Crack Babies Excerpt from "Smoke and Mirrors"

By Dan Baum, 1996.

Pregnant women would pay the highest price "for transgressing the rights of others" in Bennett's War on Drugs. No other group of drug users was treated as harshly by the media, the legislatures, or the courts. No other group took as much blame for the failure of the nation at large to act with reason and compassion. Having turned its wrath variously on Negro junkies, teenage potheads, yuppie coke dabblers, and black crack dealers, the Drug War now would elevate pregnant drug users - often poor, uneducated, and unable to get treatment - to Public Enemy Number One.

The proximate roots of the "crack baby crisis" were in 1981, when federal cuts in Medicaid stripped more than a million poor mothers and their kids of access to medical care. Within a few years, half of all African-American women had access to poor pre-natal care or none at all, and the effects showed up at once. By 1984, their infant mortality rate had noticeably worsened for the first time in twenty years - and this was a full year before crack appeared. The number of uninsured child-bearing women in California exploded by almost half between 1982 and 1986. And even those who qualified for public assistance weren't guaranteed access to care. Twelve of the state's fifty-eight counties had no doctors at all willing to accept Medicaid patients. Flu, infections, and pneumonia killed impoverished American babies in ever-greater numbers.

And then crack arrived on the scene.

Crack is bad news for pregnant women and their babies. Like men, women on crack binges neglect everything else - sleep, nutrition, safety, and their health in general. They tend to smoke cigarettes, drink alcohol, and use other drugs to moderate the intense highs and lows of crack.

Their babies show the effects . They are frequently premature, and on average smaller and lighter, with smaller heads. When suddenly deprived of cocaine they alternately howl and drop into deep sleep. At one Washington, D.C., hospital where the average neonatal stay was three days in 1989, babies born to crack-using mothers stayed an average forty-two days.

By 1989 scientists had had four years to study the phenomenon of "crack babies" and some were backing off from their initially alarming reports. Ira Chasnoff, the Chicago doctor whose 1985 article in the New England Journal of Medicine started the crack-baby panic, now cautioned that crack was only a small part of the problem for small, undernourished, and sickly babies. Pregnant women are sixteen times more likely to use alcohol than crack, he wrote, and unlike cocaine, alcohol has proven fetus-damaging effects. Chasnoff and other re searchers cautioned that the lives of poor, crack-using women were bad for babies in so many ways that there was no way to isolate crack as the primary cause of their infants' health problems. Poor women have always birthed smaller and sicker babies, and the sharp increase in the number of poor, uninsured women was certain to boost the number of ailing newborns. Prenatal care - and the insurance to pay for it---was and is a better predictor of a newborn's health than whether the mother smokes crack. "In the end," Florida health officials concluded in 1985, "it is safer for a baby to be born to a drug-abusing, anaemic, or a diabetic mother who visits the doctor throughout her pregnancy than to be born to a normal woman who does not." The Yerkes Primate Research Center in Atlanta tried to isolate cocaine's effects, administering a pure cocaine intravenous drip to rhesus monkeys for the entire duration of their pregnancies. Their babies were unaffected. Researchers of human "crack babies" furthermore found that the effects of cocaine wore off within a few months and that such babies who were well fed, loved, and properly stimulated could recover completely.

These were not, however, messages even the medical community wanted to hear. Research papers trumpeting the foetal dangers of cocaine were eleven times more likely to be published in professional journals than those claiming few or no harms, according to the British medical journal The Lancet, which analyzed all the "crack baby" studies submitted to the Society of Paediatric Research during the eighties. Moreover, the "negative" studies were better, controlling more effectively for other foetus-damaging factors and taking more care to verify cocaine use, The Lancet found.

Yet the myth of the "crack baby" grew ever larger. Syndicated columnist Charles Krauthammer dismissed "crack babies" in 1988 as a "biologic underclass whose biological inferiority is stamped at birth." Boston University president John Silber criticized "spending immense amounts on crack babies who won't ever achieve the intellectual development to have consciousness of God." The New York Times declared "crack babies" unable to "make friends, know right from wrong, control their impulses, gain insight, concentrate on tasks, and feel and return love. " Even Rolling Stone condemned "crack babies" as "like no others, brain damaged in ways yet unknown, oblivious to any affection."

Reporters sent out to write "crack baby" stories sometimes got their facts right without knowing it. After forty-odd inches of horror stories of low-income women giving birth to "crack babies," the Wall Street Journal, in a typical July 1989 front-page article, let drop that "their mothers aren't all low income. Linda, an impeccably dressed 34-year- old, now looks more like the accountant she once was than a recovering addict who once had a $2,000-a-week crack habit." Turns out, the Journal reported, "her son was born healthy." No explanation was offered as to why a woman smoking $2,000 worth of crack a week can give birth to a healthy baby. And no connection was made to the fact that, unlike every other mother in the article, Linda is an impeccably dressed accountant who likely had health insurance and proper care.

Getting poor women to stop using drugs during pregnancy wouldn't have guaranteed healthy babies, but it certainly would have helped. Even if the effects of drug exposure in utero are relatively short-lived, the home of a crack addict is no place for a baby to grow up. Infants of crack users frequently show up in the hospital again, dehydrated, underfed, filthy, and sometimes injured. If only for the sake of babies after they are born, getting pregnant women off drugs would have been not only humane, but a genuine bargain. The cost of caring for babies neglected and abandoned by crack-using parents was estimated in 1989 in the hundreds of millions of dollars a year.

