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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
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?
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.