It’s Time to Stop Stigmatizing Substance Abuse During Pregnancy



“Will they take my child?” were the words uttered by Mona from Tennessee at her recent court hearing this July, after being arrested for her baby testing positive for drugs. Mallory Loyola and Jamilah Falls were also both charged with assault after delivering newborns that tested positive for drugs. Alicia Beltran of Wisconsin had disclosed her past experience with addiction to her health provider at a prenatal appointment, but despite being sober for a year, she was consequently arrested for refusing an anti-addiction drug, forced into treatment, and lost her job. These narratives are reflective of a growing policy trend being adopted across states that allows child welfare authorities to force women into treatment or prosecute them if they refuse. Paltrow et al. have documented hundreds of similar cases across the United States where primarily low-income women of color were “detained, arrested or forced to accept medical procedures in the name of fetal protection.”

In the U.S., 5.9% of drug users are pregnant women. Many of these women will encounter stigma and negative messages during pregnancy that will impact their experiences postpartum. As a Masters of Public Health candidate and as an intern at the Homeless Prenatal Program (HPP), a family resource center for low-income communities in the Mission District of San Francisco, I am learning about the importance of the postpartum period and how critical this period is for the life course of women and their children.

Social Worker Stephanie Toomey has witnessed the damaging impact of current approaches to this issue firsthand. Toomey, a former New Beginnings Assistant Program Manager at HPP, has served countless pregnant women who were struggling with substance abuse and navigating various hostile systems for support during their pregnancy.

Toomey recalls the impact of the stigmatizing treatment by service providers her clients face:

“I had the privilege of working with moms —moms who have long histories of their children removed via Child Protective Services. Moms, who have suffered so much of their own trauma, that the challenge of fighting for their children and themselves was too daunting. Moms, who were judged and reminded by their prenatal care providers that their histories impacted the care they received and the perceptions of who they were viewed as. Permanently; as if people can’t change.”

The challenging experiences of Toomey’s clients are common for many pregnant women recovering from substance abuse. Policies, public health interventions, and dominant public perceptions often place the blame and individual responsibility on pregnant women who are struggling with drug addiction. Given the complexity of this issue and the major impact it has on women postpartum, we must shift how we think and respond.

We must first acknowledge all women need support during and after pregnancy.

Too often, women are assumed to have a natural maternal instinct and easy transition to motherhood; and when women encounter challenges such as substance abuse during pregnancy, they are viewed as being harmful and careless. A statement by former Wisconsin state representative Bonnie Ladwig highlights these dominant perceptions: “If the mother isn’t smart enough not to do drugs, we’ve got to step in.”

Representing this issue as simply a poor personal decision overlooks the circumstances that lead women to use drugs in the first place. National Advocates for Pregnant Women (NAPW) reports that despite the fact that addiction is a chronic disease caused by various issues related to prior trauma, poverty, and violence, pregnant women dealing with substance abuse are still characterized as “selfish and uncaring.” Imagine navigating parenthood after encountering stigmatizing messages of you as a “bad mother” and health providers who may immediately report you to Child Protective Services (CPS). The stigmatizing treatment and messages women face often negatively impact their perceptions of themselves and their abilities to parent.

We must change state policies. Most policies criminalize substance abuse during pregnancy, classifying it as prenatal child abuse and neglect. This punitive response often prevents women from seeking the resources they need to become sober due to fears of being reported or facing judgment. While states may force these women into treatment programs, there is a lack of treatment programs available specifically for pregnant women. Also, when seeking support, women encounter messages from providers that tell them they are not worthy or capable of parenting their child. This policy trend goes against the recommendations of maternal and child health experts of the American College of Obstetricians and Gynecologists (ACOG). ACOG recommends policy-makers and health providers focus on providing treatment and support to women who are dealing with drug use in pregnancy rather than punitively addressing this issue through the justice system. Research and health experts are making it clear that women deserve support rather than criminalization, for the well-being of both them and their children.

Approaches to this issue that center on women’s well-being and seek to strengthen the bonds with their children are making a positive impact. Research finds that comprehensive programs, with multiple services that support women using drugs through treatment and access to resources for their family, are very effective in supporting women on a path to sobriety and keeping their families together. One example is HPP’s New Beginnings Program, a collaborative program between multiple local health providers and agencies in San Francisco. Toomey describes their powerful, alternative approach:

“We didn’t work for CPS, medical providers—we centered our work on the client, in a non-judgemental, anti-oppressive, and accepting manner. We worked for our clients. Period. When we were able to collaborate with clients and partner with them, there was more willingness to access treatment, services, and the belief that there was potential for change took bloom. In case management we would prep clients on what kind of opposition and stigma they’d face at the hospital when accessing care while dealing with addiction and how to communicate that their histories aren’t who they are today. New Beginnings provided room and space for clients to grow into their best selves with non-judgemental support, harm reduction perspectives, and genuine care.”


The incredible impact programs like New Beginnings have on women is shown through program statistics on their clients in 2013: “gave birth to 111 babies, 88% of whom were born at healthy weights and 93% of whom were born drug-free.” NAPW reports that while “some newborns exposed prenatally to some substance abuse sometimes do suffer adverse short or long‐term consequences, most research demonstrates that even when women can’t abstain completely from drugs, they can nevertheless have healthy pregnancies if they get prenatal care and help for other problems, especially those associated with poverty.” These programs have also been found to be cost‐effective in comparison to imprisonment or separating the child from parent.

We must recognize the consequences of stigmatizing and criminalizing hundreds of pregnant women like Mona, Mallory, Jamilah, and Alicia has on the course of their lives and the lives of their children. There should be an investment in programs that are addressing substance abuse during pregnancy with compassion, building social support postpartum, and connecting families with crucial resources. By changing harmful states policies that are stripping mothers of their agency, we can work towards transforming the social conditions that lead to substance abuse in the first place.

Written by Adrianna Sylva Alexandrian