Transcript:

Welcome to The Long Way Home. A five-part limited series that journeys into the heart of substance use disorders and recovery. With a focus on women, people in recovery, vulnerable communities, and those who have traveled the long way home, we explore how addiction uniquely impacts pregnant people, mothers, adolescents, and young adults. 

Through conversations with leading experts, lawmakers, and people in recovery, we examine the intersection of addiction, the criminal legal system, systemic neglect, and the enduring effects of colonization. We center the right to recovery, recognizing it as a complex, lifelong process that deserves time, attention, and resources. 

This series is a space for truth telling, learning, and imagining a more just and supportive path home.

In this first episode of The Long Way Home, we explore the intersection of motherhood and addiction, with Karen Thompson. 

00:00:00 Michele Goodwin:

Karen, thank you, so very much, for joining me to discuss these very sensitive and important issues. Pregnancy justice has been at the forefront of recognizing the human dignity, integrity of the people that you’ve served, and these have been women who’ve long been left behind, back in the 1990s early 2000s. Attention being given now, but Pregnancy Justice was there when others were not paying attention, at all. 

So I’d like to start off with asking, how might we understand substance use disorder as it impacts motherhood, and at what stages. Pregnancy, postpartum, parenting. Give us a breakdown, and with that, perhaps even shine a light on the organization, because you all really have been doing the important work for a long time.

00:01:00 Karen Thompson:

Yeah. So first of all, thank you, very much, for having me. It’s always an honor to speak with you, and you, also, have been doing this work longer than most folks out there, so our paths have crossed, and we cite to you almost every brief that this organization files. So, hand in glove, we are here. 

So, first of all, just about Pregnancy Justice. Our mission is to represent people who are being criminalized because of their pregnancies, or their pregnancy outcomes. So, whether that’s an abortion, a miscarriage, or a stillbirth. And what constitutes criminalization in that context, is wide ranging, but 75% of our cases do involve folks who are using while they’re pregnant. And that is important because it touches on why some of these behaviors are being criminalized. The response to what is actually kind of a moral panic, and not necessarily an issue that is correctly relegated to the criminal defense space, and it talks about feminism, and how we treat women who we think are behaving badly, right.

And so when all of those three things come together, they form a pretty hideous parade, and what it all leads to is a carceral response to what is essentially a health problem.

00:02:29 Michele Goodwin:

And if I could, one of the things that you just touched upon, the carceral space, the carcerality. People don’t really understand that over the last 30 years, that there has just been this dramatic escalation of turning to incarceration to punish women, particularly, when they’re thought of as being bad moms, as being bad pregnant people. Can you shine some light on that? Because I think that people, people just don’t know. We talk about men and incarceration. Who talks about women?

00:03:10 Karen Thompson:

Not enough people. And you know, just statistically speaking, women are being incarcerated at rates that far exceed men, right now, and I, you know, I don’t have the breakdown of the data there, but just from our internal data, and the cases that we’re tracking, we know that in the year post Dobbs, there has been at least 230 cases of pregnancy criminalization, and as I noted earlier, 70% of those cases involve folks who are using. So we know that those numbers are being influenced to some degree by the criminalization of people who are using when they’re pregnant. 

And you know, we always have to kind of, and this is what I love about your work, and why it’s so instructive to what we’re doing, because you always have to pull out, to be able to pull back in. And one of the things that’s most important, I think, in this space is to recognize how the war on drugs came into being, and that it was very, specifically, created to criminalize communities. Not to remedy a drug use problem. Not to stop the sale of controlled substances. But to really destroy communities. 

And John Ehrlichman, who worked for Richard Nixon, fully said, that’s what we were planning to do. That’s what we wanted to do, and that’s what we did, right. When you take that and then you get to the 90s, with the kind of crack baby myth, that, like mix of things, turned into something where we saw hospitals, literally, coming together with law enforcement to arrest people who had just given birth, because they had used cocaine. And I mean taking people off a gurney, while still in their like hospital robes, half naked, and bleeding, into a jail, because there’s this idea that, basically, black women were giving birth to this new era of super predator children, right.

