The So-Called "Crack-Baby" Scare
During the late '80s, Americans shook their heads in disgust at reports that poor black mothers were sacrificing the little ones resting in their wombs for the pleasures of crack cocaine, callously dooming a new generation to "a life of certain suffering, of probable deviance, of permanent inferiority," to quote columnist Charles Krauthammer. Seizing on early studies that raised alarm over fetal damage from cocaine, scientists cited the same inconclusive data again and again. Local news organs spun their own versions of the crack-baby story, taking for granted the accuracy of its premise. Social workers, foster parents, doctors, teachers, and journalists put forward unsettling anecdotes about the "crack babies" they had seen, all participating in a sleight of hand so elegant in its simplicity that they fooled even themselves. They talked of babies shrieking like cats and refusing to bond, of children unable to focus on a task -- and then they slipped in the part they should have tested, attributing these problems to prenatal cocaine use. Reporters went into hospital nurseries and special schools and borrowed the images of premature babies or bawling African-American preschoolers to illustrate their crack-baby stories. Carol Cole, who taught at the Salvin Special Education School in Los Angeles, remembers reporters asking if they could get pictures of the children trembling. The crack baby quickly became a symbol for the biological determinism recently promulgated in its rawest form by Charles Murray and Richard Herrnstein in The Bell Curve: These (mostly black) bug-eyed morons weren't quite human -- and no amount of attention could make them so. In the late '8os, some commentators predicted they would become America's "biologic underclass." By 1991, John Silber, president of Boston University, went so far as to lament the expenditure of so many health care dollars on "crack babies who won't ever achieve the intellectual development to have consciousness of God." Early Dissent Even as news of the "epidemic" swept across America, a few of the country's most knowledgeable research scientists were beginning to doubt the phenomenon. In Atlanta, Claire Coles, a developmental psychologist at Emory University School of Medicine, had graduate students watching infants for hours at a time: "You could not distinguish the cocaine-exposed babies from the other babies," she says. Nancy Day, an epidemiologist at the University of Pittsburgh School of Medicine, stood up at a conference six years ago and admitted she thought the impairments researchers were observing were not caused by cocaine. "People," she recalls, "were just aghast." At North Central Bronx Hospital, pediatrician and researcher Daniel Neuspiel looked at his own data on newborn behavior and concluded that the alarm over crack babies was misguided. "It really got out of control," says Donald E. Hutchings, a research psychologist and editor of the journal Neurotoxicology and Teratology, "because these jerks who didn't know what they were talking about were giving press conferences. I'd be sitting at home watching TV, and suddenly there'd be the intensive care unit in Miami or San Francisco, and what you see is this really sick kid who looks like he's about to die and the staff is saying, 'Here's a crack baby.'" But what a few cautious scientists had to say did little to weaken the momentum of the crack-baby myth. In fact, researchers who found no or minimal effects from cocaine had a hard time getting their results before the public. In a 1989 study published in the Lancet, Canadian researcher Gideon Koren showed that papers reporting a cocaine effect in child behavior were likely to be accepted over those showing no effect, for presentation at an annual meeting of the Society for Pediatric Research -- even when the no-effect studies were of sounder design. "I'd never experienced anything like this," says Emory's Claire Coles. "I've never had people accuse me of making up data or being an incompetent scientist or believing in drug abuse. When that started happening, I started thinking, This is crazy." Myth in the Making The earliest and most influential reports of cocaine damage in babies came from the Chicago drug treatment clinic of pediatrician Ira Chasnoff. His first study, published in 1985 in The New England Journal of Medicine, found that the newborns of 23 cocaine-using women were less interactive and moodier than non-cocaine-exposed babies. In the years that followed, Chasnoff was widely quoted and fawned over in the press ("positively zenlike," according to Rolling Stone) and became known as the rather pessimistic authority on what happens to babies whose mothers use cocaine. Of course, Chasnoff wasn't the only researcher to report serious effects. They were legion, some publishing simple case reports that took a few cocaine-exposed kids and racked up their problems. Judy Howard, a pediatrician at the University of California, Los Angeles, piped up regularly, once telling Newsweek that in crack babies, the part of their brains that "makes us human beings, capable of discussion or reflection" had been "wiped out." Some claims of severe effects -- that cocaine causes a sharp increase in sudden infant death syndrome, for