Dr. Hallam Hurt began a study for babies exposed to cocaine in utero, or "crack babies" as they became known in the press, in the late 1980s. She enlisted 224 near-term mothers — half of whom used cocaine during pregnancy and half who did not. Almost all came from low-income families.
After the babies were born, they were evaluated every six to 12 months until they were young adults. The study received almost $8 million in federal funding from the National Institute on Drug Abuse, and became one of the largest and longest-running studies on children exposed to cocaine in utero.
Now, 25 years later, the study is ending and the results are in: The researchers consistently found no significant differences between the cocaine-exposed children and the controls. So-called "crack babies" did not suffer long-term effects.
This might come as a shock to the public, says Claire Coles, a psychologist specializing in fetal damage at Emory University Medical School, but it's something that people in the field have known for a long time.
"It's sorry that the 'coke babies' myth continues to persist in 2014," says Coles. She and other experts have long known that children exposed to cocaine in the womb "perform cognitively the same as other children."
Still, Hurt found that children in both the control and test groups had lower-than-expected IQs. This has led her and other experts to believe that cocaine doesn't cause developmental delays — but poverty can.
Effects of poverty
Lots of things affect development — a parent's warmth and affection, hunger, stress and trauma. Hurt's research tried to extract these environmental factors, and found that children raised in a nurturing home were better off. But among the children studied who had all been exposed to cocaine in the womb, 81 percent had seen an arrest, 35 percent had seen someone get shot, and 19 percent had seen a dead body, all before the age of 7.
As the children grew up, researchers kept up with 110 of them: two had been killed, three were in prison, six had graduated from college, and six more were in school.
Years of research led Hurt to the conclusion that problems and lack of opportunity arising from socio-economic status might be the biggest threat. "Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine," Hurt said in a presentation of her research.
Coles, who did her own studies on children exposed to cocaine in Atlanta, agrees that the grating effects of poverty are what should be studied more carefully. "It's environmental deprivation, not having nutrition, health care, not having a parent who can pay attention or support you," she said.
"If you are born poor in this country, you can end up with an IQ that is 15 to 20 points lower," she says. Indeed, in Hurt's research, IQ for exposed children and unexposed children was about the same — 79 and 81 respectively. Both of these groups fell below the average of 90 to 109 for other kids in their age group.
If poverty has harsher effects than cocaine, and if cocaine exposure has very little long-term effect on children, why are the ideas of the "crack baby" and "crack mom" so pervasive?
"Once something gets into the mythology of a culture, it becomes an archetype," says Coles. We think of the crack mom as someone who is "different, alien, a bad person," she says, who can serve as a scapegoat. She notes that fetal alcohol syndrome causes much more brain damage, but drinking is more culturally acceptable.
The most dangerous effect of stigmatizing "crack moms," she says, is that it has led to criminal punishment for mothers whose babies test positive, which can break apart families by sending single moms to jail and their children to foster care.
Dr. Jeanne Flavin, a professor of sociology at Fordham University and author of "Our Bodies, Our Crimes," studies women's legal status and public health. Her research follows cases like that of 28-year-old Alicia Beltran who was handcuffed at her home last summer after she reported a previous pill addiction during a prenatal checkup, even though her drug tests later came out negative.
"A drug test doesn't tell you how someone parents," says Lynn Paltrow, executive director of National Advocates for Pregnant Women. It's much more nuanced, she says, and a drug test doesn't tell how much someone is misusing drugs, or if they do in front of their children.
Wisconsin, along with Minnesota, Oklahoma and South Dakota, have laws that allow authorities to confine pregnant women for substance abuse. Alabama's "chemical endangerment of a child" law has been used to prosecute 100 women who gave birth to babies that tested positive for drugs, sending many of those mothers to prison.
"There are people who struggle with drugs and alcohol who are still fit parents," Paltrow says, noting that drug use is not the same thing as drug addiction.
Treatment and unintended consequences
Flavin acknowledges that drug use in the home is not ideal, but separating mothers and children can be even worse. "The harm and damage done by separating a mother and child is hard to overstate," she said.
What Flavin would like to see instead is more treatment for mothers and less punitive action. The time when a woman learns that she's pregnant and decides that she wants to carry the baby to term is a vulnerable, meaningful time, she says.
"A lot of women are inspired to eat better during that time, to take better care of themselves." Those are the times when she is most open to help and support, and the threats of arrest or having her children taken away is a deterrent. "Threats won't deter her from taking drugs, but they will deter her from going to the doctor," she says.
Twenty states have blocked the use of criminal child abuse or related laws against pregnant women, and the American College of Obstetricians and Gynecolologists states that "incarceration or threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse."
Punitive measures are especially unfortunate, says Flavin, because often they target families that are suffering from the stresses and complications of poverty in the first place.
"I wish that we would insist that our responses were based on evidence and science rather than stimgma, and think about the impact on the most socially vulnerable people when we are passing these laws," she says. "It bothers me that when a woman might be most open to services and help, our responses are the most harsh."