THE CRIMINALIZATION OF PREGNANT SUBSTANCE ABUSERS AND THE IMPLICATIONS FOR REPRODUCTIVE RIGHTS

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THE CRIMINALIZATION OF PREGNANT SUBSTANCE ABUSERS AND THE IMPLICATIONS FOR REPRODUCTIVE RIGHTS BY BRITTANI DANIELLE MCLEMORE A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Maria D. Vesperi and Erin Dean Sarasota, Florida April, 2013

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Table of Contents Acknowledgements iii Abstract iv Introduction 1 Chapter One: 16 Pregnant Substance Abusers and the Mass Incarceration of Women Chapter Two: 25 The Medicalization of Pregnancy and Pregnant Substance Abusers Chapter Three: 44 Chapter Four: 65 Bio Power, the Ideal Mother, and Pregnant Substance Abusers Conclusion 80 References 90

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iii Acknowledgements Special thanks to Dr. Maria Vesperi Dr. Erin Dean, and Dr. Miriam Wallace for always providing me with insight and guidance. You have all played a vital role in helping me through this process as well as all of my academic endeavors. I have greatly enjoyed every class and every discussion I have had with each of you. Thank you to my mother and father for always being patient and understanding. I could not imagine a life without your love and support. Also, thank you to the many others who have helped me through this process. There are far too many to list here, but I hope you know who you are. A special thanks to Emily Meyer, who always provided me with great food and wonderful conversation. Thank you to Liz Usherwood I could feel your support even when you were on the other side of the world. Also, a very special thanks to all of the social activists fighting for prison reform, from both inside and outside the prison cell. I know the fight might seem like an endless battle, but please know your efforts are appreciated and that you are truly making a difference in the world.

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iv THE CRIMINALIZATION OF PREGNANT SUBSTANCE ABUSERS AND THE IMPLICATIONS FOR REPRODUCTIVE RIGHTS Brittani Danielle McLemore New College of Florida 2013 ABSTRACT This thesi s will explore the criminalization of pregnant substance abuse and the effects on perceptions of motherhood Specifically, it employ s understand how legislation, the prison industrial complex and the medicalization of pregnanc y allow the state to define and assume responsibi occurrences are portrayed as operating for the be nefit of the fetus. However, I posit that these initiatives are better understood as responses to economic and social anxieties I then assess the implications of criminalizing pregnant substance abuse for reproductive rights. _____________________ ______________________ _____________________ ______________________ ______________________ Maria D. Vesperi Erin Dean Division of Social Sciences Division of Social Sciences

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1 Introduction There is a haunting question about how the most vulnerable, most impoverished people in the United States pregnant wome n, often pros titutes, sometimes using multiple drugs (prominently alcohol and tobacco), often homeless, more often than not facing violence during their pregnancies, frequently dealing with long term ill health and often mental illness as well became a symbol of everyt hing that was wrong with the country (Ortiz and Briggs 2003: 45). In this thesis, I attempt to contribute to the anthropological material on those who are imprisoned in the United States today. While my work can be understood to pertain to the plight of a ll prisoners, it specifically addresses pregnant substance abusers, a category of imprisoned individuals who has proven to be most controversial in popular discourses. Beginning in the 1980s, concern about pregnant substance abusers, commonly referred to a News programs and medical experts continuously warned the country of the ill effects of o find themselves in prison, not in rehabilitative programs, facing charges of child endangerment, manslaughter, and even murder. In this thesis, I assess the historical incidents that resulted in this occurrence and the future implications of incriminating pregnant substance abusers. I address how black, impoverished mothers have been situated as socia l deviants. In doing so, I argue that the criminalization of pregnant s ubstance abusers can be understood as a utilization of biopower that operates in response to economic turmoil, in which good mothers are defined in opposition to bad mothers, a nd this line is racially demarcated The medicalization of pregnancy and the war on the catalyst for the imprisonment of pregnant substance abusers.

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2 Background I have chosen to focus on pregnant substance abusers in light of recent debates concernin g reproductive rights in the United States. While access to abortion and birth control has always been heavily contested, since 2011 the discussion has become more popularized and polarizing. Individuals throughout this country suddenly saw their reproduct ive rights endangered. Various states and Congress have proposed numerous measures to limit access to abortion and birth control, as well as limiting funding for victims of rape and domestic violence. According to the Guttmacher Institute, which seeks to a dvance sexual and reproductive health worldwide, 2011 marked a turning point for reproductive concerns in the United States. In that year, the number of states proposing legislation seeking to restrict reproduction rights reached a record number, with 1,10 0 proposed bills, as opposed to 950 that surfaced in 2010. As a result, even more legislation was enacted restricting access to reproductive services, the major target being abortion (Guttmacher 2012). While 2011 was considered a record year for anti repro ductive rights legislation, it was displaced by 2012. Legislation limiting access to reproductive means remain on the increase abortion legislation in the United States. The wave of legislation cur tailing reproductive rights hit a new high in the month of March 2013 alone, prompting the Mother Jones article Choice March Madn Kate Sheppard, Jaeah Lee, and Tansneem Raja They Despite being Women's History Month, March has seen relentless attacks on ladies' rights. As soon as one state passes some outrageous woman restricting bill, another is right behind with something even, well, outrageous er

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3 and Raja 2013). These state laws includ e blocking access to birth control, specifically Plan B, requiring ultrasounds in order to obtain an abortion, and even banning abortion six weeks after conception. However, I could not help but notice that this rhetoric, while effective, continuously discounted thousands who were directly affected by the reproductive rights discussion. For one, people who identify as trans were continuously not included in what repro majority of people arguing for reproductive rights in the media were predominately concerned with only particular aspects of reproductive rights access to abortion and birth control. While this form of reproductive rights is extremely important for many, not just for women, this still entails a narrow conception of reproductive rights. New York Times the increasing incarceration of pregnant substance abusers in Alabama. Legislation against these women, presumably methadone and prescription pill users, was situated as an offshoot of th legislation was the interpretation of personhood which was extended to include a fetus situating this l egislation within the realm of reproductive rights. While pregnant substance abusers never entered the primary discussions of reproductive rights, some feminist blogs did assess the implications, and effectiveness, of imprisoning these women. One blog on t he website Feministe

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4 the criminalization of pregnant substance abusers only affects particular facets of the US population. Similarly to mass incarceration as whole, which tends to disproportionately affect minor ities and the poor, the incarceration of pregnant substance abusers has predominately affected black women and those living in poverty. The imprisonment of pregnant substance abusers had another detrimental effect it criminalized addiction. The prosecut ion of pregnant substance abusers does not treat addiction as an illness, but as a crime. States also fail to provide rehabilitative services for pregnant substance abusers, and instead imprisoned them. In regards to pregnant substance abusers, legislation framed two opposing forces the rights of the mother vs. the rights of the fetus, the latter needing protection from the former. Legislation focused on protecting the fetus, which was situated as a person deserving of rights, often at the expense of the include thousands of individuals who have been excluded from the conversation. In doing so, I hope to extend the scope of reproductive rights to include those who have continuously been left out. I also hope to widen the focus of reproductive rights to include pregnant substance abusers because legislation criminalizing their actions relies on a concept of personhood that can be detrimental for all. While pregnant substance abusers rarely enter the rhetoric of reproductive rights, I will hence argue that they should actually be at the center of these discussions. For these women, and the legislation against them, do not exist in a vacuum. As Ada Calhoun describes, w hile personhood amendments face difficulties passing in states, chemical endangerment laws, which still define the fetus as a person, do not (Calhoun 2012).

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5 Terminology Throughout this thesis, I commonly refer to women who consume crack cocaine, methadone, though the term is not limited to illicit substances. The reason for this is to reflect the media and legislative focus on these substances as opposed to other legal, even more pre valent substances, such as alcohol and tobacco. In Cracked Coverage: Television News, the Anti Cocaine Crusade, and the Reagan Legacy Jimmie Reeves and Richard Campbell explain how the use of some substances dominated the rhetoric concerning pregnant subs to be blamed for any baby in distress born prematurely to mothers who may or may not have taken the drug but who had unhealthy life styles that included alcohol, smoking, and drug Enid Logan documents how, due to prosecutorial discretion, women who consume alcohol or marij The focus on crack cocaine has even insisted on a differentiation between the substance and cocaine, which, according to Craig Reinarman and Harry G. Levine, is a Crack in the Rearview Mirror: Deconstructing Drug War From the beginning of the crack scare in early 1986, politicians and the media found it useful to speak of crack as if it were an entirely new substance with unp recedented powers. This was false. Crack was only a n ew form of of crack cocaine was that it was ingested differently and it was sold at a much cheaper

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6 price. They situ ate crack cocaine not as a new drug, but as a new market innovation that cocaine, Reinarman and Levine assert, allowed for legislators to pass punitive measures agains t the substance that were more stringent than those for cocaine (2004: 184). New York Times Presentations of Pregnant Drug coverage, comparatively analyzing how pregnant women who consume alcohol, tobacco, and crack cocaine are represented differently and the frequency of coverage. Springer asserts that these three substances have varying levels of deleterious effects on a fetus, as analysis uncovered that both alcohol and crack cocaine use while pregnant which were heavily reported on and more criminalized than tobacco use, were racialized with alcohol use equated with Native Americans and crack cocaine use associated with black women, even though white women were more likely to consume both substances (Springer 2010: 483). Springer not only discerned that both substances were racialized, but also that consumption of crack cocaine while pregnant accounted for the majority of the stories (48 percent), even though substance abuse of alcohol and tobacco wh ile pregnant is much more common (2010: 484). focus on illicit substances, often at the expense of others which can have an equal if not greater effects on an unborn fetus. The focus on the effects of crack also masks the effects of other factors of ill health that are common to poverty. As Reinarman and

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7 nutrition, a lack of prenatal care, and domestic violence, making it impossible to discern the sole effects of crack cocaine (2003: 193). Enid Logan also draws attention to the lack of focus on male behavior, which can have lasting effects on a fetus as well. Logan low birth weight, learning disabilities, and abnormal newborn behavior. Logan states, ale violence, malnutrition, lead paint, poverty, and racism, are immaterial to fetal rights advocates becaus e they lie outside of the implicitly patriarchal and racist parameter Literature Review: Throughout this thesis, my research has been guided by four major themes: the theories of the body. While this is reflected in the structure of my thesis chapters, this should not be understood as a separation of approaches concerning pregnant substance abusers. Instead, I argue that the se approaches should be taken together when discussing concerns and perceptions of pregnant substance a busers. There is overlap among these various components which have acted in conjunction, resulting in the incarceration of pregnant substance abusers. I bio Discipline and Punish: The Birth of the Prison Michel Foucault (1995) introduces his theory of bio power, now considered the foundational theoretical framework in understanding how power is produced and facilitated through social institutions. According to Foucault, the transition

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8 from publicized penalization, generally considered to be torture and execution, to a more priva te form of reform had lasting implications. For Foucault, these reformative measures shifted from the body as the receptacle of punishment to something more transient, with the body as a medium through which to reach something deeper. As a result, punishme nt became the most private aspect of the criminal justice system. The consequence of this, Foucault further explains, is that punis hment becomes an abstract concept for the general public. I ts effectiveness resu lts from its inevitable occurrence and justi ce is absolved of responsibility for the violence it perpetuates out of necessity. Hughes (1987) apply a feminist eory of bio power. Lock and Scheper Hughes body politic. In their assessment, the body politic is characterized by surveillance, regulation, and control. Scheper Hughes considered vulnerable (Scheper Hughes and Lock 1987: 24). Scheper Hughes and Lock Witch trials of 1692 and 1693, contemporary African societies, and even recent witch hunts in the United States. In each instanc e, the body politic attempts to purge itself of social deviants, usually interpreted as women. Slick

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9 S pins and Fractured Fact: How Cultural Myths Distort the News Caryl Rivers (1996) absorbed, greedy mother who used her children in order to swindle the state. In Educating Drug Exposed Children: The Aftermath of the Crack Baby Crisis, Janet Y. Thomas (2004) extends the stereotype described by Rivers as also applying to women who used crack cocaine while pregnant. dis women, commonly held perceptions of welfare recipients must also be addressed. In The Undeserving Poor: From the War on Poverty to the War on Welfare, Michael Katz (1989) es tablishes a historical trajectory in order to ascertain how those on welfare President Richard Nixon, as the leading cause of negative conceptions of welfare. This is a po sition also held by Martin Gilen in Why Americans Hate Welfare (1999), in which he describes how welfare recipients became racialized through the media. power operating against Hughes and Lock also assert that the medical industry can be understood as a facilitator of bio power, particularly through the social construction of illness and mental disease. The medicalization of pregnancy can also be understood as a tool of bio power, which operates to imprison women who consume substances while pregnant. I utilized this assessment by Scheper Hughes and Lock in order to situate the medicalization of pregnancy as one of the leading factors, besides the prison industrial complex, that resulted in the incarceration of pregnant substance abusers.