So, that, kind of, cultural mix, that toxic stew that we saw with the war on drugs, was meeting kind of the war on abortion, was meeting this kind of backlash to the progress of the second wave, and it all kind of became encapsulated in this spike of criminalization that we’re watching today. And you know, I always, I think it’s interesting how Jayden McCorvey was, you know, the Roe in Roe v Wade, her history is always erased in the story. And she was using while she was pregnant, as well, right. And the response was not to throw her in jail. It was like, what is the help this woman needs? Who are we going to actually focus on when we look at these issues? Are we going to look at the hurt? Are we going to look at the harm, or are we just going to say, prison and jail are the only responses?

00:06:00 Michele Goodwin:

I’m wondering how we gain empathy and compassion. What’s so important that you just shared how people feel it in the heart, that after Dobbs, which dismantled Roe in Planned Parenthood V Casey, how there has been the suffering, the surveillance that women have endured. How, as you described, what it means, like, how do we get people to understand the deep shame, and embarrassment, and humiliation, that a person must feel, if there you are, in a hospital gown, giving birth, and you’re being surveilled at the same time. So the effort isn’t all about you, and making sure that there’s a healthy delivery in birth, but it’s about the criminal punishment that’s immediately going to follow. 

As you know, as I’ve written about, as you all have written about, women being dragged out of hospitals in shackles and chains, with bloodied gowns, or being shackled while giving birth. What could be more humiliating? We don’t do that to cows, to pigs, to horses. You’ll never see an example of farm animals being taken to slaughter, that are all just chained like that. They’re allowed to walk, and that somehow there’s some sense that this is what’s dignified at a time of birth, is just stunning to me. 

And so, I do wonder about how we do that work of translation. I looked at my producers, they’re so great, and they’ve pulled up, for me, a couple of the reports, and I want to quote from a couple of the recent reports. So, the new Pregnancy Justice Report shows, high number of pregnancy related prosecutions in the year after Dobbs, and which you were mentioning, and I’m quoting here, that pregnancy as a crime shows that in the post Dobbs environment, pregnant people are under increased surveillance, and are getting arrested, prosecuted, and incarcerated for any actions that have a perceived risk of harm to the pregnancy. And then, just one other bullet point, and there’s so much that’s rich there, and we’ll have it online, as well, for our readers to be able to see. Our new report shows how the Dobbs decision emboldened prosecutors to develop ever more aggressive strategies to prosecute pregnancy, leading to the most pregnancy-related criminal cases on record. And that is a quote from Lourdes Rivera, who’s the president of Pregnancy Justice. And then saying, this is directly tied to the radical legal doctrine of fetal personhood, which grants full legal rights to an embryo or a fetus.

Karen, I don’t know even how you, how you do the work? Because I, you know, where you talk about the technical aspects of this. I’ve got other questions for you, but I do wonder, emotionally, what it’s like for you, Lourdes, and your team, to be confronted with these stories every day, multiple times in the day, of women being so brutalized, exposed to such cruelty, and that it’s not hidden. It’s public, in terms of how police and prosecuting these women.

00:09:37 Karen Thompson:

100%. I think one of the things that we have to be very focused on, as an organization is that work. That when we come in, that we are doing as much as we can with our clients to remove the kind of shame blanket, to make sure that we are seeing them in their wholeness, and their fullness, and that we understand that folks who are struggling with disorders are struggling with, you know, a mental health issue, or some sort of health care issue, that is not related to the charges that they might be facing. 

And I think, you know, there’s a way in which the law is just carrying out the wishes of patriarchy, right. We know that. We know that from race. We’ve seen how this plays out for so many other groups, and we know that to be true. So, part of the work is to interrupt those things, to say that your judgment, or your wish, your desire to give this fetus the exact same rights as the person who’s carrying it, which is never an equal exchange, right. It’s not that it, you know, you just divide it up equally. Things are going to be taken from, and assigned to, and the taken from, is always going to be the pregnant person. It’s never going to go in favor of that person. It’s always going to be taken from her. 

