American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188

Rose Sarfo

Government Affairs/Advocacy

American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188

To Whom it May Concern;

My name is Rose Sarfo. I am currently a Registered Nurse attending Excelsior College studying to obtain a Bachelor’s in Science of Nursing. I am writing you today with my concerns regarding the issue of substance abuse during pregnancy. I practice nursing full-time in the state of New York.

I am writing you to gain your support for a change in policy. Although I do not agree with the position that drug abuse during pregnancy should be deemed a criminal act that should be prosecuted with mothers put in prison, something stronger is needed other than treatment. Currently, in NYS children are removed from their parents’ custody for neglect and abuse along with endangerment of a child etc. However, drug use it is not specified. What is used as primia facto evidence is the psychological state of the parent, i.e. substantial impairment of judgment, disorientation, incompetence, substantial manifestation of irrationality etc. (The Bronx Health Link and National Advocates for Pregnant Women, 2010). Mind you, these are laws that are in place once the child is born. However, there are no strong legal requirements for women who abuse drugs while pregnant to avert these behaviors. I am suggesting mandatory testing for pregnant women when there is suspicion of substance abuse. This should be followed by mandatory classes and counseling.

According to the National Institutes of Health (NIH) (2020), based on the results of a survey conducted in 2016, “…19.5 million females (or 15.4 percent) ages 18 or older have used illicit* drugs in the past year”. The importance of this number is that women get pregnant and have children. Women make up approximately 50% or more of the nation’s population and according to Forrnay (2016) also make up 40% of those with a lifetime drug use disorder and 26% of those who meet criteria for both an alcohol and drug use disorder during the prior 12 months to becoming pregnant. Cocaine, marijuana, opioids are just some of the substances that women use when pregnant (Forrnay, 2016).

As Obstetricians and Gynecologists you know of the dangers for infants born from mothers who have abused drugs even they are prescribed. To be concise, if a mother smokes (tobacco, marijuana etc,) drinks coffee or alcohol using crystal meth etc. so does the fetus (Web MD, 2020). The consequences of abusing both legal and illicit drugs are serious. Changes in brain structure leading to permanent damage to the brain, behavioral problems due to deficits in memory and attention span, respiratory problems, heart defects, premature delivery, and low birth weight are some of the manage problems caused by the inappropriate use in illicit and in many cases legal drugs (WebMD, 2020, NIH, 2020).

According to Cara Angelotta and Paul S. Appelbaum (2017), between the years of

1977 and 2015 29 women were prosecuted in 19 states for charges such as child endangerment, child abuse, drug delivery, attempted aggravated child abuse, chemical endangerment of a child, child neglect, child mistreatment, homicide, manslaughter, and reckless injury to a child. The prosecutors proceeded with these cases despite the common views of the medical and social welfare establishments that substance abuse should be treated medically. Over 86% of these cases were overturned.

According to The Bronx Health Link and National Advocates for Pregnant Women (2010), in New York State, currently there are no laws for prosecuting mothers who use drugs during and even after pregnancy without collaborating evidence that demonstrates that the abuse of drugs that are illicit or licit caused a child physical, emotional or psychological harm. Currently, it is the position of the American Nurses Association (ANA) (2017), that the best way to help mothers with what they consider a medically diagnosed disorder is to provide treatment in the form of counseling and linkages to organizations that specialize in substance abuse treatment. The ANA (2017), also recommends that more research be conducted to learn more about the social and cultural factors that lead to substance abuse in pregnant women.

A huge debate that has always been part of the American philosophy of life is the idea of freedom. However, freedom has always been balanced with the requirement of respect for and following the law. This equates with citizen responsibility. Putting in effect the much needed policy change that is being suggested may be deemed as offensive by some. However, the benefits outweigh this slight. The lives of the unborn are in danger. The brunt to bear for children who are damaged from substance abuse from mothers falls on society.





Sincerely Yours,


Rose Sarfo

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