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10 analyzes the role of biomedical rhetoric in the case of pregnancy in assuring the rise of 00 and the 1930s. Through such rhetoric, medical practitioners were able to establish pregnancy as a disease which must be treated by doctors, situated as professionals, through antenatal care. Barker situates the medicalization of pregnancy as a form of b iomedicine, implying power relations by rhetoric, the medical industry established a norm of pregnancy, which incorporated social, racial and ethnic stereotypes of the time. Biomedicine, Barker asserts, can simultaneously carry, perpetuate, and formulate socio political agendas, which advance particular class and ethnic compositions. Through biomedicine, Barker maintains, doctors asserted control over pregnant women by means o f presumably universal and objective criteria that would ensure a healthy outcome. In order to understand the historical and contemporary implications of the medicalization of pregnancy, I assessed The Captured Womb: A History of the Medical Care of Pregna nt Women by Ann Oakley (1984), which provides a historical time frame for how the medicalization of pregnancy emerged in the West. Oakley attempts to write an historical account of the medicalized pregnancy by employing the same theoretical framework Foucault used in understanding the birth of the prison. Oakley does not attempt to understand the past in terms of the present, however; she instead writes the history of the present, alluding to Fouca power, in which he also utilizes a history of the present in order to ascertain the current state of the prison. While Oakley focuses specifically on the United Kingdom, a similar trend was also observable

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11 in the United States. In Lying In: A History of Childbirth in America Richard and Donna Wertz trace the historical trajectory of childbirth from the colonial era throughout the twentieth century. The authors attribute the rise of medicalized pregnancy to the rise of the medical indust ry and the simultaneous racialization of midwives, who were primarily blacks residing in rural areas and immigrants from Eastern Europe. In their view, the medical industry was mistakenly credited for a drastic decrease in infant and maternal mortality rat es, which solidified their validity as experts on pregnancy. Throughout my research, the concept of fetal and maternal rights emerged as a main concern regarding the war on drugs. In recent years, pregnant individuals have found themselves at the mercy of numerous laws, which seek to curtail the consumption of drugs during pregnancy. Most of this legislation depends on an understanding of the fetus as a human, deserving of rights, often at the expense of the mother. In The Mother of All Crimes: Human Right s, Criminalization, and the Child Born Alive Emma Cave (2004) explores the status of the fetus, the pregnant woman, and conceptualizations of autonomy. Cave is particularly interested in laws pertaining to pregnant women, which seek to both protect and de monize them. While there are few laws specifically targeting harm inflicted on a fetus by the pregnant mother, many other laws, which were actually established in order to protect the mother and fetus, are now being used to incarcerate pregnant substance a asserts was specifically constructed to deter harm by a third party, but is now used to demonize and incriminate pregnant individuals who bring harm to their fetuses (Cave 2004: 24).

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12 substance abusers, who are often imprisoned for child endangerment, child abuse, and even manslaughter or murder. In Making Women Pay: the Hidden Costs of Fetal Rights Rachel Roth (200 3) explains the intrusive forms of government intervention to which incarcerated women are subjected, particularly women of color. Roth asserts that substance abuse while pregnant is considered to be a criminal offense, resulting in incarceration. However, the incarceration of pregnant substance abusers is not simply a result of legislation. In Cracked Coverage: Television News, the Anti Cocaine Crusade, and the Reagan Legacy Jimmie Reeves and Richard Campbell (1994) attribute changing perceptions of mothe which women of color were seen in opposition. As a result, pregnant substance abusers were incarcerated, not fo r being criminals but for being bad mothers (Reeves and Campbell 1994: 2007). The Anthropology of Prisons: Data This thesis does not rely on or include original ethnographic material. Fieldwork proved extremely difficult for this project, mainly due to d ifficulty of access and the fluctuations and instability of resources for the incarcerated. Instead, I utilize anthropological and feminist theory that focuses on the importance of the body and biopower. In doing so, I attempt to situate this thesis within the emerging anthropological characterizes anthropological work concerning prison as self conscious, analytical, and

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13 more critical than perhaps other disciplinary approa ches. Rhodes alludes to the work of numerous anthropologists, particularly Allen Feldman, which attempts to describe how larger structures of power and authority are both expressed and resisted at the level of the body (Rhodes 2001: 73) I apply anthropolo gical, economic, and historical approaches in order to discern the various forms of domination that operate within the prison industrial complex. I situate the medicalization of pregnancy and the war on welfare as important The majority of prison studies describe male inmates without reflecting on the im plications of this depiction or the language in which it is framed consequence of a lack of focus on female prisoners, Rhodes argues, is a perpetuation of neglect and abuse. Rosemary L. Gido also stresses the invisibility of both juvenile and adult females incarcerated in the United States. Gido attributes racial and gender bias to the never present imprisoned females in both literature concerning the prisons and prison ents has actually resulted in male oriented services, which do not effectively address the increasing incarceration have increased dramatically for adolescent girls and adult women, the My first chapter focuses primarily on the rise of the prison industrial system and industrial complex has

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14 disproportionately targeted people of color and how women, the majority of whom are mothers, now comprise the fastest growing prison population. I also discuss The second chapter focuses on the medicalization of pregnancy and its effects on pregnant substance abusers. I assess how pregnancy was constituted as a realm for the medical ind ustry, resulting in the conception of doctors as authorities in relation to which doctors were presumed to be medical authorities with regard to the detrimental effects o f substance abuse on fetuses, which was used to legitimize the incarceration of pregnant substance abusers. recipients resulted in a backlash, in which funding was cut for public programs and the trajectory poor, urban black women who were also receiving welfare. In Chapter Four, I assess how biopower has operated, both through incarceration and the medicalizat ion of pregnancy, against pregnant substance abusers. I apply a historically women particularly when the state is vulnerable. I then addres consume drugs and are considered a liability to the state.

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15 later. I then contrast and compare the women and children today. I also assess the special considerations of female prisoners who include, but are not limited to, histor ies of abuse and mental illness. I also propose alternatives to imprisonment of pregnant substance abusers.

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16 Chapter One Pregnant Substance Abusers and the Mass Incarceration of Women this was not based on a generalized sense of crime, but a specific, racialized rhetor ic that Punishment for Sale: Private Prisons, Big Business, and the Incarceration Binge criminologists Donna Selman and Paul Leighton assert that, w hile Nixon was claiming to combat cr ime, he simultaneously declared that However, the war on drugs eventually came to focus specificall y on one particular drug: crack cocaine. Crack, which politicians claimed was a cheaper, stronger, and more addictive form of cocaine, was commonly associated with black, inner city youth. In response to what wa s termed Drug Abuse Act (ADAA), which sought to impose mandatory minimum sentences for drug traffickers caught with crack. The ADAA established tougher penalties for crack, but not for cocaine, even thou gh the two substances are extremely similar. The law instituted a five year mandatory minimum sentence for distribution of 500 grams of cocaine, while implementing the same penalty for only five grams of crack. The result of this legislation was an increas e in incarceration rates and sentences for black individuals. In the article

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17 commentators Caryn Devins and Stuart Kaufman assert that by the 1990s, two thirds of crack cocaine users w ere white or Hispanic, yet 90 percent of crack cocaine defendants were black (Devins and Kauffman 2012). In the case of women offenders, the crack cocaine epidemic focused heavily on the use of the drug by pregnant women. Beginning in 1983, there was an e mergence of what is now understood which can be understood as an essential component of the war on drugs. This entailed an unprecedented amount of news coverage conc erning women who consumed crack cocaine while pregnant. D e e med were portrayed as predominately black and residing in lower income, urban areas. In Crack Mothers: Pregnancy, Drugs, and the Media Drew Humphries documents the emergence and peak of reporting on Acco rding to his analysis, news stories concer ning women and crack or cocaine first emerged in 1983, peaked in 1989 and trailed off in 1991 (Humphries 1999: 20). The first stori es aired in the early 1980s, before the creation of crack, and were focused on the use of cocaine by middle class and suburban denizens. American consciousness can be understood as years 1983 1985, before crack was discovered, stories conc erning cocaine use com prised 12 percent of news segments airing on ABC, CBS, and NBC. Of these segments, the majority of stories focused on men and a small number focused specifically on pregnant women who used cocaine ( 1999: 21). While cocaine use, specifically by the rich and famous, was widespread in the media, coverage of mothers who used cocaine while pregnant was still rare.

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18 According to Humphries, women who used cocaine while pregnant were generally white, middle class and portrayed as victims of the drug. News reporters explained how women turned to cocaine because of low self esteem or to cope with personal issues ( 1999: 23). It was also assumed that t hese women were not aware of the addictive potential of the presu mably recreational drug. Humphries states that were a concern in the spread of cocaine. As a vulnerable group, they illustrated dangers of middle 1999: 24). When crack emerged in the mid 1980s, stories concerning cocaine use dropped rapidly as stories concerning crack became pervasive. Between 1988 and 1990 news reporting on crack cocaine rose to 51 percent of all news segments concerning drugs Of news segments focusing on wome n crack users, the majority (67 percent) focused solely on crack cocaine use by mother s ( 1999: 21) According to Humphries, in October 1988, NBC introd uced America to its first crack mothers: Tracy Watson, Erocelia Fandino, and Stephanie (no last name s provided), who were all women of color ( 1999: 1). Tracy, a black woman who was pregnant at the time of filming, was recorded smoking crack while disclosing her $100 a day habit ( 1999: 1). Erocelia, a Latina woman, was filmed in a Miami hospital while recuperating from the premature birth of her child which was presumably due to her crack use during pregnancy. Stephanie, a black woman, was interviewed about the newborn baby she had just recently abandoned at an inner the system (1999: 1) The prog such as Tracy, Erocelia, and Stephanie, estimating the annual number of babies bo rn under the influence of crack c ocaine to be 375,000. In larger inner cities, the estimates were much higher. The progr am reported that a t one hospital in Miami, as many as 1 in

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19 10 mothers used crack within hours of delivery ( 1999: 2). This news segment was peak in 1989. On August 6th, 1989, the Washington Post Here Besharov reports an increase in the rate of children bo rn under the influence of crack cocaine and the ill effects it can have on th em. Besharov establishes crack as a devastating threat to society, and pa rticularly children. He states that 1960s, but cocaine, and especially its derivative, crack, poses a threat to many more young childre n 1989: 1). Besharov asserts that crack use causes women to become neglectful, and even violent He establishes children born under the influence of crack to be victims of their own mothers, stating : Why aren't we protec ting these children? One major reason is that, paradoxically, we continue to entrust their care to the very parents who are threatening their well being. Instead of tackling head on the tenet of prevailing social welfare policy that holds that children are almost always better off with their mothers, discussion has focused on options for dealing with the drug addicted mothers: whether to concentrate on drug treatment services or prosecution. These are important concerns, but they do not go to the heart of w hat must be done now to protect these children (1988: 1) characterize the 199 0s, had begun. The war on crime, as initiated by President Nixon, spurred a war on drugs, which cultiv Humphries attributes the heigh t of the crack baby epidemic that was fueled and perpetuated by

