TRANSCRIPT: LYNN PALTROW'S VISIT TO THE NYTIMES DRUG POLICY FORUM

Lynn Paltrow

Hi this is Lynn Paltrow, ready to take questions. I'm Executive Director of
the The National Advocates for Pregnant Women (NAPW).

NAPW is a non-profit organization dedicated to securing the human and civil
rights, health and welfare of pregnant and parenting women, and furthering
the interests of their families. NAPW seeks to ensure that women do not
lose their constitutional and human rights as a result of pregnancy, that
addiction and other health and welfare problems they face during pregnancy
are addressed as health issues, not as crimes; that families are not
needlessly separated, based on medical misinformation; and that pregnant
and parenting women have access to a full range of reproductive health
services, as well as non-punitive drug treatment services.

Celaya

Hi Lynn,

Perhaps you can shed more light on an issue we were discussing today. Do
you have any data on how pre-natal marijuana use affects the fetus/newborn?

Dean Becker

Hi Lynn, so good of you to join us.

What would you say is the most common situation that pregnant women find
themselves embroiled in about their drug use and how does that scenario
develop, from snitches, nurses or police?

Tbarrus

Hi Lynn,

Will you please comment on the "health issues" faced by the pregnant woman
and her fetus with regard to the following CNS active drugs used by the
pregnant woman during pregnancy

tobacco coca alcohol opium coffee cannabis

Which drug, when used, causes the most harms to the pregnant woman? Which
drug, when used, causes the most harms to the fetus?

Tom Barrus, Pharmacist

Lynn Paltrow

I am not an expert on this, but understand that there is not a whole lot
out there supporting claims that it is particularly harmful. Two drugs for
which there is the most evidence of harm and potential harm are cigarettes
and alcohol.

I know that one author -- Bonnie I. Robin-Vergeer, The Problem of the
Drug-Exposed Newborn A Return to Principled Intervention, 42 Stan. L. Rev.
745, 771-76 (1990) who argues for universal testing and reporting to the
child welfare system any newborn that tests positive for an illegal drug --
excludes from her recommendation reports for marijuana because of lack of
evidence regarding marijuana use and interference with parenting ability.

Lynn Paltrow

I am not a health care professional -- but do have some information from
the legal and advocacy work that I have done. As my previous answer
indicates -- I believe there is the most evidence of harm for alcohol and
cigarettes -- but the potentially harmful effects of these drugs -- like
all drugs are mediated by such things as nutrition, prior health
conditions, prenatal care and other factors. One of the most significant
factors in pregnancy outcome appears to be poverty.

Trippin

Hi Lynn

You told me the other night that Coindon was behind the spearhead to
suppress women's rights, do you have enough support to use against him to
stop his discriminatory effort?

Celaya

Lynn

Aren't there some cultures that believe that marijuana is a useful drug to
use to alleviate labor pains?

Lynn Paltrow

You asked Aren't there some cultures that believe that marijuana is a
helpful drug to use during conception?

Certainly there are some among our own culture who may believe this. I am
however not familiar with that particular belief. I have however heard an
increasing number of women say that marijuana use helped them get through
severe morning sickness, and know of one Ph.D. candidate who is researching
that issue right now.

Lynn Paltrow

On the earlier question about relative harm from various legal and illegal
drugs, the writer might be interested in a report from the Committee to
Study the Prevention of Low Birthweight that found numerous behaviors and
risk factors besides the use of illegal substances that increase the
chances of bearing a low birthweight infant, considered to be the greatest
single determinant of infant mortality in the United States.

See Committee to Study the Prevention of Low Birthweight, Division of
Health Promotion and Disease Prevention, Institute of Medicine, Preventing
Low Birthweight - Summary 1 (1986) at 1-7. Among the many behavioral and
environmental factors that contribute to low birth weight are smoking
cigarettes, poor nutritional status, exposure to occupational hazards and
living at a high altitude.

Tbarrus

Lynn,

Is it a "health issue" or a "crime" for a pregnant woman to use the hard
drug alcohol to a level that she gives birth to a baby forever maimed and
physically deformed with Fetal Alcohol Syndrome due to the alcohol drug use
of its mother?

Is it a "health issue" or a "crime" for a pregnant woman to use the hard
drug tobacco to a level that she kills her fetus, resulting in miscarriage,
due to the tobacco drug use of the mother?

Lynn Paltrow

Q What would you say is the most common situation that pregnant women find
themselves embroiled in about their drug use and how does that scenario
develop, from snitches, nurses or police?

A. Our efforts to document arrests of pregnant women seem to indicate that
women who use cocaine are most likely to be arrested. We don't always know
how the woman's drug use came to police attention, but it does appear that
in most cases it involves health care workers who violate a variety of
ethical and legal prohibitions against disclosing highly sensitive patient
health information.

