Britney is a playful little girl. By mid-morning one Thursday in early January, she had put her hot pink sweater and pink, polka-dot pants on inside out and backwards, covered her face with shaving cream and painted a sheet of paper completely blue, titling the picture “daddy.”
She’s also antsy. Sitting for a lesson is difficult. Her squirminess lands her wrapped in the teacher’s lap.
And she’s needy. Britney, 4, is quick to hug a stranger several times. She looks her teacher straight in the eye and calls her “Mama.”
“Who you calling Mama, little girl?” teacher Mary Smith asks with a teasing swat.
Smith is not Britney’s mother. Her mother is upstairs at the Women’s Treatment Center, a non-profit program at 140 N. Ashland Ave. on Chicago’s near West Side, trying to overcome her drug addiction.
Smith, who wears long black braids and a wide, welcoming smile, explains many of the children she teaches have lived and suffered with their mothers’ addictions for years. Often, as treatment transforms their mothers, the children have to get to know them all over again, Smith said.
Eleven years ago, before Smith began teaching this class, she was told to expect the worst of African American, low-income boys and girls such as Britney, especially those whose mothers used crack cocaine.
At the time, researchers warned Smith that many of the children in her class had been significantly damaged in the womb by their mothers’ drug use.
Smith, an early childhood teacher who had long worked with poor children, correctly suspected that they were wrong.
After studying substance-exposed children, researchers now say that these babies can develop as well as non-exposed babies from the same socio-economic background.
It took researchers years to come to these conclusions. In the meantime black families in Illinois have been disproportionately affected by the public policy shaped by the early predictions, an investigation by The Chicago Reporter shows.
“This is where prejudice and ignorance collide,” said state Rep. Mary E. Flowers, a Democrat from the Auburn Gresham neighborhood on Chicago’s South Side.
Flowers, a member of the children and youth committee, said she doesn’t have the support in Springfield to mandate consistency among hospitals, which decide which babies to test for drug exposure. The continuing focus on poor, African American addicts has, ironically, harmed all families, she added.
“The doctors think they are protecting [white] mothers by not reporting them, when what they are really doing is hurting the children.”
The old stereotype of so-called “crack babies” as black and poor continues to influence which infants are identified and treated as substance-exposed. But nationwide, roughly equal proportions of whites and blacks use drugs, according to 1999 statistics from the U.S. Department of Health and Human Services. The agency reports that 6.6 percent of whites and 7.7 percent of blacks used illegal drugs.
Experts also have concluded that, for a fetus, cigarettes, alcohol and other drugs are as bad, if not worse, than crack.
But a 1992 study by the National Institute on Drug Abuse showed that nearly 23 percent of white pregnant women nationwide drank alcohol, while fewer than 16 percent of blacks did.
And most studies show that alcohol can cause as many problems as cocaine. In fact, Fetal Alcohol Syndrome is a leading cause of retardation in the United States, according to the March of Dimes, a national, White Plains, NY.-based agency that combats birth defects.
State public health data show that 56.7 percent of drug-exposed babies tested positive for cocaine. The rest were exposed to opiates, cannabis and other drugs.
While delivering drugs to a fetus is not a crime in Illinois, it does fall under the definition of neglect, giving the state a reason to open a child welfare case, said John Goad, associate deputy director of child protection for Cook County for the Illinois Department of Children and Family Services. A baby can be tested for illegal drugs immediately after birth. If the test is positive, hospital officials may keep the baby there while a DCFS caseworker interviews the family and visits the home to make sure the infant has a safe place to go, he said.
DCFS rules include alcohol in the definition of a drug-exposed infant, Goad said. But because evidence of Fetal Alcohol Syndrome does not appear until later, DCFS gets few of these cases, he said.
Black babies in Illinois are more likely than white babies to be taken from their mothers and placed in foster care because of drug exposure, the Reporter found.
“The perspective in Illinois is that it is us versus them,” said Dr. Ira Chasnoff, a Chicago-based pediatrician and nationally known expert on drug-exposed babies. “The –˜them’ is lower-class minority women. So we just throw the Illinois Department of Children and Family Services at them. And we don’t give DCFS what it really needs to help the children.”
Between July 1, 1997, and June 30, 2000, DCFS took 39 percent of 5,851 drug-exposed black babies into foster care, versus 27 percent of 1,035 white babies.
