Crack Babies: The Worst Threat is Mom Herself
By Douglas J. Besharov
This article originally appeared in The Washington Post, August 6, 1989.
LAST WEEK in this city, Greater Southeast Community Hospital
released a 7-week-old baby to her homeless, drug-addicted mother even though the
child was at severe risk of pulmonary arrest. The hospital's explanation:
"Because [the mother] demanded that the baby be released."
The hospital provided the mother with an apnea monitor to warn her
if the baby stopped breathing while asleep, and trained her in CPR. But on the
very first night, the mother went out drinking and left the child at a friend's
house -- without the monitor. Within seven hours, the baby was dead. Like Dooney
Waters, the 6-year-old living in his mother's drug den, whose shocking story was
reported in The Washington Post last week, this child was all but abandoned by
Why aren't we protecting 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 what must be done -- now -- to protect these children.
The first thing to understand in this debate is that crack is
uniquely dangerous. Other drugs have plagued our society since the 1960s, but
cocaine, and especially its derivative, crack, poses a threat to many more young
children -- because mothers use it. According to Dr. David Bateman, director of
perinatology at New York's Harlem Hospital, "Heroin was a man's drug and we just
didn't see as much of it in pregnant women. Many more women are on crack than
ever were on heroin."
Almost 20 years ago, as director of the New York State Assembly
Select Committee on Child Abuse, I studied heroin-withdrawal babies in New York
City. Nothing I learned then prepared me for the devastating damage cocaine is
doing to children.
Cocaine is very harmful to the fetus. Some infants are born with
deformed hearts, lungs, digestive systems or limbs; others suffer what amounts
to a disabling stroke while in the womb. The problem isn't of intractable
proportions: The most widely cited estimate -- up to 375,000 fetally exposed
babies (or "crack-babies") born per year -- is much too high. A more realistic
estimate is 30,000 to 50,000. But the incidence is rising in cities, suburbs and
even rural areas. In New York City, for example, there are about 7,000 such
births each year. In the District, about 1,500.
Crack is a mean drug that can induce parents to neglect and even
violence. "These mothers don't care about their babies and they don't care about
themselves," says Dr. Jing Ja Yoon, chief of neonatology at Bronx Lebanon
Hospital. "Crack is destroying people -- I've never seen mothers like this
before. Children aren't being fed. Mothers sell their food stamps. Young women
sell their bodies, and that's done in front of the children. Even when heroin
was at its worst, it wasn't like this."
Older children are often battered by their crack-crazed parents.
In one highly publicized case, a 5-year-old girl was found dead in her parents'
apartment with a broken neck, broken arm, large circular welts on her buttocks,
and cuts and bruises on her mouth. Her 9-year-old brother was found the next day
huddled in a closet. Both his legs were fractured; he had eight other broken
bones, and bruises covered his body. Less dramatic, but still hideous cases are
far from uncommon.
Cases like these lead to proposals to expand treatment services
for crack-addicted mothers. But at least for now, such services would probably
make little difference. Crack addicts typically show little or no interest in
prenatal care and are unlikely to seek it until very late in their pregnancy, if
ever. Often they present themselves at the hospital only in time to give birth.
Some new mothers abandon their sick babies in the hospital -- not returning,
even if the infant dies, to help bury it.
In fact, according to Dr. Elizabeth Brown of Boston City Hospital,
"It is not extraordinary for a woman, bored and uncomfortable, to take crack
purposely to induce labor."
Similarly, an expansion of drug-treatment services for women is
long overdue but unlikely to produce quick or substantial results. Years of
effort have yielded no widely applicable therapeutic program for treating heroin
addicts. "Crack is new enough that no one has yet figured out an effective
treatment," according to Peter Reuter, a Rand Corp. expert on drugs.
The other popularly debated alternative -- "getting tough" with
crack mothers -- is equally unpromising. True, in the past few months there have
been a number of criminal prosecutions of mothers: In Illinois a jury refused to
convict a mother whose daughter died of fetal exposure to cocaine, and two weeks
ago, a Florida mother was convicted of delivering cocaine to her baby through
the umbilical cord. In addition, some have suggested that pregnant drug addicts
be placed in custody to make sure that they stop using drugs. D.C. Judge Peter
Wolf, for example, ordered a pregnant woman to remain in jail until she
delivered her baby after she tested positive for cocaine use while awaiting
trial on theft charges.
But there are not enough prison cells for serious criminals, and
what new ones are built will not go to drug mothers. Moreover, there is a real
danger that, faced with the possibility of incarceration, many pregnant women
will not come in for prenatal care. In any event, this approach provides no
protection for the child once born, since its mother is only too likely to
return to her addiction when released.
If neither punishment nor treatment for mothers is likely to
improve things for the children of drug addicts, what can be done?
