Pregnancy and Substance Use: Alcohol, Crack Cocaine, and Opioids in Medicine, Culture, and Women’s Lives

Emma Broder


This paper aims to contextualize the phenomenon of pregnant opioid use in the current epidemic by examining it in conversation with past moments of awareness and scrutiny over pregnant substance use: the discovery of fetal alcohol syndrome in 1973, the crack epidemic of the eighties and nineties and concomitant fears about “crack mothers” and “crack babies.” Women’s substance use in various forms has for centuries been of great medical and social concern, as women’s unique role in reproduction has been seen to grant them greater control over the health of their children, and thus greater risk of harm through substance use. These past cases in the recent history of pregnant substance use illuminate continuities and disjunctures to the present opioid epidemic, and this essay seeks to identify these to better understand the medical, social, and experiential discourses around pregnant opioid use and resulting neonatal abstinence syndrome. I argue that social forces shape medical knowledge produced about pregnant substance use and that stigma heavily influences depictions of substance using women, the medical conceptions of pregnant substance use, and the experiences of people who use substances while pregnant. While this history has almost exclusively centered women as pregnant people, it is important to acknowledge that these two categories are not so closely aligned in the present day, and my use of the term “pregnant women” is primarily an actors’ term and does not reflect the reality that people of any gender can experience pregnancy.