“I have worked here for a long time and the most compelling explanation is that it is evidence of bias,” Goad said. He said racism pervades all levels of the child welfare system, from caseworkers to the courts that handle abuse and neglect cases.
Six years ago, to reduce prejudice in decision-making, DCFS officials developed more specific standards for investigations, Goad added.
Illinois has no law or policy dictating which babies should be tested for drug exposure in the womb, leaving the decision up to each hospital. No government agency tracks who is being tested.
The Reporter surveyed the 53 public and private hospitals that deliver babies in Cook County. Five of the hospitals provided data about the number of babies they test. The rest either did not respond, told the Reporter they could not provide the information, or declined to do so.
Two Chicago hospitals serving primarily black, low-income women said they test every baby, while two suburban hospitals that cater to primarily middle-class whites reported they test fewer than 2 percent.
Experts charge this amounts to a form of racial profiling, in which selective testing means a disproportionate number of black babies are identified as substance-exposed.
Hospitals are required to report babies who test positive for exposure to DCFS. The number reported in Cook County dropped 200 percent, from 3,010 in 1994 to 1,136 in 2000, according to the agency. But officials say they cannot track the total number of babies that are tested.
While black babies made up 78.6 percent of Illinois infants identified as drug-exposed in 1998, they accounted for about 20 percent of live births that year, shows the Reporter’s analysis of data from the Illinois Department of Public Health and the Illinois Department of Vital Statistics.
“It is outrageous that black, low-income women are being targeted,” said Julie Sternberg, a staff attorney for the American Civil Liberties Union’s Reproductive Freedom Project, based in New York City. The group has filed a friend of the court brief in support of the plaintiffs in a case now before the U.S. Supreme Court. They allege a Charleston, S.C., hospital’s policy on drug testing mothers and babies violates the mothers’ constitutional rights.
Sternberg doesn’t object to identifying drug-exposed infants if their mothers have agreed to have them tested. What she doesn’t like is that babies are often tested without their mothers’ consent, and without the mothers being advised of the possible consequences of such testing.
Twelve states, including Illinois, mandate the reporting of babies who test positive, according to a 1999 report by the U.S. Department of Health and Human Services.
DCFS officials, doctors, nurses and social workers have serious concerns about such infants.
Cocaine-exposed babies had a “significantly higher rate” of sudden infant death syndrome than the general population, according to a 2000 state health department report.
And Goad said he has seen many cases of women who were drunk or high who killed their children by rolling over on them while sleeping.
Most children survive, but still suffer when their mothers have no resources to get treatment. Smith sees such children in her classroom years later, and their mothers, she noted, are only now getting treatment for their drug problems.
“Poor babies,” Smith said.
Across from the red-brick Roseland Hospital at 45 W. 111th St. on Chicago’s far South Side stands a shuttered gas station with rust covering its antiquated pumps.
A side street is covered with potholes. Big, old houses line the streets. Some are boarded up and others have been demolished, leaving behind vacant lots.
Ninety-five percent of the area’s residents are black and the per capita median income is $16,735, according to 2000 estimates by Claritas Inc., an Ithaca, N.Y.-based market research firm.
Every baby born at Roseland Hospital will be tested for drug exposure, said Andrea Cross, director of perinatal services.
And 97 percent of babies born at the hospital in 1998 were black–”the most recent figures available, according to the state public health department. Almost 19 percent of the 565 babies tested positive.
Ninety-nine percent of the 1,168 babies born at St. Bernard Hospital, 326 W. 64th St., were tested in 1999, and 10 percent turned up positive, said a hospital spokeswoman. St. Bernard is in the Englewood neighborhood, where 99 percent of residents are black, and the per capita median income is $9,517.
Cross insists testing isn’t intended to punish the women or label the children. Drug exposure is an indicator that the baby will be at risk, she said, and the idea is to get the family help. “Every baby that is born here should be given the best chance at life. We have to ascertain if the mother can keep herself and the baby safe.”
Hospitals that don’t test every baby may miss those who are substance-exposed, Cross said. “I worry that babies will fall through the cracks,” she added.
Goad of DCFS also advocates for consistency among all hospitals, and said medical decisions should dictate who is tested.
“I don’t believe that we over-test in Chicago, but I believe we under-test in other places,” he said. “I think that [who is] identified has a lot to do with socio-economic status.”
