The American Public Health Association,
Recognizing that the use of illicit drug derivatives is expanding at an alarming rate among women of childbearing age1,2 and that about 375,000 newborns a year are born to women who are users of illicit drugs;3 and
Noting that prenatal use of illicit drugs increases the rate of spontaneous abortion, abruptio placentae, premature labor and delivery, intrauterine growth retardation, sudden infant death syndrome, neurobehavioral deficiencies as well as other documented medical problems and long-term developmental abnormalities;4-8 and
Realizing that many drug treatment facilities deny access to pregnant women using illicit drugs;9,10 and/or fail to provide services responsible to the needs of pregnant women including prenatal care and child care; and
Recognizing that pregnant drug-dependent women have been the object of criminal prosecution in several states,10 and that women who might want medical care for themselves and their babies may not feel free to seek treatment because of fear of criminal prosecution related to illicit drug use; and
Noting that surveys of prosecutions of pregnant drug-using women nationally indicate that women of color and low-income women are disproportionately affected by punitive measures; and
Understanding that the legal, economic, education and health care ramifications associated with this problem are of great magnitude; therefore
- Calls upon federal, state and local government and private institutions to develop and implement educational programs aimed at minimizing drug usage among women of childbearing age;
- Urges voluntary drug use risk-assessment during history taking component of prenatal care and other health care delivery services and supports the development of transdisciplinary intervention programs for pregnant women using illicit drugs;
- Recommends screening and assessment of drug-exposed babies and referral to appropriate community resources for follow-up;
- Urges existing drug treatment facilities to develop outreach programs and services to meet the specialized needs of women and their children and supports the development of new facilities to respond to this problem;
- Encourages development of drug treatment facilities and half-way houses to serve at-risk women who use illicit drugs, their newborns, and other dependent children;
- Reaffirms the Association's view of use of illicit drugs by pregnant women as a public health problem, and recommends that no punitive measures be taken against pregnant women who are users of illicit drugs when no other illegal acts, including drug-related offenses, have been committed;11-13
- Recommends the development of programs for newborns exposed to illicit drugs in utero to provide early intervention services and to assess potential developmental delays during the preschool years. Programs developed for newborns exposed to illicit drugs in utero should be integrated with existing programs for handicapped infants and toddlers;14 and
- Urges research by federal, state and local agencies to provide empirical data as to the extent and scope of the problem of illicit drug use by pregnant women and its effects on their children, as well as research on successful treatment models to provide comprehensive health and social services to drug-dependent women and their children.
- US Department of Health and Human Services, Public Health Service: National household survey on drug abuse. Washington, DC: DHHS, 1988.
- US Congress House Select Committee on Children, Youth and Families: Placing infants at risk: prenatal addiction and disease. Washington, DC: US Printing Office, 1986.
- National Association for Perinatal Addiction, Research and Education: Perinatal research and addiction update: A first national hospital incidence survey, 1988.
- Chasnoff IJ, Griffith DR: Cocaine: Clinical studies of pregnancy and the newborn. Ann NY Acad Sci 1989;565:260-266.
- Chasnoff IJ, Burns WJ, Schmoll SH, Burns KA: Cocaine use in pregnancy. N Engl J Med 1985;313:666-669.
- Rosen TS, Johnson HL: Drug addicted mothers, their infants and SIDS. Ann NY Acad Sci 1988;533:89-95.
- Livesay S, Ehrlich S, Ryan I, Finnegan L: Cocaine and Pregnancy: Maternal and infant outcomes, NIDA Research Monograph, 1987;76:280.
- Sobrian SK, Robinson NL, Burton LE, James H, Stokes DL, Turner LM: Neurobehavioral effects of prenatal exposure to cocaine. Ann NY Acad Sci 1989;562:383-386.
- The crack children. Newsweek, Feb 12, 1990, 62-63.
- Lewin Y: Drug use in pregnancy: New Issue for the courts. The New York Times, Jan 5, 1990.
- American Public Health Association Policy Statement No. 6907: Drug Abuse. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: APHA, current volume.
- Op Cit. APHA Policy Statement No. 7121: Substance Abuse as a Public Health Problem.
- Op Cit. APHA Policy Statement No. 8817: A Public Health Response to the War on Drugs: Reducing Alcohol, Tobacco and Other Drug Problems among the Nation's Youth.
- Public Law 99-457, October 8, 1986.
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