example -- were recklessly extrapolated from small samples. But the fundamental problem in interpreting the data was a failure to tease apart the effects of prenatal cocaine use from the effects of an array of other social and biological burdens that often come as a package deal. The Real Science As a group, women who use cocaine while pregnant -- especially those who are likely to get noticed as addicts or be tested for drugs in the hospital -- tend also to drink more booze, smoke more cigarettes, and dip into a greater variety of illicit drugs than other women. They generally have poorer nutrition and overall health, bear and rear their kids in conditions of more profound deprivation, and are more persistently exposed to violence than other women. Such burdens impact not only their pregnancies, but also the daily lives of their children. Cocaine or no cocaine, these kids are more likely than others to have medical, educational, and social difficulties. No one suggests using cocaine in pregnancy is harmless. But unlike alcohol, which in heavy doses can cause a set of birth defects known as fetal alcohol syndrome, cocaine is not associated with any pattern of defects. Nor does it produce infantile withdrawal, like opiates. Today there is something approaching scientific consensus that cocaine increases the risk of low birthweight and perhaps premature delivery. According to pediatrician Neuspiel, the birthweight decrement attributable to cocaine is roughly equivalent to that caused by cigarette smoking. Being premature or underweight is serious business for an infant, but the effects are by no means immutable; it's a truism in medicine that preemies of rich parents do better than those of poor parents. While some studies have found abnormalities in behavior among cocaine-exposed newborns, others have contradicted them; it appears that neurobehavioral effects are subtle if they occur at all. In any case, newborn behavior does not predict what a child will be like at age 3 or 6 or 12. A 1992 commentary in the Journal of the American Medical Association decried a "rush to judgment" about long-term effects of cocaine, concluding that the evidence was "far too slim and fragmented to allow any clear predictions about the effects of intrauterine exposure to cocaine on the course and outcome of child growth and development." Even pediatrician Chasnoff began to temper his message as he saw his work used to fan public outrage against the very women and children for whom he considered himself an advocate -- and as a large group of cocaine-exposed children whom he was following reached their third birthdays without apparent cocaine-related intellectual deficits. Now that these children are 6 or so, Chasnoff says, they appear normal in the smarts department, but display a "significant increase in rates of impulsive behavior, distractibility, [and] aggressive behavior." Is this deviance the result of biological damage? The prenatally drug-exposed kids live in the same neighborhoods and go to the same schools as the non-drug exposed controls. But their environments differ in this important respect: All the mothers of the drug-exposed children have relapsed at least once since delivering, and 60 percent are still using. The Maternal Lifestyles Project, a major study enrolling thousands of women and their infants, will likely offer a deeper understanding of cocaine effects within a few years. But to date, no researcher, taking into account a child's life experiences, has ever demonstrated that cocaine-exposed children are more unruly or any less intelligent than other children. Provide or punish? The crack-baby myth was so powerful in part because it had something for everyone, whether one's ideological leanings called for enhancing public programs to meet the crisis, or for punishing the drug-addicted mothers seen as responsible for it. For some, the assertion that crack babies were in dire trouble became a way of begging funds for substance-abusing mothers and their infants. In the late '80s both federal and state governments launched expensive projects to study the consequences of prenatal abuse and try out treatment strategies for mother and child. When, in 1992, Boston Globe columnist Ellen Goodman wrote a piece questioning the basis of the crack-baby scare, Chasnoff got calls from alarmed program directors who worried they would lose funding. The public initiative had emphasized the need to help substance-abusing women only while pregnant -- as "vessels," as Chasnoff put it. Perhaps it was feared that if those vessels no longer threatened to produce a damaged and burdensome generation, public interest would falter. At any rate, it soon became clear that the major thrust of policymaking would be to punish mothers who smoked crack. In the late '80s, local prosecutors began busting women who used drugs while pregnant or whose newborns tested positive. Between 200 and 300 such women have been prosecuted, often under existing child abuse and neglect statutes, and mostly for cocaine. Attorney Lynn Paltrow of the Center for Reproductive Law & Policy in New York City points out the slippery slope: If you call it child abuse when pregnant women use cocaine, then you have to call it abuse when they smoke or drink or engage in