In 1989, Chasnoff conducted a study in Pinellas County, Fla., which includes St. Petersburg, in which all babies born at a public hospital serving primarily low-income patients, and a private hospital that serves primarily middle class families, were tested for exposure. He found that 15.4 percent of white mothers and 14.1 percent of black mothers used drugs during pregnancy. Black mothers, however, were 10 times more likely to be reported to government authorities, he found.
“It is very biased,” Chasnoff said. “The key in selection is race and social class.”
In a federal lawsuit, Ferguson vs. City of Charleston, nine black women and one white woman contend that testing them and at least one of their babies for exposure amounts to unconstitutional search and seizure. Like Illinois, South Carolina has no legal standard for who should be tested.
In 1996, the women sued the city of Charleston, arguing that the nine factors its public hospital, Medical University of South Carolina, used to decide which babies to test were unfair. One factor was whether the mother had prenatal care. If she had no prenatal care, she was more likely to be tested, said Sternberg of the ACLU. But the “no prenatal care” standard is more an indicator of who is poor than who is abusing drugs, she added.
The ACLU and attorneys from the Center for Reproductive Law and Policy, who represent the plaintiffs, say the standard also targets black women.
Attorney Robert H. Hood, representing the City of Charleston, argued before the Supreme Court that the women were tested only after signing consent forms and therefore lost their right to protest. Also, he said taking drugs during pregnancy amounts to child abuse and the state has the right to investigate.
The Supreme Court heard the Charleston case on Oct. 4, 2000, and will rule on it by June.
Like the South Carolina hospital, Cook County Hospital lists “no prenatal care” as one of six factors physicians should consider when deciding whether to test, according to the hospital’s procedures manual. Cook County Hospital Counsel David N. Cavalho, however, declined to provide information on how many babies are tested and how many test positive, saying the agency does not compile such data. At least four other Chicago-area hospitals also use the “no prenatal care” standard in determining whom to test, the Reporter found.
Black women in Chicago were about half as likely to get prenatal care as white women, according to the Reporter’s analysis of state department of health data.
A few days after Christmas, Paulette, 24, sits in an examining room in the basement of LaRabida Children’s Hospital in Woodlawn at 65th Street and Lake Michigan with her then-5-month-old son perched on her lap.
Her 3-year-old son races up and down the hospital’s halls. Though the spirited toddler was born exposed to drugs, he does not seem to have any problems now, Paulette said.
The baby, however, is still suffering the effects of ingesting heroin and cocaine in the womb, his mother said. Paulette, a regular user before she became pregnant, said she only decided to indulge in drugs last June after she thought she had miscarried.
Two weeks later, her son was born two months premature. He wasn’t breathing.
Doctors were able to revive him. But he has been admitted to the hospital three times since then, and during this appointment at LaRabida’s Zero-to-Three Clinic, his cold and asthma are making his breathing heavy and gurgly. After her youngest was born, Paulette recalled, her caseworker put her foot down: Either she would admit herself to a drug treatment program or she would be forced to do so.
Paulette asked that her last name be withheld because she is embarrassed that she used drugs and exposed her children to them.
Paulette took them from the home she once shared with her boyfriend’s family in Austin on Chicago’s West Side and moved to the Women’s Treatment Center. At first, she enrolled in a four-week program, but it has helped her so much she volunteered to stay for an additional six weeks.
She likes the residential program because it removes her from temptations and offers structure, Paulette said.
Most experts agree that getting mothers into a drug treatment program probably is their best chance at becoming successful parents. “We can’t make a difference with the child unless the mother’s drug problem is addressed,” Chasnoff said.
Yet Rose J. Gordan, assistant clinical director of the Haymarket Center, 120 N. Sangamon Ave., noted that recovering from drug addiction is a difficult task, full of ups and downs.
“One hundred percent of the women will relapse,” she said. “The question is, will they be able to call us up, get support and get clean again?”
In 1990, Chasnoff and other researchers developed the pre-kindergarten class at the Women’s Treatment Center to study whether inpatient or outpatient treatment programs were better for families. They found that mothers who lived at the treatment center had the same chance at success as those who lived on their own, he said.
The precarious nature of drug addiction makes it difficult to determine how Illinois’ child welfare system should respond to drug-exposed babies, said Goad of DCFS.
If the agency finds that the mother is either unable or unwilling to care for her child, it takes the child into protective custody, and usually tries to find a foster home–”very often with a relative.
