Tuesday, January 12, 2016

“Fetal assault” and later environment effects on child development: using neuroscience as a tool for political policy

By Carlie Hoffman

Premature infant, courtesy of Wikipedia
“Crack babies,” “crack kids,” and the “lost generation” were all terms used by the public and the press in the 1980s and 1990s to describe children born to mothers who used crack-cocaine during pregnancy. Supported and spurred on by the media’s interpretation of preliminary research performed by Dr. Ira Chasnoff, among others, these children were often born prematurely, had tremors and a small head circumference, and, based on their description in the press, were expected to have neurobehavioral deficits, reduced intelligence, and deficits in social skills. These children were also anticipated to cost educational and social systems thousands of dollars as they matured and entered into schools and eventually the workforce.

Yet, after additional studies have been conducted and as the “crack babies” have grown into adolescents and young adults, it has been found that the negative outcomes widely described by the media were overreaching and unsupported. “Crack babies” did not, in fact, present evidence of severe, broad problems with social development and cognitive functioning and did not prove to have the predicted detrimental social and financial effects on the school system. Instead, many of these children have grown into successful adults over the past two decades. Dr. Claire Coles, a researcher responsible for producing the first studies that challenged Chasnoff’s findings, thought the era of the “crack baby” had finally come to an end. However, as Coles discussed during the December Neuroethics and Neuroscience in the News journal club, “crack babies” and similar stories about children exposed to opiates, have resurged in recent media publications (seen here and here) and are rearing their heads once again.

Misinterpretation of research has accompanied this resurgence of concern about the effects of prenatal drug exposure, and such misinterpreted findings have been used to support media sensationalism and alterations in public policy that are often punitive toward women. While Dr. Chasnoff described infants exposed to cocaine during pregnancy as having a low birth weight, a small head circumference, and shorter length, Dr. Coles challenged these findings by pointing out these symptoms can also be used to characterize babies born prematurely. Additionally, the prematurity that often accompanies the birth of babies exposed to drugs in utero likely does not arise solely from prenatal drug exposure. As Coles stated, cocaine abuse, like other drug abuse, rarely occurs in a vacuum and several factors surrounding cocaine use may contribute to premature birth. Oftentimes, pregnant women using cocaine also have a low socioeconomic status, abuse other substances, live in a stressful social environment, and experience an overall negative maternal lifestyle. It has been shown that maternal poverty has a detrimental impact on the developing infant, with gray matter volume being positively correlated with social class in children aged five months to three years (though increased brain size is not always an indicator of improved intelligence). All of these factors, in addition to cocaine use, are likely to contribute to premature birth and the associated negative outcomes that Chasnoff observed in prenatal cocaine infants.

The body of Coles’ work indicates that drug use (not limited to the use of cocaine), poverty, and lack of social support are harmful both during pregnancy and once the child is born, and that cocaine alone does not affect infant growth or cognition. However, while Coles found that a majority of the characteristics ascribed to “crack babies” could not be attributed to cocaine use alone, she did find some alterations in child development resulting from cocaine use during pregnancy. Namely, cocaine exposure leads to persistent changes in the child’s stress response and alterations in amygdala activation during arousal regulation (reflecting a difference in the ability of the child to adjust and allocate mental resources for multiple interacting stimuli). Additionally, alterations in brain connectivity and structure have been recorded in children exposed to cocaine; however, little to no functional difference has been affiliated with these changes.

A government campaign to warn against
cocaine use, courtesy of Wikipedia
After other researchers, Coles included, performed additional studies examining the effects of prenatal exposure to cocaine, Chasnoff realized his initial findings overstated the detrimental effects of cocaine on the developing infant. Yet, by the time Chasnoff realized his error and attempted to recant his strong early statements, it was too late. During the 1980s and 1990s, when Chasnoff’s research was first popularized, the nation was also battling a cocaine epidemic. Chasnoff’s claims supporting the negative effects of prenatal cocaine exposure fit into the public’s desire to discourage the growing popularity of cocaine, and, as a result, Chasnoff’s findings were quickly accepted as true. Despite Chasnoff’s revised statements and the presentation of Coles’ findings that collectively lessened the damage caused by prenatal exposure to cocaine, the notion of the “crack baby” was already well established in the media and in the collective mind of the public and thus was not easily eliminated. The media sensationalized findings that reinforced the public’s beliefs and fit into their collective social consciousness, and suppressed the later findings that refuted that claim.

