Should drug-addicted mothers be stopped from having children?

Babies from addicted mothers are often born prematurely.
By Frederiek Weeda

Some mothers - drug addicts among them - are incapable of taking care of their unborn children. Should they be interned in the interest of the children? Or should they even be allowed to have kids?

A chubby infant plays with a book in his crib. He doesn't cry or coo, but his raspy breathing can be heard across the room. Unlike most nine-months-old babies, Carlos can't sit up or roll over yet. But lately he has been smiling and he is eating well, his foster mother Wilma Aarts says. And he no longer needs artificial respiration. Carlos is the fifth child of a cocaine-addicted mother who is now expecting her sixth.

Carlos' case exemplifies a debate among ethicists, psychiatrists and legal experts: how far should society go in protecting an unborn child from its own mother? The Dutch government has been running a campaign for the past year calling on women to adopt a healthy lifestyle as early as a year before conception. But is it enough?

Some experts are saying the government should intervene if the mother's lifestyle is dangerous for the fetus, for example by forcibly interning pregnant women who are addicted to hard drugs or alcohol, as ethicists Guido de Wert and Ron Berghmans recently proposed in an opinion article in NRC Handelsblad. De Wert and Berghmans want forced internment of pregnant women to be made part of a new law proposal on compulsory mental health care, and they want the state to intervene well before the 24th week of pregnancy, when the fetus is at its most vulnerable.

One question is on everybody's mind: can a fetus of less than 24-weeks-old be considered a person in its own right, or does it become a person only when it is a viable baby? The distinction is important because the first definition would make abortion, which is allowed until the 24th week of pregnancy in the Netherlands, equal to murder.

Forced sterilisation

In Wilma Aarts' living room in Amsterdam, two-year-old Jeffrey points to the crib and says: "Brother, brother." Carlos doesn't react. Actually, he never cries at all. He makes no use of what is a baby's main means of communication. Carlos spent the first five months of his life in three hospitals and in the care of dozens of medical workers. For the first two months and a half he fought for his life in an incubator. Wilma and her husband visited with him every day; his own mother stopped visiting eight days after the birth.

In Amsterdam alone some twenty addicted women give birth to a living or stillborn child every year. It was what prompted Amsterdam juvenile judges Anne Martien van der Does and Toos Enkelaar last year to plead for a system of guardianship of unborn children. This would allow a guardian to monitor the lifestyle of the addicted mother.

Wilma Aarts and her husband discuss the issue regularly. They think compulsory internment or guardianship are not enough: addicted mothers should not be allowed to have children at all, they say. "For years now there has been a debate about forced sterilisation of some mentally handicapped women. Why not include addicted women?" Aarts says.

An emotional appeal

And yet, once a baby from an addicted mother is born, Wilma and her husband embrace it. They love Jeffrey who has been with them for two years. He's developing well despite being a premature baby and having been exposed to cocaine in his mother's womb. They are getting attached to Carlos as well. As far as they are concerned, the boys can stay with them for as long as they need to.

But someone has to convince - or force - the mother not to have any more children, the couple pleads. Aarts: "A child only gets one chance to develop its lungs and that's in the womb. These children are all born prematurely, with underdeveloped lungs."

Once she tried an emotional appeal to Jeffrey and Carlos' mother. "I wrote her a letter begging her not to have more children." Aarts never got a reply from the mother she describes as a charming woman whom she sees every couple of months.

But the mother refuses to use birth control. She lives with a man who partly bankrolls her addiction. He is the father of the three youngest children and says he too is incapable of caring for them. The mother occasionally spends time in jail. A third child lives with the man's mother; the oldest two children are in foster care.

Wilma Aarts: "Soon the sixth child will be fighting for its life in an incubator. And we won't be able to give it a home. Somebody else will have to do it."

Temporary compulsory contraception

But is forced contraception the answer or is it going too far? Member of parliament Marjo van Dijken (Labour) is in favour, she has written a draft law making forced contraception possible a long time ago. "I want every parent who has had custody taken away by a judge to be temporarily forbidden from having more children," she says.

But what if the child was wrongly removed from its home? Van Dijken: "I'm not working under that assumption. And in any case: as soon as the judges restores custody the compulsory contraception will be ended. This is not about IQ but about bad parenting."

Others think the mother should be given a chance. "Medical workers have to first try to convince the mother to live a healthy life," says Froukje Bos of the foundation for psychiatric patients, Pandora. Only in extreme situations should state guardianship of an unborn child be considered.

Bos thinks a law to forcibly intern mothers who 'inflict damage on the fetus' is going too far. "The law is for everybody. You can't make a generic law based on a few extreme cases. Where is the line? Should women who smoke while they're pregnant also be interned then?"

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