The medical and lay press have lately written extensively
about drug use by pregnant women. Evidence suggests a
significant increase in maternal drug use during pregnancy
during this decade. In New York City, for example, the
proportion of birth certificates indicating maternal illicit
substance use tripled between 1981 and 1987.* Prevalence
data indicate that, at least in certain hospitals, many women
have used illicit drugs within hours of delivery. Anonymous
urine toxicology surveys of women in labor and of neonates
in several New York City inner-city hospitals revealed
11-20 percent positive for illicit drugs (mostly cocaine/
crack).l'**, *** The medical consequences for mother and
infant can be severe. In addition to the well-known roster of
ills related to intravenous administration such as hepatitis B,
endocarditis, abcesses, etc., illicit drugs have become increasingly
associated with sexually transmitted diseases2,3
and AIDS.4 The sequelae for infants can include abstinence
symptoms, low birthweight, developmental problems, and
increased risk of infant death.5.6
Society has responded to this problem in three different
ways: criminal prosecution of the mother; allegations of child
neglect against the mother with interruption of maternal
custody; and drug treatment. The purpose of this article is to
explore each of these policy approaches in an effort to
ascertain whether each furthers the goal of reducing drug use
during pregnancy and improving maternal and infant health
and well-being.