200101
Care of Pregnant and Newly Delivered Women Addicts
POSITION STATEMENT
Approved by the Board of Trustees, March 2001
| |
"Policy documents are approved by the APA Assembly and Board of Trustees… These are …position statements that define APA official policy on specific subjects…" -- APA Operations Manual. |
|
This policy updates the 1991 position statement.
Rationale
Alcohol and other drug abuse and dependence affect many women of childbearing age. These psychiatric disorders produce harm to the health and social functioning of the individual and may also affect the health and well-being of her children. Substance abuse and dependence are often accompanied by other comorbid psychiatric disorders. In addition, many of the women who become dependent on substances are also victims of abuse and deprivation. Women living in poverty and members of minority groups may be disproportionately affected.3
Children of these mothers are at risk for growth retardation, facial abnormalities, and developmental deficiencies, arousal and affective regulatory problems, language disorders, and impulsive and hyperactive behavioral difficulties that require psychiatric assessment and intervention.
During the 1980s and 1990s, several jurisdictions initiated policies of prosecuting pregnant and/or postpartum women who have used either alcohol or illegal substances during pregnancy, on grounds of "prenatal child abuse". Subsequent incarceration, either in jails, prisons or in locked psychiatric units both deprives the mother of her liberty and seriously disrupts the incipient or nascent maternal-infant bond. One state's highest court has upheld this practice. Several states have also established involuntary commitment laws applying solely to pregnant women in ways that are not applied to men or non-pregnant women. Such policies are likely to deter pregnant addicts from seeking either prenatal care or addiction treatment, because of fear of prosecution and/or civil commitment.
The most effective way to prevent harm to both mothers and infants is to make available accessible, culturally appropriate prevention and treatment services designed specifically for adolescent girls and women. Adequate screening for substance-related disorders in all obstetric practices, with referral for treatment and careful follow-up, are also necessary parts of the continuum of care. Screening instruments are available for this purpose. In many or most geographic areas, there are few voluntary addiction treatment services willing to accept pregnant women, and few or no residential services in which a mother may bring her children. This is unfortunate, as during pregnancy and the two years postpartum, women are particularly open to treatment and treatment can be highly effective.
ACTIONS
The APA Board of Trustees intends to take a leadership role in advocating on behalf of both these mothers and their children with departments of social services or their agencies that are legally responsible for the safety of these children. This advocacy will serve to enhance these mothers' parenting, to preserve the integrity of their families whenever possible, and to ensure the safety of their children. APA also takes the following specific positions.
1. APA opposes the criminal prosecution and incarceration of pregnant and/or newly delivered women on child abuse charges based solely on the use of substances during pregnancy. (Child abuse charges may be appropriate if positive evidence of abuse or neglect is found following the birth of a child.) The best way to prevent abuse and neglect in this situation is adequate treatment for the mother and family.
2. APA advocates that adequate prenatal care be available to all pregnant women, including pregnant addicts, irrespective of ability to pay and without fear of punitive consequences.
3. APA urges that societal resources be directed not to punitive actions but to adequate preventive and treatment services for these women and children. APA strongly advocates the development and funding of the necessary inpatient, outpatient, and residential programs for mothers with their children. Services should address and foster the parental functions, as well as the care of individual mother and child.
APA opposes involuntary commitment laws that are applied only to pregnant women in ways that do not apply to men or women who are not pregnant.