So, when we see that, and when we understand that, the legal strategy grows from there. It’s like, no, we are going to litigate this in the wholeness of a person.

00:11:13 Michele Goodwin: 

So, can you give some sense then about what the consequences are? So, there might be people who say, well, okay, there is surveillance. And they might say, well, there’s surveillance, because don’t we want for people who are pregnant to be healthy, and safe, and that the surveillance is connected to promoting their health and safety? What’s your response, or quick take on that?

00:11:35 Karen Thompson:

Well, who’s safety? Who’s health? And how is jail going to guarantee any of those things for anybody, whether it’s the fetus, whether it’s the pregnant person? One thing that jail is not known for is providing great health care to the folks who are incarcerated. So, it is a myth, and a lie, to think that that is the answer to the question. 

The real question should be, what is the need that is not being met here, and that need is about people getting the treatment they need. But putting all of that to the side, one thing that we see over, and over, and over, and over again, is that when people are being charged with child abuse, when they’re being charged with murder, when they’re being charged charged with, and literally this, we have an amicus brief we’re working on right now where someone is being charged with the sale of controlled substances to their own child for breastfeeding, right. And they’re using the idea that you are selling drugs to your own fetus if you are breastfeeding with your body, to keep your child alive. It’s a warping of the law to satisfy these kind of outlandish ideas. And what we see is that these charges that are not meant to be used in this context, are getting blown out, and they’re getting broader and broader, to drag so many people into their net. 

00:12:59 Michele Goodwin:

So then, what about this? So you’ve answered this question, which is for those that say, well, the surveillance is about protecting the health, and you say the health of who, and you say, okay, that certainly doesn’t protect, it certainly doesn’t protect the health of a newborn to be born in a prison toilet, or on the concrete floor, in a prison, which is what has taken shape, or to be born in solitary confinement. It’s hard to make that argument that that’s better than providing treatment for an individual where that individual is able to receive care in a medical facility, or or at a facility that is providing care. 

Well then, what about people who say, well, surely, the incarceration must not be long. Surely, you’re probably talking about women who are found to have used some form of a drug during pregnancy, and you and I know that drug can even be that the person was found to have taken half of a valium, only one time, during pregnancy, and that can be enough for a criminal charge, prosecution. For those who say, it must not be very long, these sentences, like they maybe it’s like a weekend in jail, maybe it’s a month away, and then they’ve learned their lesson, and they’re back home. What’s your response to those who say it cannot be as bad, as some are saying?

00:14:24 Karen Thompson:

It’s as bad. It’s as bad and it’s worse. We are seeing people get 10-year, 15-year, 20-year sentences, because these are felonies. They’re not misdemeanors. They’re felony acts, right. And so, if you’re getting charged with felony child abuse, you’re not looking at a five-year sentence. You’re looking at much more extended incarceral moments, right. It’s terrible. It’s terrible. 

00:14:54 Michele Goodwin:

Sometimes there are people who are taking plea deals, right. And so I think that we should also interrupt something else, because you mentioned at the beginning of the show, the war on drugs that targeted certain communities, and we know out of that, came mandatory sentences. But behind it, I think, is this vision, that it is a corrective, that it solves something, and there is a mythology around the use of crystallized cocaine. I don’t encourage anybody to use crystallized cocaine. Not at all. Don’t. But I think that there was a misconception that was clarified through the works of doctors, like Claire Cole, Hallam Hurt, about the narrative that was associated with crack cocaine, which again, one hopes for people to be able to get the help that they need in these cases. But can you speak, just briefly, to what was the mythology, and yet, what was the punishment?

00:15:54 Karen Thompson:

Yeah, the mythology was, literally, that using crack while you were pregnant was going to turn your child into this, a social, pathological, blight on society. Literally. There was like columnists who spent a lot of ink, and a lot of time, talking about the damage that the crack baby would do to society. It would suck up all of the safety net. It would, yeah, create this super predator class. And that was Hillary Clinton. Okay. So, like there was a real social push to demonize these children. 

