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Who is a “Criminal?” Exclusion of Vulnerable Groups from International AIDS Conference Nothing to Celebrate

11:35 am in Uncategorized by RH Reality Check

Written by Marianne Møllman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Part of RH Reality Check’s coverage of the International AIDS Conference, 2012.

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As the International AIDS Conference ended in Washington D.C. this week, rumor has it that the lead organizer invited participants to celebrate the fact that “criminals” had been kept out of the conference. This with reference to the fact that sex workers and those convicted for drug crimes were prevented by current law from obtaining visas for the gathering.

Setting aside for a moment the insanity of excluding the voices of two groups very much affected by the HIV epidemic in general and by misdirected prevention policies in particular, and regardless of whether the rumors are true, we can use this opportunity to reflect on the definition, use, and potentially manipulative power of criminal laws and policies.

For starters, our concept of what is criminal is relative and fluid at best. When I did research on access to abortion for rape victims in Mexico in 2006 and 2007, I was shocked to learn that child victims of incest were considered criminals in many jurisdictions. Meanwhile, rapists could escape the label by marrying their victim, a relatively common provision in several other countries too, including Cameroon and Brazil. This notion of incest victims as criminals and rapists as…not criminals, illustrates the fluidity of the concept.

Sex workers too are not always breaking the law. In some jurisdictions, such as Canada until very recently, sex workers can avoid criminal sanctions by doing only out-calls or by working alone — conditions that tend to render their work more dangerous. In other jurisdictions, such as for example Nevada and New Zealand, sex work is generally legal, subject to regulation.

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Sensationalizing Drug Use in Pregnant Women: How the Media Perpetuates Racist and Ineffective Policies

9:15 am in Uncategorized by RH Reality Check

Written by Marianne Møllman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Well before anyone could be certain of how Whitney Houston died, several news outlets rushed to describe her as a “crack cocaine user.” And in all likelihood many will think of the popular singer as succumbing to illegal drugs, even if alcohol eventually is found to be more closely related to her demise.

This is not all that different from how the media deals with infant and child health.

Regardless of the actual causes behind low birth weight, infant mortality, and early childhood health issues, media reports are sure to blame the “crack baby syndrome” or, more recently, women’s abuse of prescription pain killers.

This kneejerk reaction is unhelpful for a number of reasons.

First of all, a pregnant woman’s use of illicit drugs is neither the only nor the most damaging pregnancy phenomenon from the point of view of infant health.

Take, for example, legal drugs, such as alcohol and cigarettes. Peer reviewed research shows that over-consumption of alcohol can cause fetal alcohol syndrome (linked with permanent mental retardation), whereas cocaine seems to act only as one contributing factor in some pregnancies to increase non-permanent risk factors such as low birth weight. Approximately twice as many pregnant women drink alcohol frequently as use illicit drugs frequently during their pregnancies.

Epidemiological research published in the mid 1990s shows that the use of tobacco products in the United States at the time was responsible, each year, for tens of thousands of tobacco-induced miscarriages, infants born with low birth weight, infants who require admission to neonatal intensive care units, as well as an estimated 1900 to 4800 infant deaths. Though smoking has gone down over the past decades, around 17 percent of adult women in the United States still smoke, and generally continue to smoke during their pregnancies.

Even drugs administered to women who are in fertility treatment have been associated with low birth weight and premature birth.

Or let’s set aside drugs altogether. Malnutrition in pregnant women is one of the main causes of low birth weight and infant mortality worldwide. In this sense, it is worth noting that food insecurity and hunger has grown steadily in the United States since the start of the latest financial crisis in 2008. (Food insecurity exists whenever the availability of nutritionally-adequate and safe foods or the ability to acquire foods is limited or uncertain). According to the latest figures, about 17.2 million households in the United States suffered food insecurity in 2010, the highest number ever registered. Yet the government’s food stamp program is increasingly under attack by pundits and politicians.

Secondly, even a superficial read of arrest and prosecution figures for drug use during pregnancy reveal such a severe race and class bias that the very legitimacy of the approach must be questioned.

Since 1985, 80 percent of the more than 200 pregnant women or new mothers in over 20 states who have been arrested and charged with crimes related to substance use during pregnancy were black or Latina. In 2000, research in Pinellas County in Florida found that while white women and women of color used illegal drugs at comparable rates, black women were 10 times more likely than white women to be reported for child abuse related to substance use during pregnancy. That same year, data from the National Institute on Drug Abuse showed that while black women had a higher overall rate of illicit drug use than white women, most women who use illegal drugs during pregnancy were white. Even so, 41 of the 42 women arrested in South Carolina under a mandatory drug testing program were black. (The program was suspended in the mid-1990s because of allegations of racial discrimination).

Meanwhile, research published in 2006 shows that newborns with white mothers are much more at risk of alcohol and tobacco exposure than newborns with black or Latina mothers.

Moreover, in many cases women with private health insurance are not mandatorily tested for illicit drug use during pregnancy. In this sense, poverty itself is what singles a pregnant woman out for persecution. It is no coincidence that the main focus for drug prosecutions for pregnant women in the United States is crack cocaine, a drug almost exclusively used by the resource-poor. As Whitney Houston herself famously said in an interview in 2002: “I make too much money to ever smoke crack.”

The point here is not that pregnant women should use cocaine, or that the government—and society as a whole—does not have a legitimate interest in ensuring infant and child health.

The point is that the prosecution of drug use in pregnant women does nothing to fulfill a legitimate policy goal and in fact seems to be racially motivated—at least in the implementation—rather than spurred by a concern for children.

In fact, if the objective is to improve infant and child health, efforts to overcome poor nutrition, alcohol addiction, lack of adequate health care, physical abuse, and/or homelessness would make for much better investments. Sadly, such policies don’t make for as sensational news.