WOMEN AND ILLICIT DRUG USE *1

Susan Boyd examines the impact of the medical and social service professions and drug legislation on women who use illicit drugs. :

INTRODUCTION

Conservative researchers are quite biased and favour stringent legal sanctions whereas liberal researchers offer logical arguments that appear to present both sides of the issue. Neither conservative nor liberal paradigms offer solutions for underlying problems associated with class, sex and race. Preliminary findings drawn from field work and 25 semi-structured, open-ended interviews with adult women who have used illicit drugs in Canada will inform this paper. All the women interviewed were mothers. The interviews were conducted outside a prison or clinic population, and all participants were assured confidentiality and anonymity.

WOMEN AND ILLICIT DRUGS

• Researchers have constructed negative images of deviant mothers who use illicit drugs (Rosenbaum et

al., 1990; Taylor, 1993). Mothers have been portrayed as sexually promiscuous, lacking maternal instincts, uncontrollable and at risk to their children. Until the 1970s there was little discussion about women who used illicit drugs; critical research tended to concentrate,'on the man about town' rather than the 'women at home with the kids' . Consequently only two ethnographic studies of female illicit drug users exist: Marsha Rosenbaum's (1981) groundbreaking study of female heroin users in San Francisco and, more recently, Avril Taylor's (1993) study of women injectors in Glasgow. Both are written from the women's perspectives and contribute to a fuller understanding of women who use illicit drugs. In contrast to the negative images projected in much research, Rosenbaum (1981) and Taylor (1993) noted that the women they interviewed shared dominant parenting values.

Preliminary findings from the Canadian inter views complement those of Rosenbaum and Taylor in relation to parenting values. This research also high lights the diverse nature of women who use illicit drugs - diverse in age, race and class. Aside from their status as mothers and their use of illicit drugs, they were not homogeneous. Moreover, Canadian women who use illicit drugs, especially women of colour and poor women, are often denied the chance to mother their own children because the diagnosis of neonatal abstinence syndrome (NAS) and suspected maternal drug use are often grounds for social service intervention. Mothers are also separated from their children when incarcerated for narcotic or related offences. However, the consequences of their illicit drug use are mediated by social status in society, one's race, class, sex, the social economic environment, the law, social services and the medical community.

The law

Women who use illicit drugs are subject to arrest, because the possession of narcotics is a criminal offence in Canada. However, the question of which drugs are legal or illegal is historical, cultural and political; the division separating licit and illicit drugs is a socially constructed phenomenon. There is no universal consensus on what is a drug and which drugs are dangerous. Although Canadian narcotic laws have become more severe since the initial legislation to criminalise substances in 1908, the use of illicit drugs has not been curtailed (Alexander, 1990; Boyd, 1991).

In Canada, criminalised women tend to be single, though many have dependent children (Chunn and Gavigan, 1 99 1 ), poor and young; often they have histories of drug and alcohol abuse (Siirnpson,1989). Women comprise about 13% of all adults charged under federal drug legislation (Single et al.,1994, p. 260) . For pharmaceutical drugs, women accounted for nearly a third of all convictions in 1990 (Health and Welfare Canada,1991, p. x). In addition, Faith also notes that 'increasing numbers of women of African heritage, from the U .S . and the Caribbean, are serving time' (1993,p.184) at Kingston (P4W),Canada's federal penitentiary for women, for importing and trafficking convictions. Furthermore, First Nations*2 women are over-represented in the criminal justice system (LePrairie,1987), and sentenced to custodial care (41.2% ) more than white women (25.7% ) (Masson,1992).

Although legal policy affects both men and women, men are not subject to recent legal sanctions against pregnant women who may have used illicit drugs in North America which have culminated in what feminists term 'the criminalisation of pregnancy'. Discourse centres on suspected fetal harm and, in the USA, legal charges of trafficking to the fetus, manslaughter, child abuse and infant neglect have been brought against pregnant women suspected of illicit drug use. Illicit drug use is suspected, because urine analysis, the primary form of drug testing, is unreliable. Furthermore, Humphries et al. (1992) discuss the race and class bias associated with drug testing in the USA, as well as the fact that drug testing can only tell what drugs were used within the last 24-72 hours (pp. 90,213). Drug testing cannot distinguish the dependent, occasional or first time user. Most: important, drug testing cannot determine whether an infant will be adversely affected by its mother's drug use. On appeal most of these charges have been dropped, though women were subject to house arrest, incarceration and separation from children. The criminalisation of pregnancy brings up larger concerns in respect to women's rights, and reproductive autonomy diminishing in lieu of fetal rights. Feminists conclude that the criminalisation of pregnancy, and emerging fetal rights (Humphries et al.,1992; Maher, 1992), have culminated in a situation where the well being and security of women's bodies is legally and physically challenged (Oakley, 1984, Gallagher, 1989).