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20 article ( 1999: where crack was demonized, but, more specifically, crack use by mothers was considered specifically deplorable. This shift in consciousness is evident when assessin g the drastic W hile white female cocaine users were considered at risk, female crack users, assumed to be black, were considered a threat to America and came to represent the ills of impoverished urban dwellers. Socially constructed as black and urban, this group of women became a threatening symbol of everything that was wrong with America. Its cities, its poverty and its welfare dependency were laid at the feet of crack mothers, who were also blamed for undermining the family and driving up the rates of infant mortality and morbidity ( 1999: 19). curtail the use of illicit substan ces, speci fically crack, among pregnant women. T he criminal justice system was considered to be the most effective way to halt crack use and protec t children (1999: 2). dical researchers Deborah A. Frank, Marilyn Augustyn, Wanda Grant Knight, Tripler Pell, and Barry Zuckerman, assert that b etween 1985 and 2000, more than 200 women in 30 states faced criminal prosecution for using psychoactive substances, primari ly crack, during their pregnancies (Frank et al 2001: 1614 ). The majority were lower income women of color. According to the report, most were arrested through policies implemented by hospitals, in which pregnant or po stpartum women were tested for cocaine without t heir knowledge Women who tested positive were reported to the police and subsequently arrested for possession of an illegal

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21 drug, delivery of drugs to a mi nor, or child abuse (2001: 1613 ). Policies in Brief: Substance Abuse During Guttmacher Institute, substance abuse during pregnancy is currently co nsidered to be child abuse in 16 states (Guttmacher Institute 2013: 1 ). In 14 states, it is required for healthcare professionals to report suspecte d prenatal drug abuse, and in four states they are required to test for suspected prenatal drug use ( 2013: 1 ). The Prison Industrial Complex and the Mass Incarceration of Women The United States imprisons more of its citizens than any other nation in the developed world. Each year, more prisons are constructed and more people are detained. of its imprisoned population. Donna Selman and Paul Leighton state that this drastic increase in prison populations (Selman and Leighton 2010: 17). This era can be understood as the age of mass incarceration and the rise of the prison industrial complex. By 2012, the trend had exhibited no indications of diminishing. The prison industrial complex emerged in the mid 1970s, and t he rise in incarceration rates is one of its most distinctive features. P rior to 1974, the United States maintai ned a steady incarceration rate In The Prison and the Gallows: The Politics of Mass Incarceration In America political scientist Marie Gottschalk estimates that b etween 1973 and 2000, the United States incarceration rat e increased more than five fold. Gottschalk states that igher proportion of the adult population in the

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22 An other important implication of the prison industrial complex is its tendency to disproportionately affect specific socio ec onomic groups. The increase in prison rates in the United States cannot be understood separately from its social, political, and economic context. In Punishment and Inequality in America sociologist Bruce Western establishes a key aspect of mass incarcera tion as the systematic imprisonment of w hole groups, specifically young black males (Western 2006: 29). This characteristic is essential in understanding the social inequalities that exist within the US penal system. By the mid 1990s, incarceration rates for adult white men were e stimated at 1,000 per 100,000, affecting one percent of the white male population. The incarceration rate for black men, in comparison, was 7,000 per 100,000 individuals, affecting seven percent of the population a rate seven ti mes higher than that of white males (Gottschalk 2006:19). In From Witches to Crack Moms, feminist sociologist Susan Boyd asserts that t he rate of increase in incarceration of women is c urrently double that of men (2004: 209). Within t he last three decades, the number of women imprisoned in the United States has increased more than eight fold ( Gottschalk 2006: 20). Women now comprise the fastest growing sector of the incarcerated population in the United States ( 2006: 19). Similar to the prison industrial co mplex as a whole, the effects of incarceration rates on women have disproportionately affected marginalized groups. Boyd estimates that t wo thirds of the female prison population is currently comprised of women of color (Boyd 2004: 209). Black women, simil ar to black men, represent the majority o f the increase in imprisonment. Boyd found that black women are five times more likely to be arrested than white women ( 2004: 209). Approximately two thirds of all imprisoned women have children under the age

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23 of 18 (Gottschalk 2006: 20). In War on the Family: Mothers in Prisons and the Families They Leave Behind sociologists Renny Golden estimates that 58 percent of children of imprisoned mothers are under the age of 10 ( Golden 2005: 3). According to Golden, the m ass incarceration o f mothers has a large impact on communities and fa mily structures, and especially on children. In a society where women assume primary responsibility for children, the incarceration of mothers can disrupt fa mily units. Approximately 90 p ercent of mother s assume primary responsibility for children of incarcerated men. However, only 28 percent of fathers serve as primary caretakers for children when mothers are imprisoned, leaving extended family members with primary responsibility ( 2005: 3 ). Just as women of color are more likely to be incarcerated, children of color are more likely to be directly affected by the prison industrial complex. Black children are nine times more likely, and Latino children three times more likely, to have a p are nt in prison then white children ( 2005: 3). Conclusion The mass incarceration of women, particularly mothers, can be understood as a consequence of the wa r on drugs, specifically targeting income mothers as targets of legislation to curtail drug use while pregnant can still be observed today when considering the continuation of mass incarceration of pregnant substance abusers and new legislation that targets them. In the next chapter, I will assess how the medicalization of pregnancy resulted in the incarceration of pregnant women, and how doctors were situated as medical

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24 experts concerning pregnancy. Through the medicalization of pregnancy, physicians were which excluded women belonging to marginalized groups. In relation to the testimonies, which further discriminated against pregnant substance abusers.

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25 Chapter Two The Medicalization of Pregnancy and Pregnant Substance Abusers Introduction The medicalization of pregnancy can be understood as a direct cause of legislation targeting pregnant substance abusers. The emergence of medicalized pregnancy was characterized by two occurrences that were not pres ent prior to the 20 th century: the pervasiveness of hospital births and the insistence on prenatal care. Through medicalization, pregnancy cam e to be understood as pathology in which all pregnant wom en were at risk of complications As a result, pregnancy fell under the medical gaze, which entailed the medical industry establishing regulations for pregnant individuals implications for drug addicted pregnant individuals, including a loss of autonomy and the ir categorization as The History of Medicalized Pregnancy in the United States Prior to the 20 th century few pregnant women, if any, received prenatal care and p regnancy was regarded as a private matter between a pregnant woman and her midwife M edical interventions were uncommon, unless th e pregnant woman was considered at risk for severe complications In The Captured Womb: A History of the Medical Care of Pregnant Women Ann Oakley explains how r outine medical supervis ion was seen as unnecessary during pregnancy and there was no systematic body of knowledge about techniques regulating the treatment of pregnancy under medical supervision (Oakley

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26 1984: 11). Before 1900, most pregnant women delivered in their homes with t he assistance of midwives. In Lying In: A History of Childbirth in America Richard and Dorothy Wertz classify hospitals as attempts to rehabilitate the s ocial degradation that occurred in urban centers due to industrialism (Wertz and Wertz 1977: 133 ). ). Beginning in the 1 8 th century, some births took place in dispensaries, which pre date hospitals, but this was rare. Dispensaries were regarded as charity efforts to assist lower class or homeless women who could not deliver in their homes. Even for the few births that took place in dispensaries, mostly midwives, not physici ans, attended (1977: 132 ). By the 19 th century hospitals assumed the role of dispensaries and emerged as an alternative for homeless, poor pregnant women ; however, these facilities were seen as unsanitary and commonly associated with di sease, death, and poverty (1977: 136 ). ice issued to pregnant women was not new. Such advice usually focused on lifestyle and did not provide a framework for me dical intervention. During the 19 th century there was an expa nsion in maternity care manuals that provided advice to pregnant women (Oakley 1984: 14 ). These guides operated under the assumption that pregnancy was nat ural and did not require intervention of any kind. However, these manuals did acknowledge the framed advice as ed pregnant women to act (1984: 14 ) M anuals pr ovided remedies for the common occurrences associated with pregnancy, such as morning sickness. Suggested remedies during this time inc luded fresh air, exercise, rest a nd an alteration in diet (1984: 15).

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27 Maternity care manuals sought to incorporate pregna ncy into medical discourse, which would later result in subjection to the medical gaze. While not operating under the assumption that pregnancy was an illness but rather a troubled, natural state, the authors of these manuals failed to distinguish between major and minor symptoms of pregn ancy The Signs, Disorders, and Management of Pregnancy written in 1834, served simultaneously to provide advice for pregnant woman and a s a textbook for those in the medical profession. As a result, the medical profession began taking an interest in pregnancy. All pregnant women not just tho se at risk of complications, were regarded as needing medical advice. In the early 1900s, there was approach to pregnancy. During this time, doctors ceased to regard pregnancy as a natural state, but instead as an illness needing treatment. This was evident in advice manuals of the day, many of which were importance of biomedical rhetoric in advice manuals, which established the cultural authority of doctors and, by extensio n, the medicalization of pregnancy. Barker focuses on Prenatal Care Bureau and first published in 1913. Through an analysis of this document, Barker traces the shift in perceptions of pregna ncy from natural to pathological. Prenatal Care was the first widespread introduction of medical advice to pregnant women. The document is estimated to have reached more 22 million women by the mid

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28 policy research er, authored the first Prenatal Care The original version of the document was only intended to serve as a manual for pregnant women to consult before childbirth. It stressed the importance of hygiene, confinement, and medical supervision, but to a lesser degree (Barker 1998: 1068 1069). By 1924, the rhetoric of Prenatal Care had altered, focusing more on the importance of medical intervention. In this version, published nine years after the The first and most natural question which occurs to the prospective mother is how pregnancy manifests itself. The presumptive signs of pregnancy are these: (1) cessation of menstruation, (2) changes in the breast, (3) morning sickness, (4) cely be room for doubt that pregnancy exits, although there are other signs upon which physicians rely, and only a physician can make a positive diagnosis (West 1924 in Barker 1998). This passage has two important implications. For one, pregnancy is situa ted as a understood as symptoms. Second, the manual states that only physicians can properly diagnose pregnancy (1998: 1069). According to this document, women were no longer able to determine for themselves if pregnancy had occurred. Manuals such as Prenatal Care contributed to the drastic increase in hospital births that took place in the 20 th century. At the turn of the century, fewer than five percent of women delivered in hospitals and prenatal care was still fairly uncommon. Beginning in 1901, however, prenatal visits became commonplace among the few women who delivered their children at lying in hospitals. In 1906, all pregnant patients at the Boston Lying In Hospital, f or example, received at least one visit from a nurse either prior to or during confinement (Oakley 1984: 53).

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29 During this time, lying in hospitals were sti ll seen as alternatives for very poor and homeless pregnant women. Here patients were seen as charit y cases and, due to their lack of social standing as test subjects (Wertz and Wertz 1977: 136). Lying in hospitals actually developed as testing grounds for new t echniques and operations (1977: 135). Doctors saw these women the charity patients and the unwed mothers who sometimes paid for part of their care as defective both in health and in moral ability, and thus as in greater need of assista nce from medical arts than were healthy and Phy sicians treating pregnant patients in lying in hospitals utilized a scientific approach, which sought to cure the diseased individual, o r, at the very least, aid in a difficult process ( 1977: 136). Doctors attempted to observe pregn ancy with a clinical eye in order to learn procedures they coul d apply to other women during an emergency ( 1977: 136). Durin g the early 1900s, physicians at lying in hospitals began to standardize certain treatments to combat disease. Treatme nt was characterized by precise and ef fective manipulations and interventions that sought to prevent and cure furthering the reconceptualization of pregnancy as pathology ( 1977: 136). Of this treatment, Wertz and Doctors were on the lookout for trouble in birth. That seemed to t hem to be their primary purpose. They found a lot of trouble so much, in fact, that they came to think that every birth was a potential disaster and that it was best to prepare each woman for the worst eventualities ( 1977: 136). By 1910, prenatal care was seen as valuable in a voiding complications caused by eclampsi a, 1 syphilis, and gonorrhea (Wertz and Wertz 1977: 140). In 1916, there were an 1 Eclampsia is characterized by convulsions or comas occurring in pregnant women either late in pregnancy, during labor, or 24 hours after delivery ( The American Heritage Medical Dictionary 2007).