Yet the federal government refused to pay for residential drug treatment for the poor because it classified drug abuse as a mental illness, and under Medicaid rules that was a state responsibility. The states were similarly unwilling or unable to provide care. Of the various drug- treatment programs in New York City in 1989, 54 percent refused pregnant women, 67 percent refused pregnant women on Medicaid, and 87 percent specifically denied treatment to Medicaid women dependent on crack. Only one hospital in the entire Chicago metropolitan area had a residential treatment program for pregnant addicts, and the program had only two beds. The state of Indiana had only sixteen beds for the treatment of pregnant addicts. Nearly a third of the women living in California had no prenatal care at all, let alone treatment for prenatal drug abuse. "We seem more willing to place the kid in a neonatal intensive care unit for $1,500 or $2,000 a day, rather than put $1,500 into better prenatal care," one psychiatrist complained to Time.

Jennifer Johnson, a black twenty-three-year-old mother of three living in Seminole County, Florida, tried several times during her fourth pregnancy to get treated for her cocaine addiction. "I thought that . . . if I tell them I use drugs they would send me to a drug place or something," she later testified. Alas, there was no "drug place" for her in Seminole County. What there was instead was jail, and the confiscation of her newborn.

When she delivered her baby on January 23, 1989, the attending doctor recorded that the baby "looked and acted as we would expect a baby to look and act." But Johnson told the doctor she had used cocaine during the pregnancy, and urine tests on mother and child bore that out. The hospital reported the birth of a "crack baby" to a state childprotection agency, which in turn called the local sheriff, who ordered Johnson's arrest.

Assistant state's attorney Jeff Deen had been waiting for just such a case to test a new prosecution tactic. Deen was fed up with seeing pregnant women get away with abusing their unborn children by using drugs. When Deen heard about Jennifer Johnson, he decided to charge her with delivering cocaine to a minor. Courts throughout the country had held to the legal doctrine - which lies at the heart of abortion rights - that a fetus is not a person in the eyes of the law. But Deen had a new argument: In the sixty seconds between the baby's birth and the cutting of her umbilical cord, Johnson had "delivered" cocaine to her baby through the cord.

Judge 0. H. Eaton Jr. of the Seminole County Circuit Court declared himself "convinced" and convicted Johnson, sentencing her to a year of house arrest and fourteen years probation. Jennifer Johnson thus became the first woman to be convicted of the special crime of using drugs while pregnant. The Court of Appeals for the Fifth District affirmed her conviction.

Given Johnson's repeated attempts to find treatment for her drug abuse, Eaton's decision seems particularly cruel. "Pregnant addicts . . . have a responsibility to seek treatment," he ruled. The same judicial reasoning applied in the 1988 prosecution of a heroin addict in Butte County, California, who was convicted of birthing a drug-tainted baby after making Herculean efforts to get treatment. For months, she travelled 130 miles round-trip to a private methadone clinic that charged $200 a month. When her car broke down, she hitchhiked. When her money ran out, the clinic stopped treating her, even knowing she was seven months gone. Visibly pregnant, she asked several doctors and clinics in her area to help her, but none would do so. Twenty-four hours after giving birth, the district attorney confiscated her baby and charged her. "I don't see people making a choice unless you force them," he explained.

As has often been the case in the War on Drugs, the drug warriors wanted it both ways. Drugs are immoral, Bennett's drug office was saying at the time, because they "enslave" people and "take away their ability to function as free citizens." Yet when people fall into the "slavery" of drug use, they are prosecuted for making a bad "choice."

It is no accident that the first woman prosecuted for prenatal drug abuse was black. During a single month in 1989, Ira Chasnoff and his colleagues collected urine samples from every pregnant woman who visited a public health clinic or private obstetrician in Pinellas County, which contains St. Petersburg and is the fourth most populous county in Florida. They found that equal percentages of both black and white women - about 15 percent - used drugs during pregnancy. But the black women were ten times more likely than the whites to be reported to authorities for drug use. And the poorest women - with incomes of less than $12,000 - were seven times more likely to be reported than those earning more than $25,000. Private hospitals and obstetricians weren't about to intrude on their paying customers' privacy with a drug test, but public hospitals often were required to do so. Typical was South Carolina, where one characteristic used by public hospitals to identify "probable drug users" for testing was "no prenatal care or late prenatal care (24 weeks)." In South Carolina, Medicaid doesn't cover prenatal care before nineteen weeks.

"If these mothers were walking away from treatment, I might feel differently," said the director of Family and Children's Services in San Francisco. "But they are not walking away from treatment. They are walking away from waiting lists."

With drugs at the top of every pollster's list, the country walked away from treating pregnant users. In one national poll, almost half thought prenatal drug abuse should be a criminal offence. Which perhaps isn't surprising, given such headlines as (in the Washington Post) CRACK BABIES: THE WORST THREAT IS MOM HERSELF and SHE SMOKED CRACK, THEN KILLED HER CHILDREN. Senator Pete Wilson of California in Iggo asked Congress to give treatment funding only to states that make it a crime to give birth to a drug-tainted baby, a classic Catch22: few pregnant women would seek drug treatment in a state where doing so invited jail and loss of the baby. In Florida, where such a law was already on the books, doctors complained to the St. Petersburg Times that pregnant women withheld important information about their drug use "because word had gotten around that the police will have to be notified." San Francisco deputy city attorney Lori Giorgi began noticing an increase in "toilet-bowl babies"- born at home or in secret. "They're afraid their babies will be taken away," she concluded.

If they birth them at all. In one Washington, D.C., case, a woman "miscarried" days before appearing before a judge who'd threatened to jail her because he thought she was using drugs while pregnant. Researchers reported being told often about such abortions. This is particularly ironic, since the movement to prosecute drug- using mothers gets much of its steam from the anti-abortion movement. Such prosecutions create a legal division between mother and fetus that doesn't exist elsewhere in the law. If a woman can be prosecuted for drugging her unborn baby, why not for killing it?