When four starving boys aged 19, 14, 10 and 9, were taken from their New Jersey adoptive parents last October, all were severely emaciated. The oldest was so stunted–he weighed 45 pounds and measured four feet tall–that police thought he was a grade-schooler. He had been found by neighbors, rooting through their trash for food at 2:30 a.m. He was so weak, he couldn't even open the Tastykake they hastily offered.
The press was quick to blame New Jersey's child welfare agency. Although social workers had visited the family 38 times over two years, they had never sought help for the starving boys, who were said to have subsisted on a diet of uncooked pancake mix, cereal, peanut butter and wallboard. As soon as they were taken from their adoptive parents, Raymond and Vanessa Jackson, the boys rapidly started gaining weight.
After the Jacksons were arrested for child abuse, their pastor, Harry Thomas, began a public relations campaign to defend the couple. The media had noted that the Jacksons' six other children–three biological children, two adopted daughters and one foster daughter–were well fed and clothed. Thomas said this was because the adopted boys were tough cases. They had eating disorders. They were victims of fetal alcohol syndrome. Worst of all, they were “crack babies,” and presumably as a result, the oldest was “a habitual liar.”
The Jacksons apparently had managed to evade neighbors' and social workers' suspicions for years by attributing their adoptive sons' problems to the fact that their mothers smoked crack cocaine while pregnant. That this excuse still seemed reasonable–20 years after the 1980s crack 'crisis' and over a decade after the medical community dismissed the “crack baby” as a media myth–shows how resilient and pernicious the stereotype is.
In a century of drug scare stories, the “crack baby” was a crowning achievement. Throughout the late 1980s and early 1990s, images of horrifyingly tiny, herky-jerky infants with eerie, cat-like cries flooded television screens and prompted columns about a new “biological underclass” and a “lost generation.” Media coverage of the crack “epidemic” began as a trickle in 1984, but by the following year had exploded into a tsunami. Crack, Nancy Reagan said, was “killing a whole generation.”
President Reagan declared “war on drugs” in 1986, and in July of that year alone, the networks' evening news programs ran 74 crack stories; in the run-up to the election, over 1,000 articles about crack appeared in newspapers and magazines. Meanwhile, the media had gotten hold of Ira Chasnoff's 1985 New England Journal of Medicine report on the possible consequences of cocaine use by 28 pregnant women. The study cautioned that the data was preliminary and no conclusions about causality could be drawn from it. But the ground was already sown for panic, and the media had no compunction about predicting the worst imaginable consequences.
Within days, CBS News had found a social worker treating an 18-month-old “cocaine-exposed” baby, who claimed that the child would grow up to be “a 21-year old with an IQ of perhaps 50, barely able to dress herself.” By 1989, a National Institute on Drug Abuse psychologist claimed that exposure to cocaine in utero “was interfering with the central core of what it is to be human.” Columnist Charles Krauthammer alleged, “A cohort of babies is now being born whose future is closed to them from day one. Theirs will be a life of certain suffering, of probable deviance, of permanent inferiority. At best, a menial life of severe deprivation. And all of this is biologically determined from birth.”
Evidence to support these claims was no stronger in 1989 than in 1985. In fact, as soon as more careful studies were done, with proper control groups and other measures to rule out other factors that could have led to developmental problems, the link between cocaine use during pregnancy and major difficulties in infants began to look far less certain. As early as 1992, the Journal of the American Medical Association decried “the rush to judgment” on the effects of prenatal cocaine exposure.
So what, exactly, does the medical research show about the effects of cocaine on infants exposed in utero? And what caused the so-called “crack babies” to seem so sickly?
As it turns out, those scrawny infants in the neonatal intensive care units who made for such dramatic video had mothers whose problems went far beyond crack cocaine. For one, most of their babies hadn't received prenatal care. Often as a result, they were born premature.
Premature birth can be caused by all sorts of medical problems that might well have been caught and treated if the mother had gotten health care during pregnancy. These problems can damage a child, even when they have no direct connection to drug use. In fact, prematurity is demonstrably much riskier for fetuses compared to a mother's use of cocaine.
When the media showed images of “crack babies,” it was often depicting prematurity rather than signs of drug exposure. High-pitched cries and jerky movements, for instance, are common in preemies. (On the other hand, some babies born too early–and some cocaine-exposed infants as well–act abnormally calm, or “floppy.” But these newborns weren't chosen by the media to illustrate the “crack baby” problem.)