Lynn Paltrow

You ask Is it a "health issue" or a "crime" for a pregnant woman to --
drink alcohol or smoke to a degree that it harms a fetus.

As our mission statement indicates we believe that it is a grave mistake --
whether thinking about children's health or women's rights -- to treat
anything a woman does to her own body as if it were a crime against someone
else. Even where there is better evidence that a drug or behavior may cause
harm -- you have to ask what would the use be of treating the woman as a
criminal? Every leading medical group in the country to take a position on
this issue opposes criminalization. Why? For one reason because it is
likely to deter women from getting health care they need -- making health
matters worse.

Lynn Paltrow

As tbarrus was intimating, I haven't seen any information that any
recreational drug, legal or illegal, is more harmful that alcohol or tobacco.

Is there any action to make prenatal use of these substances illegal? If
not, then any prosecution for use of other substances is bigotry, hypocrisy
or simply a prohibitionist ploy.

Lynn Paltrow

Q Aren't there some cultures that believe that marijuana is a useful drug
to use to alleviate labor pains?

A. Oh is that what you meant to ask? I have heard of that and know of a
case where a woman who was in labor but not dilated enough to be accepted
in the hospital yet was advised by a neighbor who happened to be a nurse
that smoking marijuana would not hurt the pregnancy and would help ease her
labor pains. When she tested positive for the drug at the point of
delivery, the state took her baby away!

Trippin

Lynn

Please let your supporters know that this marijuana law reformer (and many
more) are supporting them in your fight with the machine. It's a senseless
evil thing that is being forced upon the people of this nation.

Celaya Lynn

Every leading medical group in the country to take a position on this issue
opposes criminalization.

So. Another confirmation that the government, and especially law
enforcement is way out of bounds in sticking its nose into what
recreational substances people use.

Do you see the end of prohibition as the best way to end the specific
problem you are dealing with?

Lynn Paltrow

In fact no state legislature has passed a law to make it a crime to be
pregnant and engage or not engage in any behavior. One state though, by
judicial fiat, reinterpreted the state's child abuse law, holding that a
child includes a viable fetus. As a result the statute now effectively
reads that any harm or risk of harm to a viable fetus would constitute
child abuse. This would have to include alcohol and cigarettes.

In fact a state agency published a brochure stating "Not only is it
dangerous for pregnant women to smoke, drink, use other drugs or engage in
other activities that risk harming their babies, but it's also a crime in
South Carolina." The Attorney General, Charles Condon insists however -- in
certain contexts only, that the decision only applies to illegal drugs.

Lynn Paltrow

Before going to the next question though -- several states as a matter of
Civil child welfare laws do include alcohol use during pregnancy -- or an
FAS diagnosis as a possible basis for investigating a family or removing a
child from the parent's custody.

Dean Becker Lynn, how many women are subject to this type of inquisition
each year and how many are found guilty, lose parental rights, go to jail?

Lynn Paltrow

Certainly our current drug policy is irrational. In South Carolina a
pregnant woman suffered a stillbirth and also had a positive drug test for
cocaine. She was charged and convicted of homicide by child abuse and
sentenced to 12 years in jail. In fact there was absolutely no evidence
that cocaine caused the stillbirth -- rather the state found witnesses to
say that since they couldn't determine any reason for the stillbirth -- it
must have been cocaine. This conclusion without performing a host of tests
to rule out other possible causes. (Anywhere from 20-70% of stillbirths are
from undetermined causes) If this woman had gone out and deliberately
obtained a 3rd trimester abortion -- she could only have gotten 3 years in
jail. The state is willing to pay something like 24,000$ a year to imprison
her -- but would never dream of even paying a fraction of that amount to
provide meaningful drug treatment much less income support. As is true of
other punitive drug policies -- those involving pregnant women do not in
fact further any legitimate health or public welfare goals. They do however
work well as political tools.

Lynn Paltrow

As colleagues of mine -- like Sheila Murphy have pointed out -- focusing
attention on so called crack mothers and welfare queens is a terrific
strategy for other political purposes. So, for example, if your goal is to
end AFDC -- income support programs for poor families, you make it appear
that your hard earned tax dollars are just going to a bunch of selfish drug
using women. Similarly , if your goal is to overturn Roe v. Wade -- the
supreme court's decision recognizing a right to decide to have an abortion
- -- then you go after a drug using pregnant woman as a "child" abuser to get
a court to declare that fetuses are really persons under the law. If your
political goal is to control low income families and families of color --
use drug use -- any evidence of it -- no matter how functional and loving
the family might be -- to take the kids away.

