As legislators at statehouses across the country ponder laws that criminalize or civilly punish drug use by pregnant women, researchers in Arkansas have evaluated the working of a similar law there -- and found it wanting. Meanwhile, bills are pending in at least five states -- Idaho, South Carolina, South Dakota, Virginia, and Wyoming -- that would do the same thing. Proponents of such laws portray them as aimed at "saving the children," but critics argue such laws do little for children and are really aimed at controlling drug use by punishing young, poor, and minority women.
In 2005, Arkansas legislators passed a bill popularly known as Garrett's Law, after a baby supposedly born with methamphetamine in his system. [Editor's Note: Be wary of any law named after a victim; they seem to pass easily in a rush of emotion with science and reason brushed aside.] Under Garrett's Law, the mothers of newborn infants who test positive for illegal drugs are presumed to be guilty of parental neglect under the state's civil code, and medical personnel can report them to police and child protective service workers.
Last fall, at the request of policy analysts studying the law, the Arkansas Department of Health and Human Services, Division of Children and Family Services commissioned a report on how the law had been implemented and what its impact had been. Among that report's key findings:
- There were 412 referrals under Garrett's Law in the 12-month period examined. With some 38,405 births recorded during that period, Garrett's Law referrals amounted to a rate of 10.7 per every thousand births.
- Marijuana was by far the most commonly found drug, mentioned in just over half of all cases, while amphetamines and cocaine were found in about 25% of cases and heroin, barbiturates, or prescription drugs were found in about 7% of cases.
- In two-thirds of cases, "no health problems" were reported in the infants. On the other extreme, eight infants died, but there is no evidence that the mother's drug use was the cause of death. Marijuana was most likely to be associated with no health problems, while health problems were more likely to be associated with stimulant use by the mother. Instances of death appear to be most commonly associated with barbiturate use.
- A finding of child neglect was found to be "substantiated" in two-thirds of all cases referred and a Protective Services case was formally opened in 62% of all cases.
- Slightly less than one-fourth (23%) of children involved with referrals were removed from the family home. The drug most associated with removal of children was cocaine, followed closely by amphetamines.
- Only 5% of children removed from parents received any medical treatment related to the alleged maltreatment, although the report says it does not have complete numbers.
- Either 6.6% or 20% of mothers reported received drug treatment. Again, the report complains of sloppy reporting and does not resolve the different figures.
- Some 64% of mothers reported received some sort of "service," but in most cases that "service" was only drug testing.
"This report basically says there is nothing in the data that supports the notion these kids have health problems," said Lynn Paltrow, executive director of National Advocates for Pregnant Women. "This law is not about children's health, but has everything to do with controlling drug use in certain populations. They say people who use drugs are bad parents, but I say show me some evidence-based research that documents the extent to which drug use and parenting ability are truly associated," she said. "You have 72 million people admitting to having used marijuana -- are they all bad parents?" Paltrow continued.
While some analysts supported the law because of the broad goals of protecting the health and welfare of infants and their mothers it is supposed to advance, even they had serious concerns about its impact. "While it is critically important that women who are pregnant and giving birth and have an illegal drug in their system need to be looked at closely -- it is an indicator that something is going on -- there are several problems with Garrett's Law," said Paul Kelly, senior policy analyst for Arkansas Advocates for Children and Families, who sits on the Garrett's Law advisory group. "One thing we have found is that there are a lot of women who are not being tested. That means we are relying on the judgment of the attending physician to decide who is and is not being tested."
Kelly raises an interesting question about who is being subjected to the law. The report on the law's working does not provide a race and class breakdown of who is being reported, although that information is presumably readily available. The report does provide a breakdown by age, and not surprisingly, most of the women reported under the law were in their twenties.
"Another problem with the law is that in many cases, the finding of substance use is the sole cause of the finding of mistreatment," Kelly continued. "They may have other children who are doing well, are well-cared for, doing well in school, yet they may be taken from their mother because of substance use without any consideration of other factors involved."
The report's low figures on treatment for women in the report -- either 6.6% or 20%--also raise concerns. "There is a terrible lack of treatment available to these women," said Kelly. "We take their children away from them, yet we are not providing appropriate treatment. Are we here to help or punish? This law has had some consequences that need to be corrected."
An effort to do just that is just getting under way early in the legislative season. "We're in the middle of trying to revise Garrett's Law to make it a little less punitive and more family-friendly," said Cynthia Crone, executive director of the Arkansas Center for Addictions Research, Education and Services (Arkansas CARES), which, among other things, runs the state's largest treatment program specifically aimed at mothers suffering from substance abuse.
Advocates are in the final stages of drafting reform language and now have a sponsor in the statehouse, Kelly said. "There are several things we are looking at. We don't want the fact that an illegal substance was found in the child's body at birth to be the sole determinant of whether there is child abuse going on," he said. "If the only finding is that these women have drugs in their system, they should not be placed on the child abuse registry, but given the opportunity to seek treatment. We don't want to ruin their ability to care for their children and have gainful employment because of making foolish mistakes."
"This report doesn't find a strong association between any kind of prenatal exposure to drug use and health problems in the infant," said Paltrow. "For legislators to focus on maternal drug use as the primary threat to children's health when there are eight million children without health insurance is absurd. If we focus on things like this, it distracts our attention from much larger issues, like the 46 million uninsured, the lack of treatment, no paid maternity leave, those fundamental problems. They say it's about the kids, but the result is not more funding or treatment; instead, we're out arresting mothers."