Gender Issues in California's Perinatal Substance Abuse Policy
Noble, Amanda, Klein, Dorie, Zahnd, Elaine, Holtby, Sue, Contemporary Drug Problems
This article examines gender issues that arose when California created and passed a law related to substance-exposed infants in 1990. The law intended to clarify whether prenatal alcohol and drug use was a reportable form of child abuse. The authors conducted 32 interviews with those who created the law and those who implemented part of the law, creating a model protocol. The authors also collected documents related to the overall project, such as the final report, the model protocol itself and comments on a draft protocol, and minutes of meetings. Three gender issues arose in interviews with the law's framers and the protocol developers. First, the discourse about the law and the process of the law's creation was a divisive one. Members took sides as being either "pro-woman" or "pro-child. " These positions were also respectively aligned with a further division: one was either "protreatment" or "pro-protection." Second, there were issues related to drug testing and the purposes of such testing. Drug test results were, and continue to be, turned over to child welfare agencies when women are reported as suspected child abusers, and interviewees expressed concerns about gender equity and women's rights. Finally, fathers were noticeably absent from policy discussion and policy-related documents.
KEY WORDS AND PHRASES: Substance abuse, perinatal substance abuse, drug abuse, child abuse, feminism.
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. …