As evidenced by the “crack babies” case, once ideas that fit into cultural stereotypes take hold, they are hard to remove and often are used to inform social and political policies. Research into the negative effects of all manner of substance abuse on the unborn infant has been used to support an increasing trend toward punishing “fetal assault,” a term used by people interested in legislating women’s behavior during pregnancy, with certain behaviors (including substance use) potentially being classified as child abuse. While the purpose of such legislation is often cited as preventing substance abuse and discouraging negative maternal lifestyle during pregnancy (essentially scaring moms into becoming clean), the effective outcome of such laws is often to turn women using substances during pregnancy into criminals instead of people needing medical care. As a result, pregnant women often become afraid to seek treatment for their drug use due to the legal repercussions they will likely face, potentially causing more damage to their developing fetus.

Attempting to prevent fetal assault has given rise to several laws throughout the United States, with many being written and enforced based on preliminary research or over-interpretation or misinterpretation of research findings. One such law in Tennessee allows women to be arrested or lose their children if they are found using drugs or other substances while pregnant. Alabama’s law, referred to as the “chemical endangerment of a child,” allows a mother found using substances during her pregnancy to receive one to 10 years in prison even if her baby is born healthy, a longer sentence if her baby is born with developmental or cognitive problems, and potentially life in prison if her child dies after birth. The state of Wisconsin can take jurisdiction over an unborn child if a woman poses a substantial risk to her child and does not exercise self-control during pregnancy. In South Carolina, one woman had a miscarriage after using cocaine while pregnant and was arrested for murder. While such laws often lead to negative outcomes for both the mother and her child, these laws are often not equitably enforced, with women of lower social economic status often being punished more often than women in higher social classes.

In discussing Chasnoff and his findings with Dr. Coles after her talk, she clarified that “[Chasnoff] was never an advocate of taking legal action against women. He was, in fact, a very early advocate of fairness in this area.  He was speaking in good faith, although I disagreed with the interpretation of his early findings.” She also stated that “the media hysteria and how people get caught up with that" played a large role in sensationalizing the negative effects of cocaine on the fetus and contributed to the laws made pertaining to this issue. “The context of the problem was the media and the societal attitudes toward the problem and the punitive legalistic response to the problem, particularly in regards to women, poor women, women of color, and women’s reproductive choices.  This kind of thing has not changed and is still a terrible issue.”

There is a complex relationship between science and the
media, courtesy of Wikipedia 
Taking all this into consideration, Coles asked how scientists should share their findings, what the ethical issues for neuroscientists in providing information to the public are, and how scientific findings, such as those reported by Chasnoff, should affect social policy. As evidenced in the case of the “crack babies” and their affiliated political ramifications, harmful repercussions can come from the dissemination of scientific claims lacking validity and support. The initial use of the “crack baby” label in the 1980s and 1990s caused women to lose possession of their children, children exposed to cocaine in utero to have difficulty being adopted, any abnormal behaviors of “crack babies” during infancy and in educational settings to be interpreted entirely through the lens of their early cocaine exposure, and affected the self-perception of the children themselves.

The dissemination of unsupported scientific claims is a problem we continue to face in many forms, with more recent examples being the link between infant vaccination and autism and people only using 10% of their brains. Neuroscientists have an ethical responsibility to be precise and careful with what they say, being cognizant of the effects their claims can have on the media and on society at large. The relationship between science, the media, and social policy is complex and must be handled with care. It is the responsibility of the scientist to help people (both the public and policy makers) understand what their scientific findings mean and what their findings are actually showing, and also to suggest potential solutions to social problems instead of simply providing fuel to feed these problems. Neuroscientists are in a unique position to speak to the media and shape what information they disseminate to the public. As a result, scientists need to make sure they are saying things correctly and taking into consideration both how their science is going to be perceived and the current social climate. The media often seeks to isolate elements from scientific literature that support popular opinions without critically examining such information. Yet, after misrepresenting such scientific findings, the media will likely move on to the next fad and leave behind a mess of misinformation that scientists are left to clean up. Thus, it is in the best interest of scientists, and in the best interest of the public, to be careful with what they say. For all of us, as consumers of the media, we must be willing to objectively consider scientific evidence that conflicts with the current social climate instead of only accepting claims that fit in with our current stereotypes and political opinions. Misrepresentation of scientific findings can lead to wide-scale misunderstandings and social and political repercussions-- an outcome that is definitely within our power to prevent.


Want to cite this post?

Hoffman, C. (2016). “Fetal assault” and later environment effects on child development: using neuroscience as a tool for political policy. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/01/fetal-assault-and-later-environment.html



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