In addition, many “crack babies” were actually withdrawing from heroin and other opiates that their mothers had used along with cocaine, alcohol and tobacco. Opiate withdrawal leads to jerking and shaking–but cocaine was blamed for these symptoms, even though it doesn't cause withdrawal illness. While withdrawal from opiates is unpleasant for the infant, being exposed to them before birth does no lasting harm. Alcohol and tobacco, on the other hand, can seriously damage fetuses. Not surprisingly, both of these legal substances were widely used by “crack mothers.”
To make matters worse, these mothers also typically had long histories of poverty and victimization. More than two thirds had been sexually abused as children or were current victims of domestic violence. It was also quite common for them to have witnessed traumatic events, like seeing a relative murdered. Most were depressed.
All these stressors, particularly in combination, can seriously threaten a pregnancy. And they're probably a big reason “crack mothers” sought chemical escape in the first place. Profound stress is believed to be such an important factor in prematurity and other neonatal development problems that the March of Dimes' Campaign to Prevent Birth Defects recently targeted stress as a priority research area.
Amid all these problems, prenatal exposure to cocaine was just one part of a very complex and disturbing picture–and, it turned out, not a very significant part. Dr. Deborah Frank, Associate Professor of Pediatrics at Boston University School of Medicine, published a review of the research in the Journal of the American Medical Association in 2001. The next year, she testified that “there are small but identifiable effects of prenatal cocaine-crack exposure on certain newborn outcomes, very similar to those associated with prenatal tobacco exposure. There is less consistent evidence of long term effects up to age six years, which is the oldest age for which published information is available… Based on years of careful research, we conclude the crack baby is a grotesque media stereotype, not a scientific diagnosis.”
Says Ira Chasnoff, the author of the first New England Journal report, “From the earliest studies, [researchers] showed that there was no effect on IQ.” As for behavior, he adds, “It's very difficult to say. There do appear to be some effects. It's still up in the air–some research says yes, some says no. Right now there's no consensus.”
But experts do agree that cocaine-exposed babies are in no way doomed to a life of degeneracy, illiteracy and crime. According to Chasnoff, the most consistently noted effect of mothers' cocaine use on children is subtle difficulties with what researchers call “executive function: the ability to plan, organize and complete tasks.” Such problems can look like attention-deficit disorder (ADD) because the child has difficulty seeing things through to completion or remaining focused long enough to do schoolwork well.
Even if these problems do occur, they're not necessarily irreversible. Treatments similar to those for ADD can help. And raising a child in a nurturing, healthy environment makes a huge difference. Says Chasnoff, “By six years old, if you look at intellectual functioning, the single most important factor that predicts IQ is whether the mother continued to use [cocaine or its derivatives] after pregnancy, not during.” Frank adds that a child's exposure to violence after birth predicts behavioral and IQ lags, much more than does prenatal exposure to cocaine.
Further, according to Frank, being labeled a “crack baby” may hurt a child far more than exposure to drugs does. “The stigma sometimes leads people to ignore real problems: 'Oh, that's just because he's a crack baby,'” she says, citing the Jackson kids. “Children like them are thought to be hopeless.”
Frank has done chilling research on this phenomenon. In one study, she asked professionals to pick out the “crack babies” from a group of infants. “Even people of good will think they can tell who is a 'crack baby' and who isn't,” she says. “In fact, they can't.” Even more frighteningly, another study showed students videotapes of two healthy toddlers. If the children had been labeled crack babies, normal behavior was interpreted as pathological. Frank recalls giving a lecture and being approached afterwards by a woman who had adopted her cocaine-exposed nephew. “At two days old, the nurses told her the baby was a congenital liar!” Frank says. “One woman thought that her 18 month old still had crack in his system because he wouldn't stay quiet during a four-hour church service.” Children who are labeled as crack babies may come to see themselves as destined for low achievement and bad behavior. That perception can become a self-fulfilling prophecy.
If the crack baby is a mere figment, why has it persisted in our collective imagination? Why, in the 21st century, can parents be allowed to starve their children and blame their failure to grow on a label that doesn't correspond to reality?
Craig Reinarman, Professor of Sociology at the University of California-Santa Cruz, says the answer lies in the social purposes served by the myth. “You have, in the crack baby and mother, both a perfect victim and a perfect villain. Who is more innocent than an unborn or a newly born child? It's the ultimate angelic victim. On the other hand, who could be a more demonic villain than a woman who would put this child at risk for something as awful and selfish as her own pleasure? Central casting couldn't do better.”
