Putting Aside Moral Judgment and Making Room for Care: Reproductive Justice and Harm Reduction

by Reah Vasilakopoulos

Image by National Advocates for Pregnant Women http://www.advocatesforpregnantwomen.org/

To achieve reproductive justice for all, we need harm reduction, and to practice harm reduction as widely as possible, we need reproductive justice. Reproductive justice, first coined by a group of Black women activists called SisterSong, is defined as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”[1] Harm reduction encompasses a set of practices and beliefs which help expand individual choices and opportunities to be safer while engaging in stigmatized behavior — such as drug use and sex work.[2] Additionally, harm reduction includes institutional and systemic change to oppressive policies against people who use drugs and/or engage in sex work. For the sake of simplicity, I will focus on harm reduction and policies relating to drug use.

Reproductive justice and harm reduction both advocate for institutional, systems-based changes to create a just world for all. Both movements maintain long histories, despite their more recent definitions. Harm reduction and reproductive justice deeply relate to “what people do and have always done, with or to their own bodies, even in face of severe restrictions.”[3] It is impossible to trace beginning or end, given the movements’ close ties to human nature, feelings of euphoria, and desires of escapism. Sexual activity and/or drug use are, for many, part of the human experience. These two movements are interconnected through their long-lasting history, significant levels of stigmatization, failed prohibition and abstinence-based efforts, lacking access to safe and effective treatments, racist media fear-mongering, and heightened criminalization of both abortion and drug use.

In the United States, abortions and drugs were relatively unregulated during the 19th century, though individual states and localities often passed their own regulations. Use of psychoactive substances occurred for thousands of years, unregulated even through most of the 1800s: the Sears catalogue was continuing to offer syringes and small amounts of opioids for $1.50, while Coca-Cola contained cocaine up until 1904.[4] Abortions have been performed in every society studied by historians, for thousands of years of human history, and were typically unregulated through early United States history.[5] However, regulations soon followed and were racialized by design. Xenophobia following an influx of Chinese immigrants led to the passage of the Chinese Exclusion Act in 1882, followed by the Smoking Opium Exclusion Act of 1909, which banned possession, importation, and smoking of opium.[6] Similarly, in the mid-to-late 1800s, states began passing anti-abortion laws, fueled by fear of the population becoming overwhelmed by children of newly arriving immigrants, notably immigrants of color.[7] Unsurprisingly, this fear of immigrants’ children did not apply to British immigrants, who were assumed to have lower birth rates and thus deemed “civilized” enough for American life.[8]

The United States government continued to pass legislation targeting communities of color, low-income communities, and other marginalized groups. The Marijuana Tax Act of 1937, which taxed sales of cannabis, hemp, and marijuana, was a legislative response to government-funded propaganda that incoming Mexican immigrants were most likely to use marijuana.[9] The drug was previously most referred to as cannabis, but government officials pushed the term “marijuana” to imply the drug’s connections to Mexican immigrants. Around this time, Margaret Sanger and many researchers supported the philosophy of eugenics, aiming to limit reproduction of people with disabilities.[10] In 1976, the Hyde Amendment was passed, which barred the use of Medicaid funds to provide abortions for low-income pregnant people.[11] This law came to life while government officials were calling for welfare reform, particularly due to government and media propaganda asserting that Black mothers receiving small social assistance stipends were misusing them — hence, the creation of the “welfare queen” stereotype. There are many more pieces of legislation that are racialized in their writing or their implementation, too many to be included here.

Stigmatization and moral judgment play a significant role in public disregard and legislation against abortion and drug use. A 2019 study found that 60% of people felt they would be looked down upon by their community if others knew they had gotten an abortion.[12] Race and class both impact the experienced and perceived stigma felt by pregnant people.[13] Drug use is one of the most stigmatized behaviors, with countless studies highlighting societal disapproval and sentiments of discrimination. Stigma is a major barrier to seeking substance-related healthcare; it is only exacerbated when the person using drugs is pregnant — social norms regarding parenting, family, productivity, and bodily health are all projected onto the pregnant person.[14] Identifying openly as a pregnant person who uses drugs often leads to intervention from child welfare services and authorities, scrutiny concerning their ‘parental fitness,’ and external judgment regarding their lifestyle and priorities.[15]