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30 estimated 73,000 infant deaths attributed t o syphilis transferred from mother to child during birth. Pediatrici ans also discovered that gonorrhea could cause blindness from for 25 to 30, even 50 percent of adult cases of blindness (1977: 140). Doctors discovered that dropping a one birth could deter blindness. However, since gonorrhea was not easily detectable in the mother, doctors soon distributed the preventive treatment t o eve ry baby. This solidified doctor as possibly pathogenic (1977: 141). During the 1920s, t h ere was also a dramatic increase in the number of hospital births. This shift is now understood as a response to high infant and maternal mortality rates in which the hospital was constructed as the safe, effective choice. As the federal government expand ed, so did its involvement in maternal and infant health. Between 1900 and 1925, state bureaus developed to deal with high mortality rates. This time period was characterized by the regulation and ultimate prohibition of midwives, solidifying doctors as th e sole alternative. Of this time period, Wertz and Wertz state, By the turn of the century, midwive s were already relegated to an inferior position in the United States and hospital physicians were attending to a high percentage of pregnancies. However, in some cities midwives attended as many as 40 percent of all births, even until the 1920s and in sta tes where the practice was illegal (1977: 210).

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31 Midwives were seen as the most cost effecti ve choice for many women, especially black women and women residing in rural areas who could not afford hospital births. Also, for many immigrant women, midwives wer e considered traditional and more proper t han having a male present (1977: 212). going rate such as housecleaning, laundry and postnatal care (1977: 211). Sensing a viable threat, doctors sought to have the profession eliminated. M edical experts began publicly questioning the importance and ro vociferous opponents of midwives were physicians in private practice or in obstetrical specialization. They wanted midwives eliminated at once, as competitors and as obstacles to o bstetric education, for the cases midwives delivered were forever lost to medical 214). journals, characterizing mi dwives as poor and uneducated because they had no formal training in the techniques of childbirth. In reports and in the media, midwives were described as clumsy, ignorant, unsterile, filthy, and superst itious (1977: 212 ). The majority of these assertions reflected prejudices of the day directed especially towards blacks and newly arriving Eastern European immigrants. Medical experts in the United States held Western European midwives in high esteem as an educated class. However, the same sentiments were no t afforded to Eastern European midwives, who were already heavily discriminated against due to their ethnic backgrounds (1977: 212). Wertz and

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32 Wertz speculate that the influx of immigrants from Eastern Europe resulted in the overall stigmatization of midwi fery practices. They note that few people wanted to raise Eastern European midwives to the professional trained status attained by Western European born, middle class women; had they been, they migh t have been encouraged toward professionalism. The urban The government established an American Association for the Prevention for Infant Mortality to specifically deal wi insight and testimony from state and local medical societies. In relation to how to deal with midwives, this committee established four options: immediate abolition of midwives, eventual abolition of midwives with careful regulation until doctors could replace them, education of midwives until they reached the status of Western European midwives, and, lastly, to train midwives to wash their hands and use silver nitrates to treat blindness in infants. The major ity of public health authorities did not lean towards the sought to train and license them regarded them as a temporary, though necessary, phenomenon, to be replaced eve ntually by better trained doctors who would be willing to attend the poor. The question was not whether midwives should disappear but how By the 1930s, midwifery was a disappearing practice due to restrictions which prevented the arri val of new immigrants into the United States, and successful attacks by doctors and the media. Magazines commonly spewed racial and ethnic slurs directed towards midwives and repeated horror stories about allegedly deformed babies delivered

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33 under their car generation immigrant women, now bearing children themselves, sought the services of doctors; this was considered to be an American custom. As Wertz and Wertz conclude, Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement Christa Craven describes how the eventual phasing out of midwifery practices was considered a success for white, middle c lass, affluent feminists. These women saw the move away from midwives as an improvement to maternal and infant health services. However, for rural, lower income black and immigrant women, the shift resulted in less access to community midwives, but did not expand access to clean, efficient, and non segregated hospitals (Craven 2010: 7). Craven credits the S heppard Towner Act for the eventual demise of midwifery practices. While the legislation initially intended to train midwives, it was also utilized to de ny midwives licenses and increase government surveillance, often resulting in the decision to stop practicing (2010: 37). By 1939, ha lf of all women and 75 percent of women residing in urban areas gave birth in hospitals. The 1930s also marked a period of stringent regulation for obstetrics in the United States. In the early 1930s, data on infant and maternal mortality rates in Western countries was collected for the first time Researchers found that the United States had one of the highest rates of infa nt and maternal mortality among Western nations. In 1933, the White House Conference on Child Health and Protection issued a report entitled Fetal, Newborn, and Maternal Mortality and Morbidity which explored the causal relationship between mortality rates and delivery practices. This report found that between 1915 and 1930 there was no decline in maternal mortality, despite the

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34 increase in hospital deliveries, prenatal care, and aseptic techniques. Infant mortality caused by birth had actually increased by 40 to 50 percent. The main reasons for mortality the report concluded, was that women received either inadequate or no prenatal care and excessive intervention, which was improperly performed by medical personnel (1977: 161). During this time, while phys ician attended births were on the rise, doctors and hospitals remained inadequately regulated. Most hospitals were unsanitary and bred infectious diseases, making them less safe than the home for births (1977: 161). Doctors remained primarily unsupervised. Many treatmen ts were highly experimental and, even though they sought to combat disease, some treatments, such as the excessive use of enemas and douching, actually spread illness to pregnant patients, often resulting in death. findings, the medical profession implemented better education in obstetrics, prolonging graduate study and requirements for specialization (1977: 162). Hospitals formed committees to investigate maternal deaths, holding doctors accountable. Hospitals also established hierarchical authorities, to whom personnel would refer for proper permission and clearance for certain procedures. Doctors were placed at the top of this hierarchy (1977: 164). In an effort to prevent complications during pregnancy, doctors a dopted a model that stressed efficiency and speed. One of the most prominent features of this period was Labor began in one room and delivery occurred in another. Labor and delivery were either artificially slowed or quickened. In this construction, pregnant women were treated like damaged automobiles in need of repair; the hospital was the automobile repair and

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35 maintenance shop (1977: 165). Of this occurrence, Wertz and Wert standardized, production every precaution was taken to prevent disaster when it was, in short, as carefully Between 1936 and 1955 rates of mortality dropped dramatically, mostly due to the development of antibiotics that could combat specific infections. Regardless, doctors viewed these new statistics as evidence for the necessity of hospital intervention. Each pregnant patient was still seen as a liability, necessitating approaches that stressed pruned away improper techniques and egregious incompetence, but not the philosophy that medical arts creat diminishing practice, hospitals were established as the sole efficient and safe haven for women to deliver their children. By 1940, hospital births and prenatal care were characterized as the norm. By 1970, approximately all births, in both rural and urban areas, took place in hospitals (1977: 135). The Good, the Bad, and the Ugly: The Construction of Good Mothers One of the lasting implications of the medicalization of pregnancy is the subjection of the impregnated body to the medical gaze. This resulted in the social construction of good mothers, a category dependent upon adherence and obedience to Barker classifies this phenomenon as an example of biomedicine, stemming from

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36 sought to establish a norm Barker asserts that the medicalization of pregnancy can be u nderstood as an extension of the medical gaze, a theory Michel Foucault develops In The Birth of the Clinic: An Archaeology of Medical Perceptions (1963). Foucault commonly refers to the th century. This body dualism medicine now entails and the establishment of medicine as a field of objective knowledge, two occurrences which of object, its form took on weight and solidity. No light could now dissolve them in ideal truths; but the gaze directed upon them would, in turn, awaken them and make them stand out against a background of objectivity. The gaze is no longer reductive, it is, rather, that which explains that, within the medical gaze, the object and the subject can be considered interchangeable without necessitating an alteration in objectiv ity. This conception individual (2006: xv). Foucault situates the establishment of the clinic and the formation of natural history as similar events, both dependent upon the gaze. Both the clinic and natural history operate to see, isolate features, recognize patterns and differences, and classify. Both medical experts and natural histo rians acquiesce to the gaze, which knows, decides,

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37 and ultimately governs. The clinic, however, was the first to situate this gaze as an order of science (2006: 109). Foucault also describes a few essential differences between the clinic and natural histor y and how they both utilize the gaze. For one, he argues that the medical gaze did not pertain to everyone, but solely to doctors, who experienced the power of decision and intervention while being justified by the medical institution. Another difference, Foucault asserts, is that, unlike in natural history which attempts to discern the universality within the human experience, the clinic was trained to assess color variations and tiny anomalies. The medical gaze was not bound by a narrow interpretation of structure, making it receptive to deviance (2006: 109). The medical gaze resulted in a drastic shift in how both the medical industry and pregnant women in pre medical terms o rganized her experience around the notion of pregnancy as organically difficult, in medical terms her pregnancy came to be defined medical industry and women during this time. While women were still inclined to view their pregnancies as non seek medical advice and intervention (1998: 1070). Ultimately, the medical industry prevailed. In order to establish pregnanc y as fit for the medical realm, biomedicine operated on the principle of rationalism. This entailed establishing a standard based on presumed scientific fact and the accumulation of data. Physicians created a norm and its opposing force, the abnormal, whic h legitimized diagnosis, treatment, and medical intervention

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38 criterion was based on the p pregnancy. In this biomedical intervention, bourgeois women were established as the norm through scientific models and literature. The ideal patient, and thus mother, was defined by conflating class, race, and ethnic assumptions that favored middle class women (1998: 1072). As prenatal care and hospital deliveries became pervasive in the United States, a class system pertaining to care was established. This is most evident when assessing the emergence of patient classifications, as detailed by Wertz and Wertz (1977). By the 1940s, upper and middle class women had almost universally embraced the medicalization of pregnancy. However, poor women, women of color, and immigrants were most likely to turn to midwives and inferior clinics, generally out of economic necessary (Wertz and Wertz 1977: 223). During this period doctors began classifying pregnant patients according to their economic and marital status, as well as their level of cooperation. This class ification affected the quality of medical care each woman received. As Wertz and Wertz state: This system identified women who had had repeated illegitimate births or who had disturbed routines by asking too many questions, refusing to obey orders, or mak ing too much noise. The labeling system itself encouraged a distancing of feeling and permitted the staff to express moral and social preferences for roughly and given more dru gs to quiet her down; the married woman with few

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39 women due to economic constraints, this was considered to be a moral failing on the part of the women, who did not have the best interest of their children in mind (1977: 168). and blamed for the high rates of infant and maternal mortality in the United States. Of ideology of private practice as the answer t o all health problems, these doctors did not In The Captured Womb Ann Oakley analyzes government issued reports that attempted to counter the increasing rate of maternal mortalit y and also reflected to medical intervention. In the 1930s, the Departmental Committee on Maternal Mortality and Morbidity issued a report on the increasing rate of ma ternal mobility, which instances of embolism, 2 toxemias, 3 and postpartum hemorrhage (Oakley 1984: 72). The report continued by offering suggestions to combat maternal mortality, mainly stressing the registration of midwives attending births and pervasive prenatal and postnatal exams to be conducted by doctors (1 984: 72). This report had great effects on perceptions of the pregnant woman were themselves deficient: they lacked the necessary intelligence, 2 The sudden blocking of an artery due to a blood clot ( American Heritage Medical Dictionary 2007). 3 A condition characterized by the dissemination of toxins through the blood stream. Also referred to as American Heritage Medical Dictionary 2007).

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40 foresight, education or respons ibility to see that the only proper pathway to successful The Medicalization of Pregnancy and The Mass Incarceration of Women Lingering effects of the medicalization of pregnanc y, and its implications, can be result of the medicalization of pregnancy was an establishment of doctors as scientific authorities. In relation to pregnancy, doctors were s ituated as most knowledgeable about supply factual knowledge of the effects of crack coc aine on a fetus. Medical researchers newspapers and on television programs, where they provided testimony on the detrimental effects of crack cocaine use while pregnant. In Making Women Pay: The Hidden Costs of Fetal Rights reproductive justice scholar and advocate Rachel Roth school and grow up to be less than human, wreaking havoc on As seen in the medicalization of pregnancy, doctors established a norm for pregnant women which excluded substance abusers. In 1977, the state of California brought criminal charges against Margaret Velasquez Reyes for giving bi rth to twins addicted to heroin, making her the first woman to be charged for using drugs while pregnant. Reyes was not charged for possession of a controlled substance, which was common for drug offenders, but with two counts of

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41 felony child endangerment. The appeals court dismissed the case, claiming that the child endangerment statue did not apply to unborn fetuses ( 2003: 145 ). However, this ruling set a precedent for legislation that would characterize the next four decades. At the time, there was no l egislation that specifically targeted pregnant women. It was common for attorneys to make use of existing laws to prosecute pregnant substance abusers, even when this was not their intended use. Sometimes attorneys were unsuccessful, as in the Pamela Rae S tewart case. In 1987, Stewart was charged under a she continued to abuse amphet amines even after her doctor advised her not to. In this case, the charges were dismissed when the presiding judge upheld that the 1926 statue was intended to ensure that fathers pay child support, not prosecute pregnant women who use drugs ( 2003: 143 ). In 1989, Jennifer Johnson was the first woman to be convicted of substance abuse while pregnant. Johnson was arrested in Seminole County, Florida after delivering two children while under the influence of crack cocaine. Since the Florida Legislature had alre ady determined that exposing a fetus to drugs was not child abuse, presiding prosecutor Jeff Deen found another way to prosecute Johnson. He used this case to test his theory that pregnant woman can expose a fetus to a substance through the umbilical cord it was nonetheless accepted as valid and the state of Florida convicted Johnson on two counts of distributing a drug to a minor 4 ( 2003: 160 4 In 1992, the Florida Supreme Court overturned the conviction on the basis that the law was not intended for this use (Lewin 1992).

