The criminal prosecution of mothers of drug-exposed neonates: A case study of a policy dilemma.

摘要

The purpose of this study was to describe and analyze the policy to prosecute women who exposed their infants to drugs during pregnancy. This policy was developed and implemented by an interorganizational network of legal and health professionals acting collectively.;The findings of the study suggested that the policy was designed, not to incarcerate the women, but as legal leverage to force the mothers into drug treatment and to give the court system control over the risk factors in their infants' environments. The state child neglect laws were used as the legal means to force the women into treatment and assign custody of their infants. Evidence suggested that health professionals cooperated with the prosecution primarily as advocates for the drug-exposed infants--to protect them from abuse and neglect. The women prosecuted were poor, predominantly Black (85%), and their drug of choice was overwhelmingly "crack" cocaine. Most of the women were sent to court-mandated outpatient treatment. Approximately 90% of the women in treatment were still using drugs. Over 60% of the 75 women mandated to treatment had dropped out of the treatment or were unsuccessfully terminated. Approximately 65% of the infants showed ill effects from their in utero drug exposure.;Implications for practice suggest that drug-abusing women were not avoiding health providers for delivery of their infants due to the policy, primarily because there are no other options available, short of delivering at home. There were data to suggest that women were staying away from prenatal care, but this finding was confounded by the coincidental increase in women enrolled in prenatal care due to increased Medicaid funding. There was no evidence found that the prosecuted mothers had changed their perceptions of health professionals as a result of their experiences. Data suggested that health professionals were perceived by these women as part of the system, not as client advocates. Health professionals were viewed in a predominantly positive light by these mothers. The major exception to this positive view was the perception that pain medication was withheld from them during delivery because they were identified as drug users. (Abstract shortened with permission of author.).