The crack baby myth also helped assuage guilt about the massive cuts to social services that preceded the crack epidemic in the ghettos–and which may have exacerbated it, given that widespread crack addiction occurred almost invariably in poverty-stricken communities. The very word “ghetto” conjures up images of black and brown people, so while the crack baby was angelic, it was also a racialized, infant demon: a baby destined to grow up mentally deficient and criminal because of the damage done by its monstrous parent. “This image fit perfectly with conservative ideology, because if we had any residual guilty feelings about having cut back all the services that did even a little bit to help the poor, the idea of the vile crack mother absolved us of all responsibility,” says Reinarman.
“We had the welfare queen,” says Lynn Paltrow, an attorney and founder and executive director of National Advocates for Pregnant Women. “The only thing that could top the welfare queen was the crack mother welfare queen.”
Paltrow represents Regina McKnight, who, like the Jackson boys, is a victim of crack baby hysteria. McKnight is serving out a 12-year sentence for murder in South Carolina because her stillborn baby tested positive for a derivative of cocaine. She was convicted in 2001. McKnight is the only woman in America serving time for this “crime” and had no prior criminal record.
The ironies of McKnight's case are profoundly disturbing. The mother of two had first been given crack by her aunt, who hoped to end McKnight's depression following the death of her mother. Her mom had been killed by a speeding truck driver who has since racked up several drunk-driving convictions. Following the fatal accident, he was never breath-tested, nor was he charged with a crime. The truck driver is white. McKnight and her family are African American.
McKnight, who has a tenth-grade education, got no prenatal care during any of her pregnancies. South Carolina has no detox facilities for addicted pregnant women and does no outreach to them. It is the state with the least per-capita spending on addiction treatment in America. Until it lost in the U.S. Supreme Court in March 2001, the state had a policy of secretly drug-testing pregnant women who sought prenatal care and arresting those who came up positive. (Virtually everyone arrested under the law was black.) Paltrow helped beat back that policy, successfully arguing to the Court that the practice not only violated the women's constitutional rights, but likely also deterred them from getting help.
Since lack of prenatal care is a bigger factor than crack use in harming fetuses, and since the state had a policy while McKnight was pregnant that effectively punished drug-using women for seeking care, South Carolina may be more responsible for McKnight's child's death than was McKnight herself.
Unfortunately, the Supreme Court declined to hear Paltrow's appeal in the McKnight case, and despite amicus briefs from every relevant U.S. medical association, the highest state court upheld her conviction. There is no medical evidence suggesting that cocaine use was the only–or even the most likely–cause of McKnight's baby's death. Paltrow is still working on appeals.
Years of research have debunked the notion of the crack baby among medical experts, but the myth lingers, due largely to inaccurate media items. Recently, the New York Times cited a report published by the state of New Jersey claiming that 13 percent of all infant deaths in the state are caused by maternal drug use. There is absolutely no way that such a statistic could be accurately compiled, given how much uncertainty there is about the link between drug use and infant deaths, and considering the many other problems that women usually suffer from when they give birth to drug-exposed babies. Nonetheless, the statistic was in the newspaper of record–which will, no doubt, be cited by others as an unassailable source.
The media has also ben slow to pick up on the fact that dire predictions about crack babies growing up to be “super-predators” not only failed to materialize, but were completely contradicted as the kids grew up. The first “crack babies” hit their teens in the mid-1990s–when crime, youth violence, teen pregnancy and drug use began dropping dramatically.
More skeptical coverage is needed if the crack baby myth is ever going to die. When asked what he would have done differently in the early 1980s when his work was used to justify the scare, researcher Chasnoff said he wouldn't have spoken with the press. But with well-funded conservative activist groups still actively pushing the stereotype–one, a national group called CRACK, pays drug-addicted women $200 to be sterilized or use long-term birth control–the voice of science is needed more than ever.
Frank says that the very phrase “crack baby” is inflammatory and should be abandoned. “Nobody these days would refer to a child with trisomy 21”–Down's syndrome–“as a mongoloid idiot. 'Crack baby' is just as inappropriate. It should be no more acceptable in public discourse than the N word.”
Maia Szalavitz is a New York-based writer who is working on a book about behavior-modification programs for teenagers, to be published by Riverhead in 2005.