as well as relationship and reproductive hi stories employing a structured questionnaire. This instrument was designed to measure levels of drug use and victimization. Those who had experienced violence while pregnant were asked to participate in the second phase, a qualitative depth interview focusing on their drug use and victimization histories with an emphasis on victimizations experienced during pregnancy. Originally, we thought we needed to recruit 300 women to enroll 100 who had experienced victimizations and agreed to participate in the second phase. As it turned out, we only had to recruit 126 women, since 79% (n = 100) of the women we surveyed had experienced physical and emotional violence during their most recent pregnancy. Violence was much more prevalent than we had estimated.

The mean age for this sample was 29. Only nine percent were married, 63% were in a relationship, and 28% were single. Fifty-two percent were African-Americans, 27% white, 15% Latina, and six percent Native American or Asian/Pacific Islanders. Forty-one percent were primarily crack users, 28% marijuana users, 19% heroin users, while seven percent used powder cocaine and five percent methamphetamine. They had inadequate financial resources, lived in substandard housing, and lacked marketable job skills and adequate support systems. They had one-fourth the income and more children (2.2 versus 1.6) than the general population of women in the San Francisco Bay Area (U.S. Census Bureau, 1990). They were three times as likely to have dropped out of high school and far less likely to have been in college. Fifty-seven percent of the sample had no permanent housing. Of those, 27 (37%) were temporarily living in a friend's or relative's home, 23(32%) were homeless, 15 (21%) lived in SRO (single room only) hotels, and se ven (10%) lived in residential treatment facilities or group homes. Over two-fifths of the sample (42.9%) reported they had been homeless for three or more days in the six months before the interview.

Throughout this article, when we quote directly from interviewees' transcribed narratives, we will indicate in which of the two studies (PAD for the first study, PAV for the second study) the interviewee participated. Participants in both projects were predominantly women of color, unemployed, and living close to, if not below, the poverty level. They were directly affected by cuts in social spending during the Reagan, Bush, and Clinton administrations.

Welfare Reform

Welfare reform was a direct consequence of changes in how poverty was defined. During the Great Depression, when high unemployment created a large population of impoverished people in the United States, poverty was defined as a structural problem stemming from blocked opportunities. Poverty was seen as something that government intervention could ameliorate because people needed a "hand up" to actively rejoin the economy (Patterson, 1981:142). The New Deal of the 1930s included programs...