Criminal Penalty for Mothers Wrong, Experts Say

More than 100 experts on alcoholism and birth defects went on record Tuesday discouraging the use of criminal penalties as a means of combating substance abuse by pregnant women.

The health care and social service officials attending a national conference at UC San Diego also took a bitter swipe at the alcoholic beverage industry. They endorsed mandatory health warnings on beverages, product liability lawsuits against beverage manufacturers, laws requiring free broadcast time to counter alcohol advertising and studies of ways to tax the industry to pay the long-term costs of alcohol-related birth defects.

A 33-point platform adopted by the conferees represented “the most comprehensive document addressing policy, research and educational issues ever developed” in the area of alcohol and birth defects, according to the conference chairwoman, Christine Lubinski, a lobbyist for the National Council on Alcoholism.

The conference brought together federal, state and local officials; researchers; treatment agency workers, and others from 15 states; Washington, D.C., and Canada. The list included top officials of California’s alcohol program and the National Institute of Alcohol Abuse and Alcoholism.

The policy stance opposing legal action against pregnant women apparently was the first organized response to the prosecution of an El Cajon woman whose brain-damaged baby died a few weeks after birth. In that case, Pamela Rae Stewart, 27, is charged with misdemeanor neglect for allegedly using illicit drugs and otherwise ignoring a doctor’s orders during her pregnancy.

Critics of legal intervention warned during the three-day meeting that an onslaught of similar cases could frighten alcohol abusers away from obtaining the treatment needed to limit the damaging potential of maternal drinking.

According to researchers’ estimates, as many as 6,000 infants are born in the United States each year with fetal alcohol syndrome--a complex of defects including distinctive facial and body malformations, mental retardation and inhibited growth. An additional 36,000 infants show signs of less severe defects attributable to their mothers’ consumption of alcohol during pregnancy.

Analysts’ most conservative estimates of the social costs of these alcohol-related birth defects--both in direct services to the damaged individuals and their reduced productivity in comparison with normal persons--range from $1.9 billion to $2.4 billion per year.

The link between pregnant women’s consumption of alcohol and a specific pattern of birth defects was first identified only 13 years ago. Surveys have found widespread, if superficial, awareness of the link. But speakers at the conference said many physicians and other health-care providers continue to overlook the consequences of drinking during pregnancy.

“It’s much easier for them to continue with a lack of identification, because then they don’t have to do anything and they can pretend it’s not there,” said Rebecca Beardsley, a registered nurse who heads a nationally recognized fetal alcohol syndrome program in Lincoln, Neb.

Dr. Kenneth Lyons Jones Jr., a UCSD researcher whose landmark 1973 study first identified the syndrome, defended the medical profession, saying doctors have demonstrated increasing awareness of the alcohol-birth defects link.

“If we’re talking about suing people, we should be suing the alcohol industry,” Jones said. “They’re the ones who are not warning people about the dangers of alcohol and the unborn baby. They’ve known about it for years, and they’ve been making millions and millions of dollars on it and walking free.”

The conference called for federal regulation of alcoholic beverage labeling to be transferred from the Bureau of Alcohol, Tobacco and Firearms, which has resisted mandatory health warnings, to the Food and Drug Administration, which in the past has favored labeling.

Patricia Schneider, director of health and social issues for the San Francisco-based Wine Institute, voiced anger Tuesday when conferees suggested that advertising by the alcoholic beverage industry regularly ignores the industry’s own codes of ethics.

In an interview, Schneider said the conference program “was very unbalanced,” ignoring research that suggests that only heavy-drinking pregnant women are in danger of contributing to birth defects in their children. The findings, she said, dictate a response directed at those women, rather than universal warnings.

“What we have here is the politicization of the fetal alcohol syndrome issue,” Schneider said.

The conferees called for improved maternal and child health care and increased funding of research and treatment of alcohol-related birth defects.

They urged that special attention be directed to groups at high risk for alcohol-related birth defects, including alcoholic women, children of alcoholics, adolescents and American Indians.

Indians are among those hardest hit by fetal alcohol syndrome. Robin LaDue, a Seattle researcher, reported that 1 in 49 infants born on a reservation she studied in the Southwest suffered alcohol-related damage. One in 99 had the full-fledged syndrome--10 times the national average. None of the 61 patients in the study with fetal alcohol syndrome was capable of independent living, according to LaDue. Their median score on IQ tests was 68 (a score of 100 indicates average intelligence).

Participants in the conference raised repeated warnings about the dangers of a crackdown by law enforcement agencies and prosecutors on alcohol-abusing pregnant women. Many of the comments referred to the Stewart case.

Robert Roth, a lawyer with the Pacific Institute for Research and Evaluation in Berkeley, said such prosecutions were one of “a number of very scary ideas” proposed for using the legal system to combat maternal drug and alcohol abuse.

“The thing these various approaches have in common is that of victimizing the victim,” Roth said.

With little debate, the conferees adopted a recommendation that “every effort should be made to intervene in a treatment-oriented manner prior to legal intervention.” Intervention to protect fetuses, they said, should be limited to the third trimester of pregnancy and should impose the least possible restrictions on parental rights.

“These punitive measures shouldn’t be aimed at women if they have not had real access to treatment and prenatal care services,” Roth said in an interview. “Communities should be doing outreach in that regard before they throw people in jail.”