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42 test imony of multiple physicians and medical experts. Doctors testified in order to affirm children were born under the influence of cocaine, and, most importantly, that cocaine could be passed from mother to fetus through the umbilical cord ( Jennifer C. Johnson v the State of Florida 1991: 11 ). Although many of these assessments were contradicted by other researchers and proved inconclusive, they were still regarded as e xpert advice that This case resulted in a wave of criminal charges against pregnant substance abusers in the 1990s. In the height of the crack cocaine epidemic, more and more pregnant women found themselves in court for substance a buse. Again, doctors were essential to the incarceration of pregnant substance abusers. In the Los Angeles Times Gorman describes how doctors commonly drug tested pregnant w omen who were suspected of substance abuse, generally without their consent or knowledge. Women who tested positive were subsequently arrested and their children placed in child services (Gorman 1988). Since doctors had no scientific guidelines to follow i n order to determine which pregnant women were consuming drugs, physicians used stereotypes perpetuated by the media Provider Decisions to Test for Illicit Drug Use in the Peripartum Sett Hillary Veda Kunnis, Eran Bellin, Cynthia Chazotte, and Julia Hope discovered that black women are 1.5 times more like likely to be tested for illicit drugs. Other factors included age, single marital status, lower educational status, unem ployment, and public or absent health insur ance (Kunnis, et all. 2007: 248). In the next chapter, I will address

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43

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44 Chapter Three Introduction The incarceration of pregnant substance users can be understood as an extension of societal views concerning the impoverished, particularly welfare recipients. Although black w oman were not the sole or even primary recipients of welfare, they took the brunt of its criticisms and soon came to represent all that was wrong with America. Black mothers were considered to be selfish mothers who were swindling the state in order to sup port their lavish lifestyles, at the expense of both their children and the American taxpayer. These racialized conceptions of welfare stemmed from three prominent theories of The Undeserving Poor: From the War on Poverty to the War on Welfare, Michael Katz demonstrates how e ach theory played a particularly important role in influencing 20 th theory of the culture of poverty unintentionally continued a discourse th at sought to ending on the

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45 Oscar Lewis and the Culture of Poverty Anthropologist Oscar Lewis formulated the culture of poverty theory in his 1959 ethnography Five Families: A Mexican Case Study in the Culture of Poverty Lewis documents five families, including four of lower income, in order to establish a common ists should seek to understand (1959: 1). Of this its own modalities and distinctive social and psychological consequences for its members. It seems to me that the c ulture of poverty cuts across regional, rural urban, and culture of poverty, as I will refer to it from here forward. In 1966, Lewis published La Vida: A Puerto Rican Family in the Culture of Poverty San Juan and New York in which he sought to expand on this theory. He conceptualizes the culture of poverty as an adaptation to marginalization (Lewis 1966: xliv). He defines four essential characteristics of the cultur e of poverty. The first is the lack of integration of the poor into major institutions. According to Lewis, the reason for produce very little wealth and receive very characterize this exclusion to include illiteracy, low levels of education, lack of political involvement, and failure to adhere to middle class values, such as participating in common law marriage. Lewis id entifies another characteristic of the culture of poverty as a lack of organization beyond the nuclear and extended family. This lack of organization can also

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46 entail poor housing conditions (1966: xlvi). Groupings in impoverished areas, Lewis claims, are i nformal, temporary, and often voluntary (1966: xlvi). This can come in the form of neighborhood gangs. The third major characteristic is the absence of childhood, usually due to early initiation into sex and a high incidence of abandonment by fathers, resu lting in a female or mother centered household (1966: xlvii). The last characteristic esonates among the impoverished (1966: xlvii). With this last point, Lewis situates the culture of poverty as an explanation for why poverty inflicts multiple generations of the same family. He asserts that the culture of poverty perpetuates itself through slum children are age six or seven they have usually absorbed the basic values and attitudes of their subculture and are not psychologically geared to take full advantage of changing conditions or inc xlv). Michael Katz details how the culture of poverty, unintentionally, became an extension of prevailing rhetoric that perpetuated a negative stereotype of the poor as undeserving poor, which entails the redefinition of poverty as a moral condition (Katz 1990: 14). The theory of the undeserving poor accompanied the formation of democracy and capitalism in early 19 th century America. During this time, the distinction in the United States betwee n the impotent poor, who were worthy of assistance, and the transmutation of pauperism into a moral category tarnished all the poor. Despite the effort

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47 to maintain fine distinctions, increasingly poverty itself became not the natural result of 14). In turn, this mindset justified ill treatment of the poor during industrialization. It became increasingly d ifficult to preserve moral delineations in aid and relief, so most poor suffered regardless of ability (1990: 15). In Regulating the Poor: The Functions of Public Welfare Frances Fox Piven and Richard Cloward assert that relief arrangements, which are provisions for the care of the impoverished, arose in England during the sixteenth century because of population growth and the commercialization of culture (Piven and Cloward 1993: 21). During the late eighteenth century, relief arrangements became a majo r institution as a response to mass unemployment of agricultural workers and the resulting migrations from rural to urban areas (1993: 20). The institutionalization of relief arrangements, Piven and Cloward assert, operated in order to regulate labor. For one, relief assistance is expanded during times of mass unemployment in order to restore order. Relief also operates to regulate labor for those who are not able to work. According to Piven and Cloward, the aged, disabled, and insane are treated harshly th rough these supposed relief programs in order to ensure that able bodied workers do not resort to beggary and pauperism (1993: 3). According to Piven and Cloward, the United States developed public relief at a slower rate than other Western countries, prim arily Britain. They attribute the doctrine of self help through work, which has come to characterize capitalism in the US, for the lack affluence, but independence; not ease, but a chance to work for oneself, to be self

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48 supporting, and to win esteem through hard and honest labor. The very notion of a relief relief programs into state and fe deral legislation. Piven and Cloward situate the Great Depression as the marker for the first major relief crisis in the United States. By 1935, more than 20 million people were receiving some sort of public assistance. However, Piven and Cloward assert th at drastic increase in relief assistance was not a response to economic distress, but to the political unrest that accompanied it (1993: 45). 1940s and 1950s (Katz 1990: 16). P iven and Cloward also refer to this time period as the that a similar expansion of relief programs was also observable in the 1960s through the expansion of public we urbanization of southern laborers who were displaced and unemployed by the modernization of agriculture ( 1993: 32). the culture of poverty was utilized to propagate understandings of the undeserving poor 16). By the 1970s, Katz documents, the concept had been appropr iated by conservatives wishing to further their ideology of the undeserving poor, but with a modern academic label (1990: 19). Liberals, on the other hand, utilized the culture of poverty in order to

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49 define impoverished people as passive. With this concept ion, they situated the poor as dependent upon liberal intellectuals for social uplift from degradation (1990: 23). Daniel Patrick Moynihan and the Tangle of Pathology While many facets of America experienced poverty, the War on Poverty had a specific, racialized target in mind. According to Katz, the civil rights movement of 1964 sought to situate poverty as a specific racialized occurrence in the United States (1990: 2 predominately credited to Daniel Patrick Moynihan, who published The Negro Family: The Ca se for National Action in 1965. In the highly controversial report, Moynihan is maintaining that stability. By contrast, the family structure of lower class Negroes is highly unstable, and in many urban centers is approaching complete breakdown (Moynihan 1965: 52. Emphasis in original). Moynihan attempted to explain how multiple g enerations were afflicted by poverty, similar to Lewis before him. Unlike Lewis, who credited social adaptations to poverty, Moynihan attributed continuances in poverty to the black family structure (1965: Moynihan ascribed the deterioration of the black family to the dissolving of black marriages and the prevalence of female essence, the Negro community has been forced into a matriarchal structure which,

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50 because it is so out of line with the rest of the American society, seriously retards the progress of the group as a whole, and imposes a crushing burden on the Negro male and, 5). As a result, Moynihan asserted that more black families depend on welfare and would continue to do was heavily influenced by Catholic social welfare philosophy of the time, which emphasized family interests as the central objective of social welfare and social policy (Katz 2009: 25). President Lyndon B. Johnson was highly influenced by the report, which was reflected in his anti poverty initaitives. In a commencemen t speech at Howard University, Johnson proved himself to be acutely aware of the racial aspects of poverty. many of its cures are the same. But there are differences deep corrosive, obstinate differences radiating painful roots into the community, the family, and the nature of the The War on Poverty Becomes the War on Welfare In 1964, during his State of the Union address, Johnson declar antipoverty programs, which would last until 1972. Most of these reforms had the intent of fighting poverty by expanding opportunity and empowering communities. Other

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51 programs sought to redistribute income and expand social programs, such as Social Security, Medicare, Medicaid, and Food Stamps (Katz 1990: 77). In War on Povert y Louise Lander (1967) details the legislation President Johnson initiated. She notes that these programs have five intents: give half a million underprivileged youth the opportunity to develop skills and continue education in order to find useful work; a llow communities to develop comprehensive plans to fight poverty; allow Americans to volunteer in the fight against poverty; give workers and farmers the opportunity to overcome barriers that limit them from escaping poverty; and establish an Office of Eco nomic Opportunity, which would serve as a national headquarters for the war against poverty (Lander 1967: 9 10). As an extension of this office, Johnson also proposed the Economic Opportunity Act of 1964, which was enacted in August of that year. The legis lation established a Job Corps for men and women ages 16 21, a work training program referred to as the Neighborhood Youth Corps (NYC), work study programs for college students, an Adult Basic Education program, a preschool program for low income families, commonly referred to as Head Start, and various loan programs for rural workers, the impoverished, and migrant workers (1967: 21 23). Harrington, author of The Other America: The Po verty in the United States which was describes how Catholic doctrine heavily identify as a socialist later in life. Although Harrington chose to mask the socialist aspect

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52 of The Other America in order to ma ke it more accessible, both his socialist and Catholic influences are observable. For one, Harrington draws attention to the inequalities facing the American poor, not in an attempt to spark revolution, but to convince affluent citizens to provide assistan ce. Harrington develops a binary between two opposing Americas. One is familiar, celebrated, and advertised. This America resides in the suburbs where, due to its pervasive affluence, it appears that the economic problems of the United States have all been solved (Harrington 1962:1). The other America knows better. While the familiar America strived, Harrington asserts, another America brewed underneath the surface, mostly in silence. The American poor inhabit this sphere and, according to Harrington, they are pessimistic, defeated, and victimized by mental suffering (1962: 2). Harrington unlike any preceding it, mostly because the poor have gone unnoticed. Harrington would also serve as an important influence in the war on poverty, mainly due to his harsh criticisms of existing welfare services, which he deemed to be ineffective. He was and the welfare services they relied upon. The millions of people inflicted by poverty, en the money finally trickles down, even when a school is built in a poor neighborhood, for instance, the poor are still deprived. Their entire environment, their 9).