Well, what happens? Turn, 2000 comes along. New York Times is issuing retractions saying, you know what? We are so sorry. That never happened. The science has now shown us that those kids are just fine. Nothing was wrong with them. A lot of the moms got the care that they needed, right, and things are fine. But what we have decided that we want to do, is again, treat folks who need care as monsters, and then we treat their children as monstrous. 

00:17:06 Michele Goodwin:

Yeah, and so in this disparity that you’ve just pointed out, so what we know then from these longitudinal studies done by Dr Hallam Hurt, over 20 years, tracking children who were born after there was maternal use of crystallized cocaine, and to be in Hallam Hurt’s study, you had to have said, well, you bet you used it dozens of times, dozens of times. And she wanted to see, then, what was the outcome for the children. And at each benchmark, whether it was at three years old, seven years old, going into middle school, high school, she didn’t see. She didn’t see what was being purported by journalists, by politicians, and yet, the consequences that the mothers experienced with taking plea deals of 10 years, 15 years, 20 years, for something that did not materialize. And along the same time, what research was showing is that there was this dramatic rise in prescription medications that were being prescribed to more educated, wealthier, white women during pregnancy. Cocktails of them. Demerol, Oxycontin, various things, all at the same time, a recognition that these women were experiencing stress, and pain, during pregnancy. 

And so, there becomes this tale of two cities, that on one hand, you can be prescribed medications that respond to the stress, the pain in the back, the swelling of the feet, the headaches, all of those things, during pregnancy, and the sense that, of course, there is a moral and social good, in responding to those things, and making sure that those pregnant persons are able to be as comforted as possible during pregnancy. And on the other hand, it is, we’ve got a jail cell small enough for you, or others.

00:18:58 Karen Thompson: 

100%, and I think that, you know, you raise a really important point about the science. Because I think, if you look at all the studies, or across drugs, so it’s not just, you know, crystallized cocaine, which we now have shown, we’ve debunked completely, but we’re still, we’re seeing that for other things, including fentanyl, including opioids, generally, that the long-term harms, even if a child is born, and is demonstrating neonatal abstinence syndrome, which is basically withdrawal symptoms at birth, even with those things present, children recover very quickly. And the best way to help them recover is to keep them with their parents, and to keep them with skin-to-skin contact, to enjoy that golden hour, to have the interconnectedness, and the care that happens through the relationships, right. 

And so it’s not just about the science being wrong, but when we split people from that kind of net of care, we exacerbate the worst things about the health outcome.

00:20:02 Michele Goodwin:

It seems to me that there’s this real divide in terms of those with whom empathy can be shown for their pain.

00:20:08 Karen Thompson:

Yes.

00:20:09 Michele Goodwin:

Or their discomfort, and a real sense that we should respond to it, and that we should help them to be healed, and then, others being blamed for their social conditions, and for responding to those social conditions. 

It’s dramatic, and I would only wish that we could address that better in our society. You know, our time is just flying right by. So, I better get back to these questions.

00:20:38 Karen Thompson:

Can I just say one thing, because you did mention it earlier, and I was like, you know, that’s really interesting, because when you were talking about, you know, we don’t even treat farm animals like that, I’m thinking about that recent ice raid in Georgia, at the factory where South Korean workers were literally, shackled, and taken away to jail, and South Korea is starting a human rights investigation. And I was like, that’s interesting, because there are so many, this has been happening in jails, and prisons, in the United States forever, right. And we are used to it. We are programmed to believe that that is the correct response to certain people, and we’re okay when we see it happening to certain, those people over there, and it’s never over there. Like it always comes home, and it was, I’m horrified for those people. I also recognize how long that’s been going on, and I hope it brings some attention to other spaces, including the the way that pregnant women, here, in the United States, are definitely criminalized.

