Generations of Suffering: Drug Use During Pregnancy

Substance abuse during pregnancy represents a major threat to both women and their infants. Medical complications, including anemia, cardiac disease, cellulitis, edema, hepatitis, phlebitis, pneumonia, cystitis, urethritis, and pyelonephritis, are seen in nearly 50 percent of pregnant drug-dependent women. Major effects on the fetus include intrauterine death, overwhelming infection, chorioamnionitis, premature rupture of the membranes, poor fetal growth, and low birthweight with associated complications. Infants born to drug-abusing parents are at heightened risk for physical abuse and neglect, learning disabilities, and behavioral problems. There is clear evidence that drug use during pregnancy is a widespread and growing problem among the inner-city poor. In Hartford, CT, for example, current estimates by substance abuse treatment counselors and neighborhood prenatal care providers are that, depending on the neighborhood, seven to 50 percent of pregnant women use teratogenic mind-altering substances. A recent study of 51 mothers of low-birthweight babies who were local OB/GYN clinic patients found that 65 percent reported substance use during pregnancy, while a survey of 1,000 consecutive OB patients at one inner-city hospital found that 12 percent used illicit drugs. These data point to the need for well-coordinated drug treatment efforts for pregnant and postpartum women. This paper describes one such program, Project Recovery in Hartford, a comprehensive treatment program designed and implemented through a consortium of community-based organizations and hospital-based drug treatment providers. The paper reviews the life histories and drug use patterns of project participants and describes the components of the project developed to meet the intertwined social, economic, and health needs of project participants. Drug use during pregnancy is seen and handled in the project as a symptom of a more encompassing problem: the health crisis of the urban poor. Responding to the interconnected nature of this crisis requires long-term, multifaceted intervention, as evidenced by the several components of Project Recovery.