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53 Harrington lodged harsh criticism towards in kind benefits, which the Clearinghouse on International Developments in Child, Youth, and Family Policies (Kamerman 2000). This was one of the main aspects of welfare reform. Harrington asserted that this benefit did not actually eliminate poverty. He situated the poor, not structural issues, as the underlying cause of poverty. According to his assessment, government benefits would no t eliminate poverty until the shortcomings of the poor were addressed. In Poverty and the Underclass: Changing Perceptions of the Poor in America hardships of the poor were mainly due to inadequate training and lack of marketable skills. This approach assumed that there was a direct link between wages garnered and a end of the War on Po verty, there were lasting implications, predominately the focus on the skillsets of the impoverished without addressing the structural factors of poverty. While various programs which sought to eliminate poverty were attempted, it at a drastic shift in reform became apparent. This time period is commonly credited as the catalyst for the shift from the War on Poverty to the War on Welfare, mainly attributed to the policies of Ronald Reagan, who assumed the Presidency in 1981. For yea rs leading up to his 1980 victory, Reagan popularized his views on welfare through numerous speeches and was considered a pundit for conservative reform. Reagan spread the idea that the War on Poverty was unsuccessful, a sentiment reiterated by the governm ent and some social scientists to the American public.

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54 According to Reagan, the social reforms initiated by the War on Poverty proved to be ineffective as poverty continued to rise. By most assessments, Reagan was correct the War on Poverty was considere most subsequent history, treats the War on Poverty harshly. The nation fought a war on poverty and poverty won, has become a summary judgment assented to without z 1989: 79). While these assessments are not completely accurate, 5 they did accentuate the inherent issues underlying the War on Poverty. It was rife with contradictions and, from its inception, lacked a coherent definition of poverty. Researchers working to eliminate poverty were operating under the assumption that poverty could be measured in a scientific, objective manner, but this measurement, all measures inevitably refle William Kelso attributes the demise of the war on poverty to the failure of the from the more liberal views that the poor wer e inadequately trained or were simply unable to find well paying jobs, to the more conservative spectrum that the poor were simply unmotivated (Kelso 1994: 32). A lack of consensus plagued the War on Poverty from its inception. One key criticism of the Wa 5 Acco rding to Katz, the War on Poverty deserves a more critical assessment. Although many of these who would have remained below the poverty line found medic al care, food, housing assistance, and income of this period was Operation Headstart, which is still in existence today.

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55 The irony is that misguided welfare programs instituted in the na me of compassion have actually helped turn a shrinking p roblem into a national In 1964 the famous War on Poverty was declared and a funny thing happened. Poverty, as measured by dependency, stopped shrinking and then actually began to grow worse. I guess you could say, poverty won the war. Poverty won in part because instead of helping the poor, government programs ruptured the bonds holding poor families together (American Presidency Project 1986). stressed the capabilities of the poor, often ignoring structural inequalities. In response to an economic recession, the Reagan administration unleashed attempted to reduce government spending and regulation. Welfare income tax was reduced in the belief that the wealthiest in society would create jobs and revenue. Welfa address the issue of poverty. Influenced by pseudo social scientific rhetoric of the time, Reagan cut funding for welfare recipients. One of the most prominent works to influence Pres ident Reagan was George Wealth and Poverty published in 1981. Gilder, who is not a professional social scientist, advocates for capitalism and the great wealth and inequalities it necessitates (Katz 1990: 145). In doing so, he denounces welfare p rograms in the United States, defenders of the welfare state at its current level usually seem to assume that without the public systems the sick, the poor, the elderly, and the youth would be left to their own surprisingly little beneficial effect, but they do have a dramatic negative impact on motivation and self

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56 Gilder asserts that welfare services will only perpetuate poverty as opposed to poverty if its benefits exceed prevailing wages and productivity levels in poor However, he holds welfare accountable for the disintegration of impoverished families, culminating in his desertion (1981: 114). According to Gilder, welfare actually benefits fathers w ho do not marry the mother of their children, instilling a sense of worthlessness, men are the key beneficiaries and victims of the system. Because the system exists they are not forced to marry or remain married or lean the disciplines of upward he importance of a nuclear family unit and a good work ethic as necessary to uplift the impoverished (1981: 116). This was a sentiment commonly expressed by Reagan during his presidency. In his 1986 radio address, Reagan states: Perhaps the most insidious effect of welfare is its usurpation of the role of provider. In States where payments are highest, for instance, public assistance f or a single mother can amount t o much more than the usable income of a minimum wage job. In other words, it can pay for her to quit work. Many families are eligible for substantially higher benefits when the father is not present. What must it do to a man to know that his own children will be better off if he is never legally recognized as their father? Under existing welfare r ules, a teenage girl who becomes pregnant can make herself eligible for welfare benefits that will set

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57 her up in an apartment of her own, provide medical care, and feed and clothe her. She only has to fulfill one condition not marry or identify the father (The American Presidency Project 1986). poverty but actually blamed welfare for its continuation. In doing so, rhetoric concerning welfare at this time propagated misinformation concerning the reality of welfare Another parallel between the work of Gilder and the welfare reforms implemented by Reagan is the assessment of welfare fraud, as relayed in Wealth and Poverty for multiple forms of welfare fraud, the majority of which are committed by mothers. The most obvious, but less frequent and, according to Gilder, the most reprehensible form of fraud entails mothers who are fully employed, yet collect a day care subsidy a nd a welfare check, often because of false representations (1981: 117). Most welfare frauds, Gilder asserts, are more ambiguous, such as cases where women on welfare have working husbands, even when said husband is no longer e antifraud techniques necessarily miss the welfare mothers who live and bear children of dubious cash economy of the street, or those who dabble in prostitution, sharing apartments with other welfare mothers while leaving the children with a forty five ye ar old grandmother upstairs, who is receiving payments for Reagan repeated these sentiments during almost all of his presidential primary campaign speeches throughout 1976. During one speech in New Hampshire, Re agan cards and is collecting veterans benefits on four non existing deceased husbands. And

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58 stamps and she is collecting welfare under each of her names. Her tax free cash income alone is over recipient, his assessment was mostly exaggerated. Reagan based hi s infamous trope on the story of Linda Taylor, a black woman living in Chicago who was believed to have committed welfare fraud. Her case was heavily sensationalized in the media, where she Reagan reiterated the used four aliases to collect $8,000 (1976). Regardless of the misinformation Reagan provided, the story spread and had serious implications for the welfare reform that would take place throughout the 1980s. relied on the incident in his speeches, so it appeared that it was much more common than it actually was. In Myth of the Welfare Queen image of big spending, lavish living, Cadillac driving welfare queen was by then thoroughly embedded in Ameri associating welfare recipients with swindlers, welfare programs with corruption. Even women and welfare exploitation become explicit.

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59 The Underclass and the Feminization and Racialization of Poverty Katz details the formulation of a new poverty discourse, which emerged in the mid 1980s. This new theory was conceptualized by the term underclass which referred predominately to young, black, urban individuals living in poverty (Katz 1990: 185) and to t understood as the emergence of the racialization and feminization of poverty. While the welfare recipients criticized by Gilder and Regan were mostly considered to be black, durin marked a shift in American perceptions of poverty. Affluent Americans, politicians, and some media reports were no longer sympathetic towards those living in poverty and inste undeserving of social services. t that the poor suffered from poverty because of their unwise choices. There was also an implication that the poor were scheming America, a viewpoint expressed heavily in the media. Katz it was their sexuality, expressed in teenage pregnancy; family patterns, represented by female headed households; alleged reluctance to work for low wages; welfare dependence, incorrectly believed to be a major drain on national resources; and propensity for drug use and (1990: 196).

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60 ndeserving poor. In Slick Spins and Fractured Fact: How Cultural Myths Distort the News Caryl Rivers olumnist for the Boston Herald (Rivers 1996: 199). This is evident when assessing some news paper articles of the time. Time women are having children in droves, guaranteeing their subsistenc e on welfare. They also question if welfare reform can assist these women. Gibbs and Blackman begin their piece by describing an incident in Chicago where police entered a tiny apartment to discover 19 children living in horrid conditions. Six mothers al l of whom received was a classic example of how a big hearted, deep pocketed government ends up subsidizing disaster. In all, the six mothers who lived in filth were colle cting $5,495 a month in welfare payments. The system will keep on paying such women as long as they ly 1994 issue of U.S. News and World Report Zuckerman also adopts the rhetoric of a welfare system that establishes and perpetuates dependence in its recipients, the majority of whom are single, young mothers. Zuckerman

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61 argues that the only effective welfare reform would encourage work and self sufficiency. sonal vendetta against the system is obvious. He states: Children who grow up in welfare families are many more times as likely to drop out of school, be unemployed, become addicted to drugs, end up in prison, be on welfare themselves, or to have children out of wedlock. This is no longer acceptable to a growing number of Americans. We need to change the rules for welfare and stop rewarding long term dependency, and we must start to nurture the same ethic that the rest of the country lives by -work and self sufficienc y (Zuckerman 1994: 72). These articles were widely circulated in national newspapers and perpetuated a belief in a corrupt welfare system exploited by mothers. Of these editorial pieces, but this image became one of the horror stories that would linger in the minds of people continues to detail how th ese welfare horror stories dominate the news coverage while positive images are not mentioned. According to Rivers, welfare mothers are also of poverty. In The Myth of the Welfare Queen journalist David Zucchino describes how an image of young, black, un wed mothers was cultivated as the largest drain on welfare services. Of this occurren portray out of wedlock births as a phenomenon largely confined to black teenagers in the Why Americans Hate Welfare Martin Gilen analyzes over 1,256 poverty stories featured in U.S. News and World Report Newsweek and Time all widely read and nationally circulated magazines, between 1950 and 1992.

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62 during t his time period, they were depicted in over half of all images as poor (Gilen 1999: 113). However, the equating of black people with poverty was not consistent during this time period and depended heavily on the economic and social state of the country. Gi len asserts that there are more representations of blacks affected by poverty during times of during economic recessions (1999: 122). This occurrence, according to Gil en, results in a sympathetic portrayal of white individuals affected by poverty, which is not extended to blacks (1999: 125). Black women became the primary targets of welfare reforms while black young men became the primary concern of the police resulti ng in the prison industrial complex and mass incarceration observed today (Katz 1990: 95). However, the focus on welfare were not taking advantage of the state, but also be cause black, un wed teenage mothers did not account for the majority of people on welfare. According to David Zucchino, in 1995, during the height of welfare cuts, teenage mothers only accounted for 7.6 percent of welfare recipients. Between 1960 and 1995, during the height of concern pertaining to teen pregnancy, the rate of out of wedlock teen mothers actually dropped. Also, during the 1990s white individuals were actually slightly more likely to be on welfare than their black counterparts (Zucchino 1997: s of black welfare mothers are far

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63 better predictors of their attitudes toward poverty and welfare than their perceptions of Welfare Queens and Crack Moms Two stereotypes associated with black women operated in conjunction with one another and were often equated. In Educating Drug Exposed Children: The Aftermath of the Crack Baby Crisis, Janet Y. Thomas assesses t crack abusing women. Crack mothers were considered part of the underserving poor and American taxpayer. Like the socio were portrayed as being sexually irresponsible, neglecting their children, and using government funds to su In Inventing the American Modern Family: Family Values and Social Change in 20 th Century United States contemporary historian Isabel Heinemann situates the y approximately a decade. The Heinemann asserts, already redefined conceptions of black womanhood, which was now equated with social deviance and economic exploitation of both the government and the taxpayer (Heinemann 201 2: 162). The

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64 n the incarceration of pregnant substance abusers.