Social services

In the USA, Maher (1992) notes how welfare policy intersects with criminal justice controls and 'functions as an independent and gender-specific form of punishment and regulation' towards women (p.158) . Maher examines how women who use crack cocaine in the USA are regulated and controlled through administrative law and welfare policy. In Canada, many women who use illicit drugs also come into contact with social services. Intervention and apprehension of children can play as much of a role as the criminal law in regulating poor women. Middle-class women interviewed in Canada were less fearful and had less contact with social services. For middle-class women, the law and the fear of arrest were primary, especially if they or their partners were dealing or transporting large quantities of illicit drugs

Poor women who use illicit drugs are often challenged by social services in relation to their mothering. In Canada, many social service professionals equate illicit drug use with poor mothering which places children at risk. Many poor women have had their children apprehended temporarily or permanently, and placed in foster care. Of the Canadian children in care, First Nations children are over represented. Although First Nations people represent less than 4% of the total population in Canada, Monture (1989) found that, in the province of British Columbia,39% of children in care are First Nations and this rate is higher in the prairie provinces (p.2) Monture (1989) defines the welfare system in Canada as an extension of the criminal justice system for First Nations people, because both punish people by removing them from their families and communities. In addition, this has had devastating effects on the traditional structure of the family and community, similar to the removal of First Nations children to residential schools in the past.

Preliminary findings from the Canadian interviews note that many of the women interviewed were poor, and over 25% were First Nations. Many were raised in foster care and their own children are now in care. Several women had their children apprehended at birth after being diagnosed with neonatal abstinence syndrome. Thus, the cycle continues. As mentioned above, not all women who use illicit drugs come to the attention of social services. Middle-class and upper-class women rarely do as they often have economic and social buffers to rely on. Thus, women who are poor, First Nations and single parents are most at risk for child apprehension in Canada.

Recently, social services have extended their interest from live children to the developing fetus. In Canada, there have been several cases where ministries of social services have apprehended the unborn fetus. On appeal it was ruled that only 'live children' can be apprehended; thus the fetus cannot become a ward of the court (see Re 'Baby R' 1988). Yet, what is of concern for women is that the apprehensions occurred when a mother failed to comply with medical advice or when social workers believed their client to be unfit to care for her pregnancy and unborn child. These attempts at fetal apprehension are precedent setting in their implications for all women.

Medical intervention

The history of the medical treatment of women in Canada emphasises the continuing struggle by women to define their own experience of pregnancy, birthing, menopause and health, and their struggle to regain legal access to midwives, birth control and abortion, to limit sterilisation and to have choices about delivery. Since the 1980s there has been a proliferation of research and interest by the medical community in the developing fetus and infants born to women who use illicit drugs. Medical research claims that maternal drug use can cause a wide range of symptoms. These include, although are not exclusive to, the following: fetal wastage, interuterine growth complications, fetal alcohol syndrome, developmental problems, behavioural problems, incomplete development, learning disabilities, withdrawal symptoms and death.

The image presented by medical researchers and the media is often one of the white male doctor holding a premature infant - a separate entity from the mother. Often we are informed that the child is suffering from withdrawal symptoms which may include tremors, a high-pitched cry and arching of the back. In fact, many infants do not exhibit withdrawal symptoms; most infants born to women suspected of maternal drug use are not premature or of low birth weight (Myers et al., 1992, p.1); and most births are unremarkable (Hepburn,1993; RobinandMills,1993, p.18).