One obvious step is for government and community leaders to expand
their currently impoverished efforts to get out the message that drugs and
parenthood do not mix. Hard as it may be to imagine, some young mothers do not
believe that crack is bad for their babies. In this crisis, public-service ads
that use such euphemisms as "Beautiful Babies: Right From the Start" are no
longer enough. The message needs to be blunt: "Using drugs while pregnant is
wrong. It cripples and sometimes kills babies."
But sterner measures are also needed. To start with, hospitals
should be given the legal power to care for drug babies until they are medically
ready for discharge. About half the states have laws that allow hospitals to
hold endangered children against parental wishes. These laws protect children
when there is no time to apply for a court order or obtain police assistance.
All states should have them.
Recent amendments to the federal Medicaid program guarantee that
hospitals will be reimbursed for the added and sometimes extraordinary costs of
caring for these children. But word has been slow to get out and many
cost-conscious hospital administrators have been releasing children before they
are medically ready for discharge. Again, an educational effort is needed.
Public authorities must also face up to the fact that concern must
not stop with a hospital discharge. The simple truth is that children should not
be left with drug-addicted parents who cannot or will not care for them. Most
children of addicts -- even those living in dreadful conditions like Dooney's --
are allowed by public authorities to remain at home where they suffer serious
abuse and neglect. In 1987, of New York's child-abuse fatalities involving
children previously known to the authorities, two-thirds were drug-related.
What's going on? Why don't judges and caseworkers remove more of these obviously
endangered children from the custody of their drug-addicted parents?
Part of the problem is money. Foster care, especially for children
who often need special treatment, is expensive -- depending on the child's
condition, from $ 5,000 to $ 20,000. The District, for example, seems determined
to save money by ignoring the plight of these children. Recently, nurses at D.C.
Children's Hospital notified the District's Department of Human Services each of
the two times that a 1-year-old child was sent home after testing positive for
PCP, and both times he was returned to the hospital with a higher level of
drugs. Typically, the District's child protective agency will not become
involved unless the mother abandons her newborn.
Another problem concerns attitudes. Permeating all child-welfare
decisions are deeply felt -- but unrealistic -- social attitudes about the
importance of preserving families. In recent years, much has been learned about
diagnosing and treating abusive and neglectful parents; programs in all parts of
the nation are helping parents to take better care of their children, thus
avoiding the need for foster-care placement. So it is natural to believe that
these addicted mothers can be helped.
Reflecting attitudes of society at large, judges and caseworkers
are unable to accept the realities of addiction. Instead, they convince
themselves that, somehow, this parent will make it. Thus, any sign of
improvement in the mother's functioning is seen as an indication that the child
can be left at home or returned, even though there is no reason to think that
her drug problem has been licked.
One repeatedly sees admirable -- but misplaced -- efforts to give
parents chance after chance to turn their lives around. Four months after one
infant was discharged from a six-month foster-care placement and returned to her
mother and grandmother, she was found to have serious burns on her back,
possibly made by an iron. The child was immediately returned to foster care.
Subsequently, the mother admitted using crack to her social worker, and six
months later, despite being enrolled in a drug treatment program, she gave birth
to a baby with cocaine symptoms. Yet the agency's goal is still to return the
older child, now almost 3 years old, as well as the newborn, to their
We must face the implications of the mother's addiction -- and our
inability to break her habit. If parents cannot care for their children, the
children should be removed from their care. This may require the overhaul of
federal foster-care and adoption laws which have been wrongly interpreted to
preclude early removal of these children.
Adoption should be a real option for children whose parents show
little prospect for improvement even though this means terminating parental
rights. Drug children should not be allowed to get lost in a foster-care limbo,
as is now so frequently the case. Courts and agencies are notoriously unwilling
to free children for adoption. One crack baby's father had served four months in
jail for killing the boy's baby sister six months earlier. The mother, who was
frequently beaten by her husband, was in touch with the foster-care agency only
sporadically. In early 1987 she gave birth to another cocaine-exposed child. Now
more than 3 years old, he still lives in a temporary foster home. Nationwide,
fewer than 10 percent of the children in foster care are freed for adoption.
To make the termination of parental rights easier, the D.C.
Mayor's Advisory Board on Maternal and Infant Health has proposed to reduce the
"complexities" of the District's adoption procedures. The issue runs deeper,
though. Laws and attitudes must also change. No one likes to give up on parents,
to label them as "hopeless," especially since many are themselves victims of
broader social problems. But their children deserve a chance -- even if we must
assume long-term responsibility for their care and upbringing.
These are not total solutions -- but they would do more to protect
the children of addicts than wishful thinking about drug treatment or arguments
about criminal prosecution. Each day that we fail to take decisive action means
suffering, even death, for thousands of children.
Meredith Moore and Vincent Cannato helped prepare this article.
Douglas Besharov, resident scholar at the American Enterprise
Institute, was the first director of the National Center on Child Abuse and
Neglect. His book, "Recognizing Child Abuse and Neglect," will be published by
the Free Press this winter.
(For a PDF version, please click here.)
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