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The State Where Motherhood Is a Crime

Photograph by Twenty20

If the "war on women" is still raging in the United States (and I believe it is), the state of Tennessee is on the front lines. One of the most damaging recent attacks on women's health in Tennessee was the passage of the 2014 "fetal assault" law, which makes it a criminal offense to have taken narcotic drugs while pregnant. The law threatens a pregnant woman with up to 15 years in prison if she gives birth to an infant addicted to narcotics or "harmed" by them.

Media and women's health organizations are beginning to publicize the impact of the law now that at least 28 women have been prosecuted, many of whom were too afraid of losing custody of their children and being sent to jail to seek addiction treatment or even prenatal care. In a cruel catch-22, the government that invented this crime has made it almost impossible for thousands of pregnant women to avoid committing it.

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Tennessee is ranked No. 2 in the country for prescription drug abuse, and the number of babies born with neonatal abstinence syndrome (or NAS) is three times the national average. Supporters of the law claimed that it would serve as a wake-up call for women with drug dependency issues and motivate them to get help. Unfortunately, the law did nothing to give the thousands of primarily poor women struggling with addiction who become pregnant every year access to any help at all.

Only a handful of drug treatment facilities in Tennessee will accept pregnant women, and the law provided no new funding for those programs to increase capacity or train staff. Even fewer rehab clinics will accept TennCare, Tennessee's state Medicaid program.

What this means is pregnant women without private insurance who are unable to write a $3,000 check are being turned away after seeking help at dozens of treatment centers. They are sitting on 6- to 18-month waiting lists for residential programs or for affordable housing during outpatient treatment. They are avoiding prenatal care, giving birth outside of hospitals or birth centers, and fleeing the state in fear of being separated from their babies.

I'm trying to imagine what it must be like to face the impossible position that Tennessee has created for women struggling with addiction.

Even more dangerously, many pregnant women are attempting to detox alone despite serious warnings from doctors. The medical community agrees that opioid-addicted women who become pregnant should not quit completely. Without opioid-replacement drugs like Methadone, the physical shock of withdrawal carries a high risk of pre-term labor and miscarriage. TennCare does not cover Methadone or any medication-assisted addiction treatment for pregnant women.

"To say that Tennessee actually cares about people's health and access to health care is far from the truth, and that includes reproductive and sexual health," says Allison Glass, State Director at Healthy & Free Tennessee, a coalition that advocates for sexual health and reproductive freedom. Glass sees the law as both incredibly ineffective and punitive, targeting a vulnerable population and continuing the perception that women with dependency issues can't be mothers.

Certainly, the "Fetal Assault" law also did nothing to provide basic reproductive health care for the women of Tennessee. In 2011, the state government cut off federal funding to Planned Parenthood and transferred that money to local public health departments. Unlike Planned Parenthood, those departments provide women's health and contraceptive services only on certain days and at certain times, ignoring realities like time off work, childcare, or traveling long distances that impact women's ability to use them. Did I mention that 96 percent of Tennessee counties do not have an abortion provider?

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Jeff Teague, president and CEO at Planned Parenthood of Middle and East Tennessee, sees this as a "no win situation. It's damned if you do, damned if you don't." Teague feels that the "Fetal Assault" law was well intentioned, but that it demonstrates a complete lack of understanding of the complexities of the issue.

"We all want women with addiction issues to get help," says Teague. "We all want women to have healthy pregnancies, healthy births, and healthy children, but treatment options are not readily available."

Cynthia Greenlee, a spokesperson for National Advocates for Pregnant Women, agrees, adding that "some women will consider ending a wanted pregnancy because they fear a positive drug test and its repercussions … in what is essentially a non-choice."

I'm trying to imagine what it must be like to face the impossible position that Tennessee has created for women struggling with addiction. Unable to prevent or terminate a pregnancy. Unable to find addiction treatment. And then prosecuted when they give birth. If these women's suffering won't move Tennessee's lawmakers to abolish the "fetal assault" law, perhaps simple math will. In the 18 months since the law took effect, the number of babies born with NAS has not gone down.

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