This paper examines gender issues that arose when California created and passed a law related to substance-exposed infants in 1990. The law, explained in some detail below, intended to clarify whether prenatal alcohol and drug use was a reportable form of child abuse. Putting maternal substance use in context, it is important to note that there is a long historical tradition of a double standard that condemns women for drinking publicly or drinking to excess even on occasion, as men are generally permitted to do (Ettore, 1992; Morgan, 1987; Sandmeier, 1980). There is a similarly strong prohibition against female drug use, which contrasts with a certain tolerance for youthful male experimentation. It should be recalled that in the early years of cigarettes, smoking by women was frowned upon. Public (e.g., barroom) or heavy drinking by women has long been associated in traditional cultural discourse with female immorality. This gender-specific immorality, and hence the condemnation of heavy female drinking per se, typically revolves around sexual misconduct. These stereotypes are exemplified by the focus on "promiscuity" in early research on alcoholic women (Ridlon, 1988) and in research focusing on drug use and sexuality (Inciardi et al., 1993).
Hence heavy or public drinking or drug use has been severely stigmatizing for women and has been indirectly but indelibly associated with maternal unfitness. Women's maternal role, in fact, has long been central to research on women's drinking and drug-taking (Fillmore, 1984; Gomberg, 1979; Rosenbaum, 1981). Likewise there is a history of public concern with the health of pregnant women as it might affect their offspring, dating back to the decision to uphold protective labor legislation in Muller v Oregon in 1907 (Paltrow, 1990). This linkage can occur even in the absence of evidence of any direct impact of a woman's drinking or drug-taking on her actual performance of parental responsibilities such as nurturing, housekeeping, economic support, discipline, and so forth. Thus it is often difficult to disentangle concerns with actual maternal irresponsibility from moral judgments about a mother's visibly drinking or taking drugs at all.
Background: pressures to respond
In the mid to late 1980s, perinatal substance use in the U.S. came to be defined as a major concern in association with several perceived trends and shaped by diverse interests groups: scientific research on the health consequences of prenatal maternal substance use for the fetus; social welfare concerns for the psychosocial impact of maternal substance abuse on the child; and public institutions that were experiencing the fiscal and organizational effects of a growth in perinatal substance use. Media publicity generated political pressure to act, and interventions were developed to reach pregnant women and delivering mothers. Consequently substance-- exposed infants became the subject of countless legislative hearings and speeches, as well as of new laws and policies. Law and policy formulation was complicated by the linkage of this social problem to other complex social and political issues such as the war on drugs in relation to crack cocaine, heightened attention to child abuse in general, and the abortion debate and its significance to the reproductive rights of women (Larson, 1991 ).
Consequences of prenatal maternal substance use for the fetus
Concern over the possible physiological and developmental effects on infants of prenatal maternal substance use was first sparked by clinical research that identified fetal alcohol syndrome (FAS) (Jones and Smith, 1973). For a limited number of newborns, apparently mostly limited to those born to chronic heavy drinkers, FAS is shown to consist of severe irreversible, lifelong effects. Large prospective studies have found statistical associations between low to moderate levels of prenatal alcohol exposure and outcomes on a variety of educational, behavioral and psychological tests (Institute of Medicine, 1996). …