In her article comparing the War on Abortion to the War on Drugs, Lynn Paltrow explains how the framework of epidemics and racialized language were used in the 1980s to discourage drug use and abortion while stigmatizing those who used drugs and/or had abortions. During this time period, the crack-cocaine ‘epidemic’ and the teen pregnancy ‘epidemic’ were sweeping the nation. Despite Black and white people using cocaine in similar rates, Black communities bore the brunt of negative media attention and fear-mongering regarding supposedly high levels of crack-cocaine use.[16] Similarly, despite higher numbers of unwed white mothers and a decrease in teenage pregnancies in the 1970s and 80s, young Black women were blamed for the supposedly heightened rates of teenage pregnancy.[17] As Paltrow describes, the ‘epidemics’ — supported by government campaigning and media propaganda — were blamed for systemic problems, allowing the government to avoid accountability and shift undue blame to Black communities around the country.[18] This redirects attention towards individual failure, wrongdoing, and immorality in an attempt to ignore systemic issues of “unemployment, poverty, racism and sexism that drastically reduce individuals’ ability to exercise choice and maintain control over their lives.”[19]

Drug use during pregnancy is a significant intersection of both reproductive justice and harm reduction movements. Clinical drug testing for drugs is commonly used to monitor and report people of color for drug use during pregnancy. Laws to punish pregnant people for “fetal harm” — despite research proving that fetuses are often unaffected — have led to hundreds of arrests of low-income women of color, arrested on the basis of prenatal drug exposure.[20] Common charges brought against pregnant and parenting people for drug use include child abuse, neglect, and endangering a minor.[21] There is little difference between substance use for Black and white pregnant women, yet Black newborns are four times more likely than white newborns to be reported to Child Protective Services following delivery.[22] Researchers found that disparities persist even after designing of prenatal substance use protocols. In a 2015 study, an adopted hospital protocol did not reduce reporting disparities — nearly five times more Black newborns were reported to CPS than white newborns.[23]

Criminalization of self-induced abortion is another tool used to incarcerate and monitor pregnant people. As Lynn Paltrow writes, criminalization efforts of both abortion and drugs rely on “the pretense that it [is] necessary to protect middle-class white women and to reinforce their traditional place in society.”[24] Surveillance and incarceration for drug- or abortion-related offenses fall primarily on women of color, especially low-income women of color. As of 2018, 7 states have laws directly criminalizing self-induced abortions, 10 states criminalize harms to fetuses done by the pregnant person, and 15 states have “criminal abortion laws” that have been wrongfully applied to people who self-induce their abortions.[25] Many pregnant people who take abortion-inducing drugs, whether the medications are successful or not, are later charged with feticide, manslaughter, child abuse, and/or neglect.[26] Countless women, like Kenlissia Jones, Jenny McCormick, Purvi Patel, and Samantha Flute, have been wrongfully criminalized under these laws.[27] It is unconscionable that people seeking abortions, whether those abortions are successful or unsuccessful, can be harmed in such ways and victimized for straying outside of the norms of pregnancy behavior.

Reproductive justice and harm reduction are not separable from one another, given the long history of drug use and abortion, stigmatization of these actions, and the projection of societal expectations of bodily health, pregnancy, parenting, family, and social functioning onto individual people. By respecting the variety of ways in which people live their lives, and helping them to fulfill their choices, we can better understand one another, meet needs in a helpful manner, and make room for life lived in its many forms. It is time for advocates for reproductive justice and harm reduction to address the deeply rooted causes of societal concerns, seek out changes at individual and institutional levels, and envision a collective future for all people stigmatized for drug use and abortion. With collective change and wide-reaching support, we can push towards a more just, caring world.

References

Baltimore Harm Reduction Coalition. “Harm Reduction,” 2020. https://baltimoreharmreduction.org/harm-reduction/.

Biggs, M. Antonia, Katherine Brown, and Diana Greene Foster. “Perceived Abortion Stigma and Psychological Well-Being over Five Years after Receiving or Being Denied an Abortion.” PLoS ONE 15, no. 1 (2020): 1–21. https://doi.org/10.1371/journal.pone.0226417.

Donovan, Megan K. “Self-Managed Medication Abortion: Expanding the Available Options for US Abortion Care,” 2018. https://www.guttmacher.org/gpr/2018/10/self-managed-medication-abortion-expanding-available-options-us-abortion-care.

Drug Policy Alliance. “Stigma and People Who Use Drugs,” 2020. https://www.drugpolicy.org/sites/default/files/DPA_Fact_Sheet_Stigma_and_People_Who_Use_Drugs.pdf.