00:21:41 Michele Goodwin:

Okay, Karen, so you’ve taken us back. You’ve taken us back, and I’m glad that you have, right, because at the core of it, how do we understand this? So, how do we understand this difference between pregnancy, that on one hand, a pregnant woman who’s been prescribed prescription medications that are actually substantive, the core of them, no different than the others, that are from the street, are treated in a way in which with respect, with care, with dignity, and concern. On the other hand, the being treated as being part of the worst of society, an inability to be able to see the person, and the struggle. And it seems to me that you’ve really taken us back to an origin story, right. Like this origin story of some people lacking the legal definition and stat status as being a human being, right. As being just property.

00:22:39 Karen Thompson:

100%, and I, again, this is where I think our work really overlaps, because I think that we lose context in the reproductive justice space, about the very real foundations of reproductive justice, and abuse, in the United States, and if you don’t bring into the conversation, that we as a nation, depended on the forced labor, the forced reproduction of black women in this country, to expand a property base, expand and build on wealth, a wealth that depended on the fruit of somebody’s womb to be expanded, if you don’t keep that always within the conversation, then you lose the capacity to understand why we think about pregnancy the way we think about pregnancy.

And and look, it’s not the same. It is just definitely not the same for black women and white women in this country, or for black and brown women, and white women, in this country. They’re different things. The way that people are thinking about those pregnancies are different. And part of that is if you’re in the throes of a demographic panic, if you believe that white people are losing numbers, and that they have to be added to, then when you criminalize them, you’re doing that for different reasons, than for black and brown bodies, who are only seen as workers, right, and to create more of a workforce. When you see those kind of divided lines, they’re going in different directions, but the destination, the control of the body, in surface to, both capitalism and to patriarchy, those are still where we end up. 

How we get there might be different, but that context is critical to understanding why things are happening the way they’re happening.

00:24:45 Michele Goodwin:

So one point, since you mentioned the racial differentials, I want to just offer a statistic, and then turn to questions about care and treatment, which is, we know from studies that date back, that black women are 10 times more likely to be reported by medical providers for having shared their social medical history of drug use, than white women. So, even that alone, going to a prenatal appointment, and sharing one’s social history, which medical providers ask, well, have you had anything to drink? Are you using any drug. And so, we know from statistical analysis, and from studies, that black women have, at a much, much higher rate, 10 times more likely, when sharing that, that they have, disclosing that they have used some drug, being reported to law enforcement and Child Protective Services, meaning then, the investigations their children being taken away from them, and more. 

So, Karen, let’s turn to treatment, and community support. So, what does it look like in terms of an alternative. If you could shape an alternative that included care for individuals who have substance use disorder, what would that look like? What’s the alternative to incarceration?

00:26:05 Karen Thompson:

And I’m going to caveat this, which I know is never a lot of fun on the podcast, but I do caveat it, because I am not a social worker. I am not a medical provider. I am an attorney. But I am an attorney who has eyes to see. And who also reads, and watches, to see what folks are doing in the world to assist. 

And so, health care is health care. Period. So, if someone needs to be given the care that they need for their substance abuse issues, then they should be provided that care, and that is something that was available. People who wanted to go to rehab, could have a little bit of Medicaid funding to cover that. If there was some assistance in that space, it would be available to them. If they went to a hospital to give birth, rather than calling CPS on them in the hospital, and conducting blanket drug tests, people who work in the hospital, the staff there, could be like, what do you need to be able to have a healthy birth, right now, and then be able to support the child that you bring into the world, right. And so, we don’t have that infrastructure. It’s not as robust as it needs to be. And what we also see is, even people who are trying their best to provide those sources for people who are rehabbing, even if it’s only for women, they won’t take pregnant women in those rehab organizations, right. 

So, the specificity of the experience kind of falls out, even in the places that are supposed to be there to support. So, I think some of the problem is we just don’t have the resources to give people the care they need. And so, what happens is that law enforcement, or prosecutors, then show up in court, and they are like, look at this mess of a person who is standing next to me, and the judge is like, whoo, you know what? You need to go to jail, to dry out, and then, that becomes the answer to everything. 

And so, I think if there is a response, it needs to be that, again, that interconnectedness of care, where people are getting their needs met, where we’re putting the effort and the resources to find out what those needs are, and to address them adequately.

