State Policies on Substance Abuse During Pregnancy

The Guttmacher Institute in the United States works to advance sexual and reproductive health and rights through research, policy analysis and public education.

The two-page Substance Abuse During Pregnancy is part of their “State Policies in Brief” series and tackles the subject of how women’s substance abuse during pregnancy is dealt with at a policy level. While no state specifically criminalizes drug use during pregnancy, many prosecutors use other criminal laws to address prenatal substance use.

“Several states have expanded their civil child-welfare requirements to include prenatal substance abuse, so that prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. Further, some states, under the rubric of protecting the fetus, authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant women who use drugs; these policies sometimes also apply to alcohol use or other behaviors.

A number of states require health care professionals to report or test for prenatal drug exposure, which can be used as evidence in child-welfare proceedings. And in order to receive federal child abuse prevention funds, states must require health care providers to notify child protective services when the provider cares for an infant affected by illegal substance abuse. Finally, a number of states have placed a priority on making drug treatment more readily available to pregnant women, which is bolstered by federal funds that require pregnant women receive priority access to programs.”

The summary includes a checklist of which states consider substance abuse during pregnancy as child abuse or grounds for civil commitment, which states require reporting or testing when substance misuse is suspected, and which states have specific programs for pregnant women who use substances and give pregnant women priority access to general programs.

For more on the criminalization of prenatal substance use and legal issues related to FASD prevention, see earlier posts:

• Legal Measures to Prevent Fetal Alcohol Spectrum Disorder (December 4, 2013)
• Testing pregnant low-income moms for drugs in New York creates outrage and controversy (January 1, 2013)
• Taking a closer look at the movement towards compulsory substance use treatment for pregnant women in Finland (October 18, 2012)
• Prosecuting Pregnant Women with Addictions (May 14, 2012)

Decolonizing FASD Policy in Canada

Poster, STOP Fetal Alcohol Syndrome/Fetal Alcohol Effects NOW, First Nations and Inuit health, Health Canada, 2002

It makes sense that the way we understand a problem shapes the solutions we develop. Gemma Hunting and Annette Browne have recently published an article in the journal Women’s Health and Urban Life (click here for free full-text) that looks at how issues related to alcohol use, mothering, and Aboriginal women are often understood.

Despite the growing discussion among researchers that Aboriginal communities may be no more affected by FASD than non-Aboriginal communities, Hunting and Browne argue that FASD continues to be perceived as an ‘Aboriginal issue.’ The problem with this is that, rather than paying attention to all women’s alcohol use, negative misperceptions about Aboriginal women, and Aboriginal health and social issues are perpetuated.

They address some key prevailing ideas (incorrect ideas!) such as:

• Aboriginal people have a genetic vulnerability to the effects of alcohol (despite compelling evidence that this is not true)
• Aboriginal women are not capable mothers (they connect this to policies that started in the 1960s and continue today in child welfare practices)
• Increased awareness about the dangers of alcohol use during pregnancy will lead to changes in behaviour (relates to the idea that health education is the primary solution to FASD)

Overall, Hunting and Browne show that the assumptions underlying FASD prevention policies and interventions, while well intentioned, can inadvertently contribute to racializing and stigmatizing Aboriginal people in Canada (and abroad for that matter). It also means that we continue to focus our energies and resources on who we think are “high risk groups” for FASD rather than on all women and on addressing the broad range of factors that influence their drinking.

For more on this topic, see previous posts:

• Cultural Safety and FASD Prevention (August 23, 2012)
• Aborignal midwifery and Poverty & Pregnancy in Aboriginal Communities (August 17, 2011)
• Alcohol and Colonization in Māori Society (December 8, 2010)
• Representations of Aboriginal Women in Canadian Pregnancy Information Sources (November 25, 2010)
• Postcolonial Theory for Beginners (September 1, 2010)

Further Reading

Hunting, G. and Browne, A. (2012). Decolonizing Policy Discourse: Reframing the ‘Problem’ of Fetal Alcohol Spectrum Disorder. Women’s Health and Urban Life, 11(1): 35-53. (Free full-text here).

Salmon, A. (2004). ‘It takes a community’: Constructing Aboriginal mothers and children with FAS/FAE as objects of moral panic in/through a FAS/FAE prevention policy.  Journal of the Association for Research on Mothering, 6(1), 112-123. (Free full-text here).

Tait, C. L. (2009). Disruptions in nature, disruptions in society: Indigenous peoples of Canada and the ‘making’ of Fetal Alcohol Syndrome. In L. J. Kirmayer & G. Valaskaki (Eds.). Healing traditions: The mental health of Aboriginal peoples in Canada (pp. 196-222).Vancouver: University of British Columbia Press.

Wilson, S. A. & Martell, R. (2003, October). The story of Fetal Alcohol Syndrome: A Canadian First Nation’s response. Women & Environments International Magazine, 60/61: 35-36.

STOP Fetal Alcohol Syndrome/Fetal Alcohol Effects NOW, First Nations and Inuit health, Health Canada, 2002 – Inuktitut