In Cook County in 1990, the agency took about 7 percent of the babies who tested positive into state custody, compared to 24 percent in the rest of the state, according to agency data. By 2000, DCFS officials took 33 percent of drug-exposed babies in Cook County into custody, slightly more than the rest of the state.
The Cook County increase is due in part to cases in which a woman already has an exposed baby, received treatment and later gave birth to another exposed infant, Goad said. In those instances, it is likely her children will be put into foster care.
Before a drug-exposed baby is sent home, a DCFS caseworker visits the home to see if the mother has extended family to help her, and also examines her history in the child welfare system.
If the child does go home, Goad said, a case file is opened and the family receives services such as drug treatment and emergency day care. Goad could not provide statistics on the number of substance-exposed infants who are sent home, but are subsequently taken into court-supervised custody because of abuse or neglect.
The importance of follow-up is underscored by an analysis of state statistics by the Children and Family Research Center at the University of Illinois at Urbana-Champaign. In fiscal year 1999, children in the DCFS system who lived with their families were more than six times as likely to be abused or neglected as those who had been taken into custody, the center found.
And in 1990 LaRabida’s Zero-to-Three Clinic surveyed the caretakers of 98 children who were substance-exposed and examined the physical and mental condition of the children. It found that biological parents were more likely than foster parents to say they needed social services and were “depressed.”
“The babies who went home with their biological mothers were not faring particularly well,” said Dr. Nancy Roizen, a developmental pediatrician who conducted the study.
Paulette knows the stress of having an addiction while caring for a child. The home where she lived with her boyfriend was dangerous, and she often worried about her 3-year-old getting into other people’s drugs or being abused, she said. She often kept him in her room to keep him safe.
In 1996, when Paulette got tangled in drugs, she dropped out of Triton College in west suburban River Grove. She hopes to return after treatment. She also has dreams for her children. “I want them to have everything I had,” said Paulette, a white woman who grew up in Oak Park. “I want them to live in the suburbs.”
Paulette’s children can overcome their early exposure to drugs only if they are raised in a stimulating, healthy environment, research shows. Many studies show that drug exposure in the womb does not have devastating effects on a child’s development. The children can thrive if they grow up in a nurturing environment, said Barry Lester, director of the Infant Development Center at Brown Medical School.
“We call poverty and exposure to drugs the double whammy,” Lester added.
A long-term study at Albert Einstein Medical Center in Philadelphia underscores this point. Eleven years ago, Hallam Hurt, chairman of the hospital’s division of neonatology, and her colleagues began following 219 babies born in Philadelphia, half of whom were “heavily exposed” to cocaine in the womb and half of whom were not.
So far, the researchers have not been able to detect a “statistically significant” difference in intelligence between the two groups, Hurt said. That is not to say, however, that the picture is rosy.
By the time they were 4 years old, 150 children remained in the study. Researchers gave them each an IQ test, and 118–”78.6 percent–”scored below average, she said. By third grade, nearly one-third had been held back at least one grade in school, Hurt said.
The study indicates that in general, children living in low-income, urban areas are in trouble, she said. Much, she added, remains to be learned as the study continues.
“The issue of what is happening to inner-city children is gigantic,” Hurt said. “We went looking for a pony and found an elephant.”
Back at Mary Smith’s class at the Women’s Treatment Center, the children play around the large yellow room. Joel sits in front of a computer listening to a story; Joney pretends to eat Play-Doh; and Jammel and Isaiah rhythmically shrug their shoulders and swing their bodies to a blues song on the radio.
Some will be in her classroom for three weeks, others for three months, Smith said. She worries where they will go once they leave, whether they will get into another program or be overtaken again by the poverty and drugs around them.
She wonders whether they will reach their potential. “After all, they are just kids and they have had a hard time,” she said.
Kay Komie, manager of LaRabida’s clinic, also worries. Demonizing mothers and labeling the children as damaged has hurt them, she said.
Many of the mothers who bring their babies to the clinic believe their drug use has already destroyed their children’s chances at being successful, she added. “The myth of the crack baby has made an impression. I worry that it will be a self-fulfilling prophecy.”
Sarah Karp is a Chicago-based writer. Contributing: Micah Holmquist. Tanisha N. Blakely, Tim Hollander and Jill Leahy helped research this article.