Michele Bratcher Goodwin,
"Reproductive Carrots and Sticks"
(page 5 of 9)
Part II: Race, Class and the Illusory Concept of Drug Choice
Studying the choices that pregnant women make, including their drug
use, can better assist legislators in crafting good public policy. For
example, poor women, especially those who lack medical insurance, do not
have access to prescription medication to address depression, anxiety,
and other mental health issues. To this class of women, self-medication
may seem like the only available option to treat depression and
anxiety.[27]
The drugs that they consume can be obtained without
insurance, are easily accessible, and cheap.[28]
For some women, that
will mean buying easily available illegal drugs that are sold illegally.
Thus, drug choice is an illusory concept. If given the option between
treating their addictions with affordable, legal medications, dispensed
by physicians, and buying crack on the streets from dangerous drug
dealers, pregnant women would likely choose the former option.
However, physicians are sometimes complicit in prosecutorial regimes
against pregnant women, and race is sometimes a factor. In Charleston,
South Carolina, for example, the collaboration between local police,
prosecutors, and the medical staff at the MUSC resulted in
the planning and implementation of a covert
"Search and Arrest" policy. This policy targeted some women and not
others.[29]
The secretive plan required doctors and nurses to search
pregnant women for evidence of cocaine or crack
use.[30] Using public
service announcements and advertisements, MUSC staff and local law
enforcement encouraged drug-dependent women into the hospital, urging
pregnant women to help their developing fetuses by receiving free
prenatal services. At first glance, using PSAs to encourage women to
seek free prenatal screening seems more carrot than stick.
However, upon hospital staff identifying those with "dirty" urine
tests, nurses quickly provided that information to local police and
prosecutors.[31]
In the process however, doctors and nurses trampled
an undiminished expectation of privacy, undermined the physician-patient
relationship, and disregarded the search and seizure requirements of the
Fourth Amendment. That the policy was only implemented at MUSC, the
single hospital in Charleston with a predominantly African American and
low-income population, gives some indication that the locus was
purposeful and those caught in the dragnet were the intended
population.[32]
The "Search and Arrest" policy did however accomplish one goal: it
allowed the state, without warrants or probable cause, to conduct
nonconsensual searches of pregnant women who sought prenatal care. But
the policy did not improve pregnancy outcomes, reduce cocaine use, or
increase the number of women successfully completing drug treatment
programs as none were offered.[33]
On the other hand, recent studies indicate that net worth influences
health outcomes and sheds light on drug and alcohol abuse among
whites.[34]
These studies could dispel the notion that poor blacks
comprise the more significant population of drug users of in the United
States.[35]
For example, among adults, studies indicate that "annual
and current alcohol prevalences generally are highest among whites, at
an intermediate level among Hispanics, and lowest among
Blacks."[36]
Another study conducted in Baltimore indicates that among women with
twelve or more years of education, white women are more likely than
their black counterparts to be heavy alcohol
users.[37] That data,
combined with studies from the National Institute on Drug Abuse (NIDA),
reveals that white women are more likely to smoke and abuse alcohol
during pregnancies.[38]
The NIDA study also shed some preliminary
light on drug use among racial groups. For the year of the study, the
NIDA survey found that an estimated 113,000 white women compared to
75,000 African American women had used illicit drugs during
pregnancy.[39]
Yet, as one study found, black women are ten times more
likely to be reported to a child welfare agency for drug use than white
women.[40]
This and similar studies indicate that race and wealth
continue to influence our normative understandings of mothering and
shape our notions of who qualifies as an appropriate mother.
What does this data tell us about the ways in which state resources
are utilized to respond to drug dependency among women and social policy
commitments to helping fetuses? There are a few possibilities. On one
hand, we could read policies that primarily focus on illicit drug use as
an effort to save poor and black babies. Viewed through this lens, we
could imagine that reproductive policing is an ex ante screening device
designed to predict the potential for later child neglect or abuse. Or
reproductive policing could be seen as an economic alternative to
rehabilitation. Essentially, the state has made a calculated decision
that, despite less efficiency, it is better to incarcerate rather than
rehabilitate poor, drug-dependent women. Another possibility is that,
despite medical studies warning against incarcerating drug-dependent
women, legislators have concluded that institutionalization of pregnant
women produces a deterrent effect. Unpacked further, it is possible
that legislators believe better prenatal resources are available to
black women in prison than through state-funded hospitals. But such
readings of current drug law policies are irrational.
On the other hand, it is possible to conclude that such policies are
not effective, in that arrests occur primarily among poor African
Americans, despite compelling evidence that wealthier women engage in
substance use during pregnancies, but are not targeted by the state. A
revised approach, one that polices a broader spectrum of behaviors that
relate to harming fetuses, would likely result in the punishment of more
pregnant women, particularly white women. Yet, that approach would be
rationally related to the state's purported goals. Rather than
shielding political elites within a community from the rules that
ensnare poor women, such an approach might better equalize or promote
democracy within the context of reproductive policing.
But there is something problematic in a broad, unrestrained approach
to addressing maternal drug use. While FDLs reveal hostility toward
the privacy interests of poor, usually minority, drug-dependent women,
they are an imperfect proxy for achieving social welfare among any group
of women. How much better off is a baby that is born in prison, or a
toddler that grows up with a mother in prison? Has the state reduced the
potential for long-term harm to the child or given greater value to the
child's life by imprisoning its mother? Legislators should want to know
whether the unintended consequences of this type of reproductive
regulation exacerbates rather than reduces harms to
children.[41] The
evidence suggests that children do not benefit from parental
incarceration; children of incarcerated parents are six times more
likely to "go to prison."[42]
Thus, a clear distinction must be made. FDLs do not promote life.
Nor do FDLs guarantee children a better quality of life. Clarification
of the state's goal is an important step in realizing what the law is
designed to do as well as what it cannot (ever) accomplish.
If reproductive policing is arbitrary, and disproportionate in
enforcement, why have some in the medical community become complicit in
its practice? One answer might be the repugnance factor. By this, I
mean to suggest that pregnancies are perceived as more communal than
private (despite the fact that sex and family-raising are considered
private).[43]
And, as a communal space, individuals, including doctors
and nurses, feel more entitled to comment, critique, and even evaluate
the pregnancy. Recent reports published in the American Journal of
Obstetrics the Journal of Nurse and Midwifery explain that doctors
and nurses are more critical of pregnant women's
conduct.[44] In part,
the heightened awareness of and attention to behavior during pregnancy
might be explained by contempt for pregnant women who breach social and
medical expectations. It also might be explained by fear. Physicians and
nurses act out of the concern for fetuses and frame the unborn as
"innocent" and pregnant drug addicts as "blameworthy." The
moral authority against drug-dependent women is heightened in these
situations as the "victim" is an "innocent" fetus.
Clearly, for some doctors, the legal status of the fetus is not only
elevated to that of the mother, it enjoys greater respect, generosity,
and consideration. One author recently suggested that "[t]here can be
no 'rule of law' if the Constitution continues to be interpreted to
perpetuate a discriminatory legal system of separate and unequal for
unborn human beings."[45]
That women and their fetuses are bound
should not be understood to make the lines concerning their behavior
brighter and clearer. Rather, the boundedness of women and their
fetuses demonstrates the legal complications of disentangling fetal
rights from the women who carry them. Taken to its logical conclusion,
a woman could be subject to criminal penalties for failure to provide
adequate water, nourishment, or a healthy environment to a developing
fetus or for attempting to save her life at a risk to the fetus.
Page:
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9
Next page
|