any of a host of behaviors that are potentially just as dangerous. Criminal convictions for prenatal drug use, when challenged, have generally failed to stick. Not so with actions by the civil child welfare system. Thirteen states require doctors to report drug use in pregnancy or positive drug tests in newborns. Nine states specifically define drug use during pregnancy as child abuse or neglect, triggering a range of responses from treatment and other services to an investigation and the possible removal of the child. The bulk of these policies were put in place between 1988 and 1991, as the crack-baby scare peaked. Some of the policies ostensibly designed to protect cocaine-exposed babies ended up isolating them instead. In the late '80s, the practice of automatically keeping newborns in the hospital if they tested positive for cocaine, now largely but not universally abandoned, contributed to an unmanageable population of boarder babies at some urban hospitals. In New York City, most of these babies eventually went home to their families -- after languishing in a crowded hospital nursery for the dawning weeks or even months of their lives. Of those who stayed in the system, according to a study of one six-month period in the mid-'80s, 30 percent still didn't have a permanent home by the time they were 3 years old. Self-fulfilling Prophecies Quite frequently, people present developmental psychologist Dan Griffith with a little person they call a crack kid. "Based on that," says Griffith, a private consultant in Park Ridge, Ill., who once worked with Chasnoff's group, "I have no idea of what I'm going to see. It tells me nothing about the child." Developmental psychologist Claire Coles, who is also a clinician, has seen "crack babies" who were in fact colicky babies. Often, she says, the anti-social behavior attributed to crack-induced brain damage is a classic sign of neglect. In her work, for example, she has encountered children who ate from the garbage -- not because of brain injury, but because they were not accustomed to being fed. During the height of the crack-baby crisis, experts counseled caretakers to swaddle cocaine-exposed infants, keep them in a quiet, dark place, and avoid gazing into their eyes. This makes sense for any baby with a raw, easily over stimulated nervous system. But to apply these practices to babies who have no symptoms is, in Coles' words, "utter, utter folly." Griffith, who has seen hundreds of cocaine-exposed children, believes only a few were developmentally delayed because their caretakers had deliberately under stimulated them from infancy. Still one has to wonder, what can a child become when everyone around him braces for the worst? Being identified as drug-exposed sometimes gets a child special state-sponsored services, but it also carries the potential for stigmatization and self-fulfilling prophecy. If a child was exposed to drugs in the womb, people now assume the worst. A June 1990 federal report explained that would-be adoptive parents were reluctant to take on "crack babies" because of their potential long-term problems. Teachers, too, were aghast to learn, as the '90s began, that they could soon expect the "crack babies" in kindergarten. "The arrival of those first afflicted youngsters will mark the beginning of a struggle that will leave your resources depleted and your compassion tested," warned an article in The American School Board Journal. The Myth's Legacy In recent years, the headlines about crack babies have trumpeted the good news: They've beaten the odds! There's new hope! But the odds should never have been laid so early, and those headlines should read, "Oh God, what have we done?" The publicity blitz that spread the crack-baby myth has not been matched by an attempt to unmake the myth -- and many, many people still believe in it. Leake and Watts, a large foster care agency in New York City, still refers drug-exposed babies and their foster parents to a special program where, even if a child seems just fine, he is closely watched. Last year, in a segment about an ongoing legal challenge to a South Carolina hospital that had newly delivered mothers hauled off to jail if their infants tested positive for cocaine, 60 Minutes showed sick babies, implying that their problems were cocaine-related (while claiming legal considerations precluded identifying exactly which babies were cocaine-exposed). Only a few months ago in a New York Times Magazine piece entitled "It's Drugs, Stupid," Joseph Califano Jr., a former secretary of Health, Education, and Welfare, wrote that "crack babies" can cost $1 million apiece to bring to adulthood, and suggested that the children of addicted welfare mothers who "refuse" treatment be put in orphanages or foster care. In some professional circles, the term "crack baby" has given way to "drug-exposed baby." But even layered over with euphemism, however gently its promulgators protest their good intentions, the meaning of the crack-baby epithet is clear. It means we can blame the problems of the least privileged children on the unnatural conduct of their mothers. It means we can all rest easy in the futility of giving our time and money to feed, house, educate, and love these children, whose failings are inborn and past remedy.