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65 Chapter Four Bio Power, the Ideal Mother, and Pregnant Substance Abusers Introduction The incarceration of wome n who consume substances while pregnant is not only state. In this chapter, I will assess the establishment of pregnant substance abusers as social deviants and bad mothe rs in the face of reconceptualizations of motherhood. I will regulate the actions of all mothers. I will then assess the economic implications of incarcerating pregnant substance abusers, where the state is presumed to be intervening on behalf of the fetus due to health and moral concerns. I will argue, however, that the state is actually int incarcera ting pregnant substance abusers. Foucault, Motherhood, and the Crack Baby Epidemic power. In Discipline and Punish: the Birth of the Prison Michel Foucault develops the concept of bio power, which is now a foundational theory for understanding relations among the individual, the body, and the state. Foucault traces the historical aspects of the prison, specifically

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66 fo cusing on the emergence of discipline and its displacement of torture as the main mechanism for punishment. He asserts that this transition marks a pivotal moment in Western conceptions of rehabilitation and reform. Of biopower, Foucault argues that the bo dy was redefined through new relations of power that resulted in obedience of the body as it became more useful to those exerting power over it (Foucault 1995: 138). Discipline This would entail increasing the economic utility and political terms of obedience for body was entering a machinery of power that explores it, breaks it down a nd rearranges one wishes, but so that they may operate as one wishes, with the techn iques, the speed, and alter the indi vidual (1995: 200). The panopticon is important in assessing social regulations placed upon pregnant bodies and the establishment of substance abusers as deviant. Developed in 18 to cells. A tower is placed in the center of the structure, with windows placed in a position that corresponds with the cells on the periphery. A supervisor is then placed in the tower, in order to observe the occupants of the cell who madman, a patient, a condemned man, a worke (1995 : 200). When the structure is included in prisons, Foucault asserts, it operates to

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67 establish a state of permanent visibility that may or may not be continuous. According to Foucault, when surveillance is not necessary because the possibility of surveillance will result in self discipline, since subjected individuals would assume that they are always being watched. Foucault sta sustaining a power relation independent of the person who exercises it; in short, that the inmates should be caught up in a power situation of which they are themselves the bearers The panopticon is not limited to prison architecture, however. Although the panopticon was designed to function in a specific institution, the prison, it also has a more general use in defining power relations in everyday life (1995: 205). F oucault 205). One of the most striking aspects of the panopticon, once it has been removed from its penitentiary context and into the wider structures of society, is that it allows for those allows for a strengthening of power due to the reliance on continuous discipline and subtle regulation (1995: 207). Foucault refers to this as the emergence of the disciplinary society (1995: 209). One of the most important aspects of the disciplinary society is that legislation, which seeks to discipline subjects of the state, is not applied universally to all. In a sense, due to the implied observation of the panopticon, it does not have to be. Public torture and punishment, which Foucault states are characteristics of the 16 th and 17 th

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68 centuries, were supplanted by discipline through observation in the 18 th century, where it remained as the defining aspect of power relations (1995: 124). panopticon operated in order to dictate and regulate a ppropriate behavior for all mothers. Social controls expressed over pregnant substance abusers often stress the importance of the family unit, which is perceived to be under threat by substance use and welfare mothers, situating these women as social devia nts. As mentioned in the last chapter, biomedicine effectively established a norm for motherhood, to which pregnant substance abusers were placed in opposition. Through biopower, not adhering to social norms resulted in incarceration. However, the prison i ndustry was not the sole operator of the disciplinary society it entails, operated n actions of all mothers. Beginning in the 1980s, societal perceptions of mothers underwent a drastic change. In The Mommy Myth: The Idealization of Motherhood and How It Has Undermined Women, feminist cultural critic Susan J. Douglas and reproductive ethics expectations for American mothers. They state: norms, and practices, most frequently and powerfully represented in the media, that seem on the surface to celebrate motherhood, but which in reality promulgate standards of perception that are beyond your reach Doug las and Michaels 2004: 4). This new

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69 being (2004: 6). According to Douglas and Michaels, news reports, magazines, and television shows play a p articularly important role in establishing a norm for mother and maternal behaviors that can often override community norms (2006: 19). as Good Housekeeping and Ladies Home Jou rnal who were presumed to be rejecting intensive mothering and were seen as threats to the newly defined family structure. During the emergence of new momism, the pregnant substance abuser became an extension of the welfare queen, both situated in opposition to the intensive mothering new momism entailed. Through and the panopticon, pregnant substance abusers were not only incarcerated, but served as Of this occurrence, Douglas and Michaels state there had to be delinquents who dramatized what happened to those who failed to (2006: 177). As Douglas and Michaels assess, while w elfare mothers were situated as bad mothers were the exact opposite of the middle class, generally white mothers that new momism entailed. Crack mothers were considered to be the absolute antithesis of new

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70 they were too self centered, they were deviant, and dangerous, not only to their children The crack baby epidemic, Douglas and a divide demarcated along racial lines. The establishing of crack moms as social deviants simultaneously distinguished good moth ers from bad while stressing the importance of new momism. Crack moms served as a warning to all mothers of what could happen if new momism was not strictly Douglas an a controlling symbol; they represented both the fragility of motherhood and the family stories about the future of America, a future that was bleak, handicapped, poised on the brink of self destruction. And all because these mothers could not, or would not, control ac cording to Douglas and Michaels, in which all pregnant women were influenced to be wary of their actions. Good mothers were portrayed to act in the best interest of their children, selfish mothers to be only concerned with themselves (2006: 161). In Crac ked Coverage: Television News, the Anti Cocaine Crusade, and the Reagan Legacy journalism analysts Jimmie Reeves and Richard Campbell characterize momism can also be under family agenda, established by President Reagan. In this construction, Reeves and Campbell assert that

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71 Campbell document how the shift of crack baby coverage to specifically racialized subjects situated black mothers in opposition to good mothers and as morally inept. They 209). As a result of the crack baby epidemic, all black mothers were subsequently blamed for overpopu lation, escalating welfare costs, and the ill children (1994: 210). The Economic Implications of the Crack Baby Epidemic: Beginning in the 1980s, during the rise of the crack baby epidemic, legislators claimed that they wer e attempting to deter pregnant women from consuming substances in order to protect the unborn, innocent child. However, thinly veiled under the facade of protecting innocent lives, politicians were actually expressing concerns over the cost of : A Prolego menon to Future Work in Medical Anthropology Nancy Scheper Hughes and Margaret Lock (1987) attempt a feminist expansion of o power. Scheper Hughes and Lock also reference the work undertaken by anthropologists Mary Douglas and Leith Mullings, who both focus on historical and contemporary witch hunts. In Purity and Danger: An Analysis of Concepts of Pollution and Taboo, Dougla s explores how the body politic exerts more social control when it feels threatened, often

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72 resulting in increases in surveillance and the purging of traitors and social deviants (Douglas 1976: 115) In Therapy, Ideology, and Social Change: Mental Healing i n Urban Ghana, Mullings assesses how witch hunts can come to represent cultural expressions of distress, even when a threat is present but the true aggressor is unknown. Mullings, who conducted field work in Ghana, attributes witch hunts to social anxieties over capitalism. Witch hunts also serve as a form of resistance to eroding traditional values, which can be understood as a cause of capitalism, but are attributed to witches instead (Mullings 1984: 164). In order to evaluate the power inflicted upon preg nant and in dialogue with one another. Taken together, I argue that the state is prone to exert social control over pregnant substance abusers, who are deemed deviant, whe n it is vulnerable due to economic stress Through this occurrence, the importance of traditional values is emphasized often masking the ill effects of capitalism. In relation to the crack baby and subsequent pill baby epidemic, pregnant substance abu sers were situated as social deviants who rejected the cultural norms of new momism abusers were seen as not only narcissistic and morally inept but as economic liabilities extensively, often including the testimonies of doctors, who painted a less than ideal picture for the future of these children. It was a commonly held belief that crack babies would mature into depraved, depressive, and even violent burdens on the American people. District attorneys, who were counseled by the findings of medical experts, even to their lack of consciousness (Roth 2003: 142). In Black Women, Cultural Images, and

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73 Social Policy political analyst Julia S. Jordan Zachery details how Joseph Califano, Jr., former Secretary of Health, Education, and Welfare, publicly estimated that crack babies would cost the American public approximately $1 million apiece. Jordan Zachery states, Zachery 2009: 50). It so from various defects, and axpayers would be left to assume financial responsibility for them. During this time, legislators were not acting on behalf of the unborn child exposed to cra ck, but in fear of it. These same concerns would be expressed in the early 2000s or Flores states that children Flores 2012). Attorney General of Florida Pam Bondi actu ally tal abstinence simultaneously with economic recessions experienced in the United States. In the early 1980s, a global recession affected much of the developed world and the countries that relied on them for trade. While the United States was able to escape the recession earlier than most, the country was still plagued by mass unemployment, inflation, and drastic

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74 increases in oil prices well into the mid 1980s (Rattner 1981). In the early 2000s, the Unite d States would experience another recession, this one much more severe and continuous. Similar to the recession experienced in the 1980s, this recession is also characterized by mass unemployment. Throughout the first decade of the 2000s, more people exper ienced poverty, unemployment, and debt. The primary target of this economic recession has been the middle class. While the United States once had the largest middle class of any Western country, this demographic group, once considered a marker for social a nd economic progress, is quickly disappearing. Reporter David Case explores whether the middle class can now be considered an endangered species (Case bbs 2006). The focus on pregnant substance abusers masked the actual causes of economic recessions which were the economic and political policies of the time Instead, crack mom s were situated as presumed economic threats and became scapegoats for economi c turmoil. A focus in the media was the economic the American taxpayer, which masked the widespread poverty many Americans were experiencing. In The Culture of Poverty, Cr y assess how alterations to public policy and meanings of race are reflected in perceptions ed poverty as an outcome of a certain kind of childhood and parenting, and hence were able to discount economic, political, institutional structures as casual. Thus, these discourses

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75 work to mask the ways that the state failed to invest in working class fa milies and Implications for Reproductive Rights The incarceration of pregnant substance abusers has serious implications for reproductive rights in the United States. While controversial legi slation such as Roe v Wade has already been heavily contested, in recent years the attack on reproductive rights mocratic strategist Zerlina Maxwell documents the wave of anti abortion measures that have swept state and federal legislation since 2010. These antiabortion laws range from ultrasound bills to personhood amendments, which define life as beginning at conce ption, thus criminalizing all abortions (Maxwell 2012). However, current discussions concerning reproductive rights tend to exclude pregnant substance abusers. I will attempt to interject these women into the discussions by drawing parallels between the cr iminalization of substance abuse by pregnant women and legislative attacks on reproductive rights. In Making Women Pay: the Hidden Costs of Fetal Rights, Rachel Roth recounts the increasing levels of incarceration facing pregnant substance abusers. By 1992 the United States had more than 150 documented cases of women facing criminal charges for substance use while pregnant, predominately crack cocaine. Many faced convictions (Roth 2003: 146). In addition to possession of a controlled substance, these women were charged with delivering drugs to a minor, child abuse or neglect, cruelty to children, contributing to the delinquency of a minor, assault with a deadly weapon, and, in cases

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76 where the fetus of a known substance abuser was stillborn, manslaughter or murder ( 2003: 146 ). By 1992, approximately 33 states and the District of Columbia had passed statues specifically criminalizing substance use by pregnant woman ( 2003: 162 ). The majority refer women to rehabilitative and education services. However, a grow ing minority of states now characterize pregnant substance use as child abuse or neglect and, thus, a criminal act. In these instances women are tried and, if found guilty, remanded to corrective facilities where rehabilitative services are often not avail able or are not up to par (2003: 172). The majority of these laws rely on an understanding of the fetus as a living, biological entity. The statutes are commonly referred to as the fetal vs. maternal rights debate, in which the fetus is situated as a pers on with rights that should be protected, often at the expense of the mother. The establishing of a fetus as a person has serious implications for reproductive rights in the United States. Of the crack baby epidemic, Jimmie Reeves and Richard Campbell state reduced to her reproductive identity. In this reduction, the media construction of this she devil would animate a complex set of meanings that often dovetailed what the fetal rights rhetoric of the antiabortion move In The Mother of All Crimes: Human Rights, Criminalization, and the Child Born Alive rule 6 on pregnant women in the United States and the United Kingdom. According to that allows for various criminal charges, specifically manslaughter and homicide, to 6 The born alive rule is a common legal practice that allows for various criminal charges, specifically manslaughter and homicide, to apply only to a fetus that is born alive. While its use is heavily contested d in 22 states (US Legal).