Nevertheless, the effects of maternal drug use continue to be controversial. Much of the research on maternal drug use is from the USA where there are few socio economic supports. For example, in the USA universal health care is not available and the level of poverty is much higher than in Canada. In contrast, researchers from the Netherlands, England and Scotland, where there are more socio economic supports, have noted that many of the non-specific effects attributed to maternal drug use are also 'observed with socio economic deprivation or associated factors such as smoking' (Hepburn,1993, p.53). Moreover, Hepburn (1993) notes that the only specific effect o maternal drug use on infants is neonatal withdrawal symptoms. In the USA and Canada there have been no maternal drug studies on upper-class or middle class illicit drug users. Low-income women make up the study population. Thus, the conditions of poverty get mixed up with the conditions of illicit drug use (Myers et al.,1992, p.4).

Furthermore, infant withdrawal from maternal drug use does not always occur and infant withdrawal cannot be predicted. Of 200 babies born in Glasgow to mothers using illicit drugs or legal methadone, only '7% required treatment for withdrawal while even fewer required admission to the special care nursery' (Hepburn,1993, p.54). Hepburn (1993) claims that, when mothers who use illicit drugs are offered economic, social and antenatal care during pregnancy, they have comparable birth outcomes to non drug using mothers. Siney (1994) has comparable data from Liverpool where antenatal care is centred around a midwife drugs specialist and liaison with many health-care professionals. Hepburn's ( 1993 ) and Siney's ( 1994 ) findings illuminate the differences discovered between research findings in the USA and in countries that have different socio economic environments and drug legislation.

Although there is some public interest, in Canada, in maternal use of tobacco and alcohol, and licit drugs which appear to be more harmful than illicit drugs, there has been little public interest in exploring other variables. Exposure to toxic environments, malnutrition, lack of housing, lack of income or poor antenatal care have adverse effects on pregnancy outcomes. If pregnancy outcomes were truly a 'health issue' Canadians might consider eliminating the social environmental variables affecting pregnancy rather than stigmatising a generation of children and their mothers.

In Canada, doctors and nurses often inform social services if there is suspected maternal drug use. Public Health records and school records report suspected NAS. Thus, the providers of social services and health care participate in policing women. Many women are afraid to reveal their drug use, whether licit or illicit. One must question the medical scientific community's interest in the developing fetus. Their assumption that this interest benefits society -is suspect. Rather, women and children need non-judgemental, flexible and user-friendly social and health support that is woman centred and client directed.

CONCLUSION

Liberal and conservative paradigms dominate the discussion of maternal drug use. Mothers are often absent from the discussion which focuses on the fetus and fetal harm. When mothers are included, their failure to mother is emphasised, and regulations and legal sanctions have been suggested to curb their behaviour. Liberal and conservative paradigms limit the questions asked and the areas researched, ignoring and obscuring deeper issues of social control, sex, class and race.

If one examines drug use historically, it becomes apparent that the 'drug problem' is socially constructed. If one considers harm and dangerousness of specific drugs, it is alcohol and tobacco that are most toxic and harmful to health. From this perspective, one is required to ask different questions and to search for reasons why we have chosen to stigmatise a large segment of our population in Canada and elsewhere. One is also required to question why, at this moment in history, women who use illicit drugs, especially mothers, are being persecuted.

In conclusion, women in Western society have witnessed social service, legal and medical regulation since the late 1800s (Oakley, 1984). Punishing and regulating pregnant women suspected of illicit drug use will not be contained to only this small population. All women will be affected, because all of society is affected by harsh and punitive drug legislation. Sheila Kitzinger notes that 'every society regulates the right to motherhood and "selects" those women who are allowed to be mothers' ( 1992, p. 17 ) . In Canada, as elsewhere, women are often denied the chance to mother and raise their own children. It would be to Canada's benefit to look towards the Netherlands, England and Scotland, where specific regions have developed programmes that welcome women rather than punishing them. And it would be to our benefit to decriminalise illicit drugs and distance ourselves from US policy which continues to extend the arm of the law to punish women (and men ) who are suspected of illicit drug use.

Susan C. Boyd, School of Criminology, Simon Fraser University, Burnaby, BC, Canada, V5A 1 S6.

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*1 Susan C. Boyd is a PhD Candidate at the School of Criminology, Simon Fraser University, and is currently doing research on women who use illicit drugs in Canada. This paper was originally presented on March 8,1994, at the 5^th International Conference on the Reduction of Drug Related Harm, Toronto, Ontario, Canada.

*2 First Nations people are status and non-status Aboriginal people of Canada.