Throughout the late 1980's and still today, "crack moms" and "crack babies" are the subject of vigorous public debate. Much of this public discussion has been governed by speculation and medical misinformation reported as fact in both medical journals and in the popular press and has been extremely judgmental and punitive in many instances. The harshest response has been the call for the arrest and prosecution of women who use cocaine during pregnancy. In a country that had come to learn that certain drugs, such as thalidomide and DES, can cause serious damage to a child exposed to them prenatally, it is not surprising that people are concerned about the possible effects of prenatal exposure to cocaine. But a concern that could have become the basis for rational scientific inquiry as well as compassionate and constructive discussion quickly became a conclusion that all children exposed prenatally to cocaine would be damaged irrevocably and that their mother's selfish and irresponsible drug-taking behavior is to blame for a national health tragedy. One key question is why was there such a "rush to judgment" both about the medical effects of cocaine and about the women who used it while pregnant. While there is no one, simple answer, it is clear that the issue of drugs and pregnancy touches on some of the most highly charged and deeply entrenched political issues of our day. It involves America's long tradition of punishing drug use rather than providing treatment and education. Because the problem of cocaine use in pregnancy was presented as one predominantly as a problem of the African American community it is deeply intertwined with issues of race, race discrimination, and the legacy of slavery: while illicit substance abuse crosses all race and class lines, this particular debate has focused on low-income African-American women, many of whom are rely on welfare. Because it involves women and pregnancy, the issue of drugs and pregnancy is inseparable from issues concerning the status of all women as well as with sex and sexuality. As a report from the Southern Regional Project on Infant Mortality observed: Newspaper reports in the 1980's sensationalized the use of crack cocaine and created a new picture of the "typical" female addict; young, poor, black, urban, on welfare, the mother of many children and addicted to crack. African American women, however have been disproportionately targeted for arrest and punishment, not because they use more drugs or are worse mothers, but because, as Dorothy Roberts explains "they are the least likely to obtain adequate prenatal care, the most vulnerable to government monitoring, and the least able to conform to the white middle-class standard of motherhood. They are therefore the primary targets of government control." Substance abuse/addiction is a major public health problem in the United States, and adverse consequences are manifested disproportionately among African Americans and women. A 1-year point prevalence study found that 9.5% of the total adult US population (15.1 million people) had an addictive disorder. An alcohol disorder was diagnosed among 7.4% and other drug abuse and dependence disorders were diagnosed among 3.1%; of these, 1% had both alcohol and other drug abuse disorders. African Americans have a significantly higher rate of mental disorders than any other group. Approximately 12% of the total African-American population in the United States was found to have used illicit drugs, and African Americans have a higher drug abuse or dependency rate than whites or Hispanics. There are several reasons why African Americans are regarded as being at risk for a range of adverse consequences from substance abuse. First, they are more likely to use these drugs intravenously. Second, they have more persons with lower levels of education, and level of education is increasingly being recognized as an important correlate of substance use in that those who are...
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