Skip to main content

Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Pregnancy, substances and social attitudes

Susan Boyd

Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 31

Women’s bodies have long been under the gaze of medical and public scrutiny, and women’s individual responsibility for the outcome of their pregnancies places a burden on them that is unrivalled in any other area outside of parental responsibility. Women’s concern for their pregnancies is fed on by medical professionals who construct new reproductive technologies (RTs) as positive and necessary and as providing a ‘choice’ for women. However, the new reproductive technologies have not necessarily created more choice; choice and access to some RTs is severely restricted for those not rich and white enough. At the same time that health care, education, housing, and social services have been cut, funding for reproductive technologies has increased, even though there is little scientific evidence to suggest RTs improve maternal outcomes.

As social factors that shape pregnancy, such as nutrition and poverty, are ignored, some women are offered expensive, intrusive, and selective technology to improve their chances of becoming pregnant. However, our love affair with technology is misguided. At the same time that the medical profession and much of the public praise reproductive technologies—such as in vitro fertilization, which often results in multiple births due to fertility drugs - they are also making efforts to limit the reproduction of women of colour, the poor, and those suspected of using illegal drugs. Racial and eugenic ideologies and practices shape reproductive technologies, risk assessment, ‘care’ and maternal drug policy.

Lynn Paltrow, of the National Advocates for Pregnant Women, notes that we place women who use fertility drugs and have multiple births (up to six children) on a pedestal and those suspected of using illegal drugs like cocaine during pregnancy in prison.1 As medical professionals seek to help ‘some’ women conceive with fertility drugs and new reproductive technologies, women who use illegal drugs are offered sterilization. White women, and their multi-birthed in vitro infants, have graced the cover of popular magazines such as People. They are proclaimed as heroes, and individual, religious and corporate sponsors have rewarded them, giving them free homes, diaper service, groceries, and money. Most of these women also took fertility drugs to stimulate multiple ovulation, which contributes to multiple births. Unlike the national attention given to mothers using illegal drugs, little attention has been given to the severe health problems many of these multi-birth in vitro infants are born with and the health problems many of them will experience as they mature. Because a woman’s uterus cannot physically hold five full-term infants, multi-birth infants are born prematurely, leaving them vulnerable to health problems such as visual disabilities and respiratory distress syndrome.2 There are also risks to the mother, including negative side effects from the fertility drugs and rupturing of the uterus. For those mothers who take fertility drugs in conjunction with in vitro fertilizer, further risks associated with the surgical procedure are involved.

Moral reformers are not rallying to criminalize women who take fertility drugs to induce ovulation, even though the negative impact on their fetuses and the negative birth outcomes are undisputed. For these mothers are constructed as upholding conventional gender-role norms, and are seen as self-sacrificing and maternal. Outside the obvious ramifications of trying to care for three to five infants at the same time, disabilities are five times more common and immediate and long-term health problems more prevalent in multi-birth children than single-born children.3 While moral reformers claim that infants born to mothers who use illegal drugs will be a drain on medical, social and legal resources, they fail to note that premature infants whose mothers used fertility drugs are also a drain on these resources. Nor do they comment on the cost of care in intensive care units, which can run up to $210,000 US for an infant under 2.2 lbs.4 In addition, the fact that fertility drugs and in vitro fertilization are experimental is rarely explored. Critics note that in vitro fertilization failure rates are as high as 85–90%, very expensive, and are neither accessible nor a ‘choice’ for all women.

Our collective love affair with medical technology, which is constructed as an aid to those who can afford it, especially in the United States, deflects our attention from questions about the quality of life and who gets selected to reproduce and to parent. It also diverts us from asking why illegal drug use during pregnancy is seen as harmful (given the evidence of such harm is sketchy at best), when some legal drugs and reproductive technologies can contribute to poor birth outcomes and permanent disability.

About the Author

Dr. Boyd is Associate Professor with the Faculty of Human and Social Development at the University of Victoria


Reprinted with permission from a section entitled “Medicalization” in (2004). From Witches to Crack Moms: Women, Drug Law, and Policy. Durham, NC: Carolina Academic Press. pp. 82-84







  1. Paltrow, L. (2001). The war on drugs and the war on abortion: Some initial thoughts on the connections, intersections and the effects. Southern University Law Review, 28(3), 201-253.

  2. Koren, G. (1997). The children of neverland: The silent human disaster.Toronto: The Kid In US; and Strong, T.H. (2000). Expecting trouble: What expectant parents should know about prenatal care in America. NY: New York University Press.

  3. Launslager, D. (1994). From one to five: Mulitple births and the family. In G. Basen, M. Eichler & A. Lippman (Eds.), Misconceptions: The Social Construction of Choice and the New Reproductive and Genetic (Vol. 2, pp. 117-126). Maple Pond, ON: Voyageur.

  4. Strong, 2000.

  5. See Basen, Eichler, Lippman, 1993/4 (Vols. 1 & 2)

Stay Connected

Sign up for our various e-newsletters featuring mental health and substance use resources.