00:28:22 Michele Goodwin:

We always ask, on our podcast before we close out, what’s the silver lining? the points of hope ahead for people who may be very doubtful about a commitment to justice in our nation, and world, in these times, and so, we like to think about where there are spaces of hope. And if you could help us with that.

What, for you, within the context of all that we’ve discussed, stands out as a silver lining or a point of hope? 

00:28:58 Karen Thompson:

I always struggle with this question, because I don’t want to, like I don’t want to sugarcoat that we are in terrible times. And while terrible times aren’t new, the particular circumstances of these terrible times, are new for us. And so, I want to be hopeful, but I also want to recognize that we are in what we are in. 

That being said, I also feel like we paint hope as this tiny, little Tinker Bell thing with wings, that’s fragile, and dainty. And hope is like a prize fighter, right. Like hope has a black eye. A busted-up nose. Her lip is bleeding. Clothes are torn, because hope is getting beaten up, and she’s standing up, and still landing punches. 

And so, when I think about hope in this moment, I think it’s about the fact that we are still showing up, that we are really dedicated to truth telling, no matter what the, kind of, impact is on that, the pushback is on that. We are completely focused on how we are going to make this world better, and that means that sometimes you have to lose to win. That means that we have to struggle with this idea of shame, that I think so many people feel very overwhelmed by. This idea that they are bad, that they’re doing something bad, when in fact, they’re just in a world that is painting them in a very particular way. 

And the fact is, we, people understand, we have this conversation on a broader level, when we talk to partners on the ground, when we bring it into the courtrooms, people understand that these ideas of fetal personhood that lead to this over policing, that lead to the surveillance, they’re not working, that they’re not the answer. When we recently closed a settlement in Alabama, in a county there, that was just treating pregnant people in their jails, terribly, and we settled with them, in Alabama, right.

So we know that there is hope, that there are ways to go forward to address this crisis of carceral response to pregnancy, and I think we will decriminalize pregnancy. It’s going to take us a second to get there, but it’s happening. And you know, with your work, with Dr Roberts’ work, with Jamila Parrott from Physicians for Reproductive Health, who is fantastic organization, that I hope everybody looks up, and looks into, we can get a different world, together. We can think about different ways to react, to keep families together, to keep people healthy, and to make the justice system just.

00:31:48 Michele Goodwin:

I love this vision of hope. You’ve given me a whole new idea of thinking about the scales of justice, and actually placing an image, giving hope an image, and what hope looks like. I love it. I love it, and I thank you. Thank you, so much, Karen Thompson…

00:32:09 Karen Thompson:

Thank you, for having me.

00:32:11 Michele Goodwin:

From Pregnancy Justice, for joining me. Really appreciate it. 

00:32:14 Karen Thompson:

It’s been an honor. I appreciate it. Thanks, Michele.

Guests and listeners, thank you, for joining us for our special limited series podcast, The Long Way Home. We want to thank our guests, and to our listeners, we thank you, for tuning in to learn more about addiction and recovery.

For more information about what we discussed today, head to msmagazine.com This podcast series is available on Apple Podcast, Spotify, iHeartRadio, and wherever you listen to your favorite podcasts. We are ad free, and reader supported, so we encourage you to support independent feminist media. 

Look for us at msmagazine.com for new content, and special episode updates, and if you want to reach us to recommend guests for our show, or topics that you want to hear about, write to us at ontheissues@msmagazine.com.

We want to thank collaborators for this project, including Professor Regina LaBelle. She is the Director of the Center on Addiction Policy at the O’Neill Institute for National and Global Health Law at Georgetown Law. She is also a professor of addiction policy at Georgetown, where she is also the Founder and Director of the Masters of Science in Addiction Policy and Practice Program.

Our producers for this episode are Roxy Szal. Oliver Haug, Allison, Whelan, Mariah Lindsay, and our intern is Emerson Panigrahi. We also thank Jennifer Weiss Wolf. The creative vision behind our work includes art and design by Brandi Phipps, editing by Natalie Hadland, music by Chris J Lee, and we are always grateful to you, our listeners.