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77 apply onl y to a fetus that is born alive. While its use is heavily contested and varies from State v. Lamy 158 N.H. 511 ). Cave analyzes the various ways the born alive rule has been interprete d by both U.S. and British legislators. This rule has commonly been referenced when assessing criminal acts perpetrated by a third party, or someone other than the pregnant woman. In recent years, however, the born alive rule has been expanded to encompass women who cause injury to a fetus while pregnant. In this interpretation, whether the fetus is then born alive is irrelevant for the purposes of the state law, the fetus is defined as a person (Cave 2004: 42). This definition of personhood is evident wh en assessing the Chemical Endangerment Law ( Code of Ala. § 26 15 3.2 ) which was passed in the state of Alabama in 2006. The law makes it a Class C felony 7 to administer or expose a child to a controlled substance. The law reads as follows: (a) A responsib le person commits the crime of chemical endangerment of exposing a child to an environment in which he or she does any of the following: (1) Knowingly, recklessly, or intentionally causes or permits a child to be exposed to, to ingest or inhale, or to have contact with a controlled substance, chemical substance, or drug paraphernalia as defined in Section 13A 12 260. A violation under this subdivision is a Class C felony. (2) Violates subdivision (1) and a child suffers serious physical injury by exposure t o, ingestion of, inhalation of, or contact with a controlled substance, chemical substance, or drug paraphernalia. A violation under this subdivision is a Class B felony. (3) Violates subdivision (1) and the exposure, ingestion, inhalation, or contact resu lts in the death of the child. A violation under this subdivision is a Class A felony. 7 A felony warranting more than ten years but less than twenty five ( 18 USC § 3559 Sentencing Classification of Offenses)

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78 (b) The court shall impose punishment pursuant to this section rather than imposing punishment authorized under any other provision of law, unless another provision of l aw provides for a greater penalty or a longer term of imprisonment. (c) It is an affirmative defense to a violation of this section that the controlled substance was provided by lawful prescription for the child, and that it was administered to the child i n accordance with the prescription instructions provided with the controlled substance. The law was originally designed to protect children from potentially explosive meth labs. In the article published on the New York Times website Criminaliza Ada Calhoun explains that, while the law does not specifically address pregnant individuals who consume substances, it has primarily been used to imprison pregnant substance abusers. Since its inception, the law has been invoked to co nvict approximately 60 pregnant women, and it has been heavily challenged by groups including Planned Parenthood, the ACLU, and the American Congress of Obstetricians and Gynecologists ( Calhoun 2012 ). These advocates have challenged the use of the chemical endangerment law on the grounds that it unjustly targets pregnant women (2012) Calhoun interviews Emma Ketteringham, the director of legal advocacy at the National Advocates for Pregnant Women, who argues that this law establishes a dangerous precedent. As Calhoun explains, She [Ketteringham] endangerment law effect, endangerment law, pregnant women have rights to equal protection under the law (Calhoun 2012 ) On January 14, 2013, the Alabama Supreme Court ruled in favor of current uses of the

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79 chemical endangerment law, pertains to a fetu s (re: Amanda Helene Borden Kimbro ugh v State of Alabama 2013 : 54 55 ). Conclusion The crack baby epidemic culminated in the prosecution of pregnant substance abusers. Although crack cocaine is no longer the central focus, the same approaches can be observed when assessing pregnant women who consume other controlled substances such as prescription pills and methadone. In the concluding chapter, I will discuss the alternative to imprisonment, and discuss the role of anthropology in social justice for incarcerated women.

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80 Conclusion feature in the media since the mid 1990s. However, medical researchers continue to focus on the long term effects of crack cocaine use by pregnant women. The findings have con generation of children with vast health and mental detriments, was quite exaggerated. Even more alarming, medical researchers and social scientists have discovered that the concerning pregnant substance abusers were never corrected or refuted. Only recently ha On January 26 th 2009 the New York Times published an article online entitled concluding that contrary to popular belief held in the 1980s and 1990s, there was no researchers were certain that fetuses exposed to crack cocaine would suffer from long term, significant, and det rimental effects. The anticipated result of the crack baby epidemic, Okie states, was a generation of severely damaged children. The actual result, however, was much different. Researchers who have been following children exposed to crack cocaine in the wo mb have found that the long term effects are relatively small. These studies have concluded that, while using crack cocaine while pregnant is undoubtedly harmful, the expected results were heavily dramatized. While cocaine

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81 initially slows fetal growth, chi ldren exposed to the drug in the womb have been able to grow in both brain and body and eventually normalize in size (Okie 2009). The effects of crack cocaine, scientists have discovered, are actually less severe than alcohol or tobacco, which are more com monly used by pregnant women. The same sentiment was expressed by Craig Reinarman and Harry Levine in Crack in the Rearview Mirror : Deconstructing Drug War Mythology and all of the detrimental heal th implications attributed to prenatal exposure to crack was based on unverified data and incomplete research (Reinarman and Levine 2004: 192). Reinarman and Levine assert that the commonly held belief about the damage done by crack use in utero being ir reversible is babies were going to incur over their lifetimes quietly slipped out of use, with nary a incarcerated and lost custody of their children, and many children found themselves in foster homes. Whi le it is hard to fault medical researchers for a seemingly obvious assessment that crack cocaine is damaging to a fetus, medical researchers and the media outlets that disseminated their findings were not basing their reports on science, but on social beli epidemic as a moral issue, not a health issue In recent years, she discovered that the long term effects of crack cocaine were subtle and hard to generalize (Okie 2009). Mark Lester, professor of pediatrics and psychiatry at Robert Wood Johnson Medical School, also discovered that it

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82 is difficult to discern between the effects of crack cocaine and the effects of poverty and parenting practices (Okie 2009). d Differences ce abusers in Addicted Babies: en are situated as criminals while their unborn children are seen as innocents, subjected to the ve detrimental, long lasting health effects. Also, s prescription pills and methamphetamine even though there is a lack of conclusive evidence. In an art icle published on the USA Today website entitled Leinwand Leger speculates that the number of children born with NAS has quadrupled. However, in this same article, Leger also states that national data is not available and that

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83 even most state data is unreliable since they have not yet started collecting quantifiable is derived from inconclusive or incomplete data. ba ace. While the statistics on the number of women incarcerated for pill use while pregnant have not been reported on just yet, numerous articles have portrayed these women as white. In an article published on the Huffington Post website entitled awal Ignores These infants have been characterized as the 21s t epidemic, which swept the country at the height of the war on drugs. But many contend that comparison is irresponsible because it ignores the racialized and pejorative rhetoric of that era, specifically the inherent implication that the term refers to a black baby ). However, this does not mean that biopower does not operate in the same way for on a specific conception of motherhood, which favors some women and at the expense of others. For one, prescription pill addiction and methadone use, which are encompassed in class, lower income white individuals. On March 19 th 2012 the first report was published studying the outcome of children exposed to meth in the womb. In an article on the report published online, states

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84 that this report discovered that a fetus exposed to meth is most likely to live in a Special Considerations of Women Prisoners Drug use by pregnant women is an unsettling occurrence that should be stopped in order to ensure the safety of the mother and t he unborn child. However, legislation targeting these women do es not curtail drug use and often do es more harm than good. Punishing women for drug use while pregnant ignores the oppression and abuse that can a ffect them Legislation targeting prenatal drug use ignores and negates the importance of establishing drug treatment facilities or pro viding proper services for women, who are often the victims of abuse and mental illness. In 1996, Steve n Donziger published The Real War on Crime: The Report of the Na tional Criminal Justice Commission in which he ascertained that the majority of incarcerated women had a history of abuse, mental disorders, and difficult childhoods (Donziger 1996: 150) b e understood as mutually dependent factors. According to Golden, multiple studies have discovered a correlation between abuse, which often results in post traumatic stress disorder, and a reliance on drugs (Golden 1996: 6). Donziger also claims more than h alf of all female inmates were victimized by physical abuse and a third by sexual abus e. Twenty mental illness. Approximately a quarter of all incarcerated women have also attempted

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85 suicide (Donziger 1996: 150). A report by the Center F or Reproductive Rights, tive responses to prenatal drug use deterred pregnant women from seeking tr eatment for drug addiction. In some cases, pregnant women have evaded health care professionals and even delivered their children at home in order to avoid drug screenings, which wo uld res ult in their prosecution (Center For Reproductive Rights 2000). Often, women who do utilize hospitals during their pregnancies end up in jail through drug screenings that target them. While in jail, they are separated from their children and do not receive the services they need, such as drug rehabilitation. Multiple forms of systematic oppression hav e also operated to incarcerate and further stigmatize women, especially mothers. Obstructions to education, a lack of employment opportunities, and cuts in s ocial welfare programs have affected the welfare of women who are subjected to poverty. As Renny Golden states, Indeed, drug relapse is up, and not the unrelenting social obstacles she faces due to a lack of opportunities to receive a living wage, child care, decent housing, health care, decent schools for her children, and access to drug rehab programs ( Golden 2006: 6) In Meeting the Mental Health Needs of Female Juvenile Offenders: Where Are We Now, and Where Do We Go From Here?" criminologist Rebecca Boyd identifies six barriers w omen face in obtaining mental health resources specifically as juveniles These barriers, which Boyd co nsiders to be systemic, include resources such as a lack of availability and inadequacy of female fa cilities, staffing, and funding. M ental health

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86 screenin g, assessment and diagnosis are not gender responsive, heavy caseload management prevents quality att ention for the individual, programming and treatment, education and training, and justice system culture are not responsive ( Boyd 2009: 10 13). These barriers, Boyd assert s are significant in limiting the establishment, availability and effectiveness of f emale oriented mental health services (2009: 10). As a result, many women, even as juveniles, enter into the criminal justice system w ith severe mental health issues but with no programs that address these issues. Alternatives to Prison As I have argued, the prison industry does not properly address the specific dilemmas facing women substance abusers. I advocate for a new understanding of substance abuse, which situates addiction as an illness, not as a moral failing, and accounts for the numerous factor s that can result in addiction. However, few alternatives are available for pregnant substance abusers. While ways to address this issue have been heavily debated and contested, there is no clear consensus on the best option. I advocate for more gender spe cific treatment centers that are easily accessible. Throughout my research, I have encountered multiple stories of women who wanted desperately to receive treatment for their addictions, yet there were no options available for them, mostly due to a lack of funding. I do not believe that treatment facilities should be mandatory, however, for this can result in fear for many women who would otherwise seek help, but on their own terms.

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87 What Anthropology Can Do I strongly believe that anthropologists are in a privileged position to give voice to imprisoned populations, due to the emphasis on fieldwork. One of the most profound ethnographic works on women suffering from substance abuse and poverty is Love, Sorrow, and Rage: Destitute Women in a Manhattan Reside nce by Alisse Waterston can be applied to the theoretical argument I have formulated so far. The plight of destitute women, suffering from drug addictions and illness and living in crime ridden areas, is a well known yet highly misunderstood concept. In Love, Sorrow, and Rage, Waterston attempts to dispel some of these misconceptions by telling the stories of those who are appear in newspaper article after newspaper article. Waterston conducted two years of ethnographic fieldwork at the Woodhouse, a facility in New York City that proves services for impoverished women. to offer intimate portraits of the women and to reflect on political and economic processes that contextualize the lives of the women and the institution in which they Love, Sorrow and Rage Waterston details the difficulties social scientists might encounter in the field when working with those effected by poverty, mental illness, disease, and substance abuse Although anthropologists are faced with personal and professional limitations, Waterston asserts that this type of fieldwork is not ineffectual. Waterston recounts the story of in the

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88 field. According to Waterston, her research did not help Nora through AIDS prevention, that as social scientists our most important role is to confront power and explain the deep first place: poverty and structural inequality, the lack of affordable and adequate housing, limited access to preventive health and mental health care, the consequences of institutionalized care, and, on an individual level, the deepest psychological aspects of fieldwork allows for the invisible to become invisible w hile also highlighting systematic oppression and relations of power (2011: 69). critically exa shifts in drug use, such as cocaine to crack, and associated patterns, such as setting and consum ption (Carlson et al 2009: 60). Carlson, Singer, Stephens, and Sterk also pay particular attention to the methodology of anthropology and the important insights it can ethnographic researchers endeavor to present an ac curate and detailed description of how people who use drugs view their drug use and related behaviors, their lives in genera also conclude that ethnographers should pay special attention to ethics due to the nature of their work, which entails conducting interviews in settings that are comfortable for informants and reflexivity (2009: 62).

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89 In this thesis, I have attempted to draw attention the criminalization of a marginalized group pregnant substance abus ers. I advocate for more ethnographic work, which documents the lives, stories, and special considerations of all incarcerated women. Such ethnographies should also uncover the vast interconnected forms of domination, power, and systemic oppression that op erate in the daily lives of individuals today.

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