Expecting better: improving health and rights for pregnant women who use drugs

Unfortunately, pregnant women who use drugs face highly stigmatizing and inaccurate perceptions from both health care providers and the public at large, negatively impacting the quality of their care and supportive services. This publication seeks to move beyond the myths and anxieties about drug use during pregnancy to recommend simple approaches to benefit and protect the health of both pregnant women and newborns. These lessons are being learned across the globe: a growing number of countries, including Australia, Canada, Romania, Ukraine, and the United Kingdom, and institutions and agencies such as the World Health Organization have updated their protocols to reflect the understanding that drug use in pregnancy is not a “moral failing” and need not necessarily lead to bad health outcomes. Common to effective approaches is a commitment to prioritizing access to supportive, nonjudgmental care respectful of women’s rights and choices over interventions that emphasize control and punishment, or deny women an opportunity to participate in decisions affecting their lives and that of their families. Based on review of national and international practice and evidence, the principles described here can help those seeking to improve policies and practices that affect pregnant women who use drugs.

Few behaviors by women are as stigmatized as using drugs while pregnant. Across cultures and religions, women who use drugs and become pregnant are portrayed as unfit or irresponsible mothers. Media reporting on this issue, too often leans toward the sensational. Images of babies experiencing opioid withdrawal symptoms emphasize their suffering and suggest, inaccurately, that they will experience long-term harm. In the United States, during the 1980s and 1990s, media reports of “crack babies” implied that children born to mothers who used crack cocaine were permanently damaged. Research shows that media claims of developmental harm to the fetus from prenatal drug exposure—whether legal and illegal—are greatly exaggerated. In contrast, environmental factors such as social isolation, poverty, food insecurity, and lack of access to quality health care can have a greater impact on the health of a baby than prenatal exposure to drugs.

In a systematic review of 200 studies on children exposed to opioids in utero, findings indicated “no significant impairments in cognitive, psychomotor or observed behavioral outcomes for chronic intrauterine exposed infants and preschool children.” Exposure to opioids in utero can have short-term health implications after birth— primarily withdrawal symptoms, also called “neonatal abstinence syndrome" or “neonatal opioid withdrawal.” These withdrawal symptoms are also associated with medically prescribed treatment for opioid dependence during pregnancy, such as methadone and buprenorphine.4 Contrary to much media coverage, neonatal abstinence syndrome is a short-term and easily treatable condition that does not have a lasting impact. Similarly, claims about so-called “crack babies” suffering from long-term developmental delay lacked evidence and were proven to be largely driven by racist stereotypes rather than facts. The brain-damaged “crack baby” was a myth: A recent systematic review following cocaine prenatal exposure found “no consistent negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language.”