Flavin, Jeanne, and Lynn M Paltrow. “Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense.” Journal of Addictive Diseases 29, no. 2 (2010): 231–44. https://doi.org/10.1080/10550881003684830.

Foundation, National Abortion. “History of Abortion,” 2020. https://prochoice.org/education-and-advocacy/about-abortion/history-of-abortion/.

Goldstein, Jessica. “Drug Enforcement Administration Museum Guide.” The Washington Post, August 5, 2011. https://www.washingtonpost.com/lifestyle/style/2011/07/28/gIQAdieswI_story.html?_=ddid-5-1589902440.

Latson, Jennifer. “What Margaret Sanger Really Said about Eugenics and Race.” TIME, October 2016. https://time.com/4081760/margaret-sanger-history-eugenics/.

National Advocates for Pregnant Women. “How the War on Drugs Provides the Path to Ending the Right to Abortion,” 2019. https://www.youtube.com/watch?v=eIxAfcSywxE.

Onion, Amanda, Missy Sullivan, and Matt Mullen. “War on Drugs,” 2019. https://www.history.com/topics/crime/the-war-on-drugs.

Paltrow, Lynn M. “The War on Drugs and the War on Abortion: Some Initial Thoughts on the Connections, Intersections, and the Effects.” Southern University Law Review 28, no. 3 (2001): 201–54.

Paltrow, Lynn M, and Dorothy Roberts. “Overturning Roe: More than Abortion Is at Stake.” National Advocates for Pregnant Women, 2018. https://www.youtube.com/watch?v=4Ej2zG4JpXY.

Roberts, Sarah C.M., and Amari Nuru-Jeter. “Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting.” Journal of Behavioral Health Sciences & Research 39, no. 1 (2011): 3–16. https://doi.org/10.1007/s11414-011-9247-x.

Roberts, Sarah C.M., Elaine Zahnd, Carolyn Sufrin, and Mary Anne Armstrong. “Does Adopting a Prenatal Substance Use Protocol Reduce Racial Disparities in CPS Reporting Related to Maternal Drug Use? A California Case Study.” Journal of Perinatology 35, no. 2 (2015): 146–50.

SisterSong. “Reproductive Justice,” 2020. https://www.sistersong.net/reproductive-justice/.

[1] SisterSong, “Reproductive Justice.”

[2] Baltimore Harm Reduction Coalition, “Harm Reduction.”

[3] Paltrow, “The War on Drugs and the War on Abortion: Some Initial Thoughts on the Connections, Intersections, and the Effects,” 203.

[4] Goldstein, “Drug Enforcement Administration Museum Guide.”

[5] Foundation, “History of Abortion.”

[6] Onion, Sullivan, and Mullen, “War on Drugs.”

[7] Foundation, “History of Abortion.”

[8] Foundation.

[9] Onion, Sullivan, and Mullen, “War on Drugs.”

[10] Latson, “What Margaret Sanger Really Said about Eugenics and Race.”

[11] Foundation, “History of Abortion.”

[12] Biggs, Brown, and Foster, “Perceived Abortion Stigma and Psychological Well-Being over Five Years after Receiving or Being Denied an Abortion.”

[13] Biggs, Brown, and Foster.

[14] Drug Policy Alliance, “Stigma and People Who Use Drugs.”

[15] Flavin and Paltrow, “Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense.”

[16] Paltrow, “The War on Drugs and the War on Abortion: Some Initial Thoughts on the Connections, Intersections, and the Effects.”

[17] Paltrow.

[18] Paltrow.

[19] Paltrow, 224.

[20] Flavin and Paltrow, “Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense.”

[21] National Advocates for Pregnant Women, “How the War on Drugs Provides the Path to Ending the Right to Abortion.”

[22] Roberts and Nuru-Jeter, “Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting.”

[23] Roberts et al., “Does Adopting a Prenatal Substance Use Protocol Reduce Racial Disparities in CPS Reporting Related to Maternal Drug Use? A California Case Study.”

[24] Paltrow, “The War on Drugs and the War on Abortion: Some Initial Thoughts on the Connections, Intersections, and the Effects,” 208.

[25] Donovan, “Self-Managed Medication Abortion: Expanding the Available Options for US Abortion Care.”

[26] National Advocates for Pregnant Women, “How the War on Drugs Provides the Path to Ending the Right to Abortion.”

[27] Paltrow and Roberts, “Overturning Roe: More than Abortion Is at Stake.”

The political leader of the pro-choice movement in Maryland.

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