The punishment or treatment of addictive pregnant women and the risk of mental illness on their unborn child are very controversial issues in social work today(Young, 1996, 33). Should child-removal or time in a correctional facility punish substance abusing pregnant women, or should they be sentenced to a type of addiction treatment program? Does maternal substance abuse fall under the categories of child abuse and neglect? These questions, along with other ambiguous problems will be discussed in great detail throughout this report, such as how a social worker deals with these cases.
Being in a social work field, one will realize that not everything is a cut and paste from the handbook. There are situations, more than often, where educated choices gained from training are needed to be applied. That is a good explanation on why punishment vs. treatment of addictive pregnant women is so controversial.
Punishment could possibly have sexist or racist motives and then ultimately work more to show inequalities between the classes, rather than protect the children (Young, 1996, 33). Policymakers, law enforcement officials, and the general public all have punitive responses to the issues surrounding drug-exposed infants.
It is even shown through observation that a number of judges have given heavier sentences to pregnant addicts vs. non-pregnant addicts for the same crime (Young, 1996, 34). Also, court-ordered removal of a baby at birth, without trial or hearing, is very common now. This removal is based on the ground that the mother or infant has a positive drug test at the time of birth. This procedure has increased dramatically in the past 10 years despite the severe shortage of foster homes in the United States (Skoe, 1996, 274). There are also a number of states that require social workers and other healthcare professionals to report substance-abusing pregnant women to state authorities, rather than seeking a treatment for them. As a result of this pregnant women sometimes avoid with social workers(Young, 1996, 35).
These examples of how punishment is granted are ridiculous. Healthcare and social service agencies should be the ones making the decisions on such cases, not the courts (Altman, 1998, 853). It is true that anyone who uses drugs are responsible for that use. But once addiction takes over it puts a limitation on responsibility. The dependence becomes involved in the person's way of life until they are not responsible for their continuing use. Experts agree that stopping the
usage of a dependent drug cannot be done by a mere act of will. Addiction changes the will to do a drug into the need to do a drug. It becomes a condition - and criminal law should punish people for acts, not conditions (Young, 1996, 36). By giving punitive reflexes to these women we are saying that they are responsible for their drug use as well as their pregnancies, these are problematic assumptions for social workers to hold (Young, 1996, 37-39).
From punitive policies came controversy on the morality of it. With this, some state and local governments encourage treatment over punishment. For example, California has a law that gives priority to pregnant women in drug treatment programs. Also, New York City has a program that allows drug dependent mothers to take their newborns home, as long as they seek treatment and agree to weekly visits from a social worker (Young, 1996, 35). In the last five years there has been an increase in the number of treatment programs available for pregnant women. This may sound like good news, but it still poses a problem. Who pays for and how long should these services be provided? Most insurance companies limit the number of sessions a client can be reimbursed for and the number of service providers available providing a list
of certain professionals they are allowed to use. Also, in most states Medicaid will only pay for a portion of the cost of drug treatment (Skoe, 1996, 274-275).
Because of these limitations many agencies mainly see clients only in groups and monitor the services received to make sure they are needed. Group leaders will use approaches that focus on "short-term" therapy in order to help clients cope more quickly. Solution-focused therapy is a current trend used today. This approach focuses on the strengths of the clients. It helps them to come up with solutions to resolve their problems. Questions such as "what worked before" are used to evoke the client's own ideas (Altman, 1998, 851).
Empowerment is also another trend used by social workers today. Empowerment is "the process of increasing personal, interpersonal, or political power so individuals can take action to improve their life situation" (Young, 1996, 49). Working with most of these addicted pregnant women, social workers report them as having a since of "powerlessness." They face problems from every direction in the environment and that often puts a limit on their functioning. Therefore, they feel that they cannot do anything to change their environment. By using the method of empowerment social workers help their clients see that they can create change, not by fi their problems but by giving them encouragement. People who are empowered can and aren't afraid to make changes in their lives (Altman, 1998, 855).
Getting the funding for treatment programs in the past was nearly impossible. People didn't understand that spending money in one problem area would save money in others. By providing these services to substance abusing pregnant women, it helps them to keep a positive attitude on life and makes room for real criminals in correctional facilities. Social workers are making much progress in encouraging treatment over punishment, but they still have a long way to go. There is still a strong need for more treatment programs even though in the past ten years they have practically been defined. Ten years from now, at this rate, there will be a more systematic way of separating the two; until then any help is good help.
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