The criminal prosecution of mothers of drug-exposed neonates : a case study of a policy dilemma

Abstract

The purpose of this study was to describe and analyze the policy to prosecute women who exposed their infants to drugs during pregnancy. The time frame of the study was from July, 1989 to January, 1992. This policy was developed and implemented by an interorganizational network of legal and health professionals acting collectively. Case study was the methodology used in this research. Data were collected from numerous sources, including semistructured interviews of members of the interorganizational. network and the women prqsecuted. Additional data included court records, laws, policies, protocols, quality assurance records, minutes of meetings, letters, demographic data, observations of court proceedings and . parole settings as well as publications in the public domain. The theoretical framework was the collective-action view of · '":H ·· organizational behavior. The findings of the study suggested that the policy was designed, not to incarcerate the women, but as legal leverage to force the mothers into drug treatment and to give the court system control over the risk factors in their infants' environments. The state child neglect laws were used _as the legal means to force the women into treatment and assign custody of their infants. Evidence suggested that health._ professionals cooperated with the prosecution primarily as advocates for _the drug-exposed infants--to protect them from abuse and neglect. The women prosecuted were poor, predominantly Black (85% ), and their drug of choice was overwhelmingly "crack" cocaine. The vast majority of these women had experienced physical and sexual abuse. Mo.st of the women were sent to court-mandated outpatient treatment. Five women were sent to prison; all five had additional criminal charges. Approximately 90% of the women in treatment were still using drugs. Over 60% of the 75 women mandated to treatment had dropped out of the treatment or were unsuccessfully terminated. Approximately 65% of the infants showed ill effects from their in utero drug exposure. These effects included hyperirritability, hypertonicity, delayed social development, and poor eye contact and tracking. , These symptoms showed improvement between two and four. months of age. Custody placement of the 109 affected infants was: 36% with th·e mothers, 28% with relatives of the mothers, 24% in foster homes, 8% adopted outside the family. Two of the infants died. ' Implications for practice suggest that drug-abusing women were not avoiding health providers for delivery of their infants due to the policy,· primarily because there are no other options available, short of delivering at home. There were data to suggest that women were staying away from prenatal care, but thi~ finding was confounded by the coincidental increase in women enrolled in prenatal care due to increased Medicaid funding. There was no evidence found that the· prosecuted mothers had changed their perceptions of health professionals as a result of their experiences. , There was no expressed loss of trust nor any evidence that. there had ever been any trust in health professionals related to patient confidentiality. Data suggested that health professionals were perceived by these women as part of the system, not as client advocates. Health professionals were viewed in a predominantly positive light by these mothers. The major exception to this positive view was the percepti?n that pain medication· was withheld from them during delivery because they were identified as· drug users.