Lynn Paltrow

Few people realize that for women in the US, achieving the status of full
citizen is an unfinished project. Although many gains have been made -- the
constitution's protection do not fully extend to women who are pregnant. A
few examples: · While it is generally recognized that people have a right
to bodily integrity and the right to procreate, women face an array of
restrictions on their reproductive decision-making, from restriction on
access to abortion services, to restrictions on alternative birthing
practices to a wide variety of health and welfare polices that devalue and
undermine motherhood for low income and women of color.

Although it is generally accepted that adults can decide what medical
treatment they will or will not have - once a woman becomes pregnant others
may be able to make that decision for her. Angela Carder was forced,
against her will, to undergo surgery because it was believed it would help
her fetus; in fact, it failed to save the fetus and contributed to her
death. Pregnant women may be punished for informed refusal of HIV treatment
and are often denied recommended forms of drug treatment. And, while many
states now permit adults to determine whether and what treatment they will
accept if they become critically ill or incompetent, some states exclude
pregnant women from this right of self-determination. · Employers in some
high-paying industrial jobs have told fertile women that they need not
apply, claiming that these were fetal protection polices. Other employers
have simply told women holding minimum wage jobs that they would lose their
jobs if they became pregnant.

So while some courts are declaring fetal personhood -- women are not yet
fully persons under the law.

Neitzen James

Lynn I have various opportunities to interact with CPS workers in my
county. Can you provide some good 'entry level' studies or other resources
about the 'crack baby' myth? What is currently known about the long-term
prognosis for cocaine-exposed newborn? Last I heard, they'd found nothing
that could be separated from the effects of poverty itself. Keep up the
good fight Lynn!

Lynn Paltrow

Thank you all for your questions and participation. I have to go -- but
there is a lot of useful information on our web site
www.advocatesforpregnantwomen.org

Thank you to DB for organizing this and helping me through my first on line
web forums. Lynn

Lynn Paltrow

Can't resist one more answer -- though you can find this on our web site.
We would be happy to send fact sheets and other material to help educate
CPS and other workers. For now --- Research has found that crack-exposed
children are not doomed to suffer permanent mental or physical impairment,
and that whatever effects may result from the use of this drug are greatly
overshadowed by poverty and its many concomitants - poorer nutrition,
inadequate housing, health care and stimulation once the child is born. See
Deborah A. Frank, MD et. al., Growth, Development, and Behavior in Early
Childhood Following Prenatal Cocaine Exposure A Systematic Review, 285 JAMA
1613 (Mar. 28, 2001); Wendy Chavkin, MD, MPH, Cocaine and Pregnancy - Time
to Look at the Evidence, 285 JAMA 1626 (Mar. 28, 2001); Hallam Hurt, M.D.
et al., Problem-Solving Ability of Inner-City Children With and Without In
Utero Cocaine Exposure, 20 DEV. & BEH. PEDIATRICS 418 (Dec. 1999). Alan
Mozes, Poverty Has Greater Impact Than Cocaine on Young Brain, Reuters
Health, Dec. 6, 1999. See also Linda C. Mayes et al., The Problem of
Prenatal Cocaine Exposure A Rush to Judgment, 267 JAMA 406 (1992). As yet
other researchers explain

The "crack baby" on which drug policy is increasingly based does not exist.
Crack babies are like Max Headroom and reincarnations of Elvis - a media
creation. Cocaine does not produce physical dependence, and babies exposed
to it prenatally do not exhibit symptoms of drug withdrawal. Other symptoms
of drug dependence - such as "craving" and "compulsion"-cannot be detected
in babies. In fact, without knowing that cocaine was used by their mothers,
clinicians could not distinguish so-called crack-addicted babies from
babies born to comparable mothers who had never used cocaine or crack.

JOHN P. MORGAN & LYNN ZIMMER, The Social Pharmacology of Smokeable Cocaine
Not All It's Cracked Up to Be, in CRACK IN AMERICA DEMON DRUGS AND SOCIAL
JUSTICE 131, 152 (Craig Reinarman & Harry G. Levine eds., 1997).

Trippin

bye Lynn.....thank you

Dean Becker

The greatest evil of drug prohibition is the collusion of our government.

Lynn, you are astounding. I so much appreciate you taking the time to visit
with us. When you encounter a new problem or solution dealing with your
advocacy for pregnant women, please drop back to these screens and update
us. Thank You!

Donald Way

Thanks for coming Lynn, you're a great guest!

Neitzen James

Wow, thanks Lynn. That was excellent!

Tbarrus

Thank you Lynn for participating in the NYT's Drug Policy Forum tonight!