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November 30, 2013

Open Letter Urging That Policies Addressing Pregnant Women and Opiate Use Be Rooted in Science, Not Stigma

Open Letter Urging That Policies Addressing Pregnant Women
and Opiate Use Be Rooted in Science, Not Stigma

November 25, 2013

Dear Governor LePage,

We are writing this open letter in response to your email and radio address concerning "Drug-Dependent Newborns, a Disturbing Trend" (Nov. 13, 2013). We share your concern about the health and well being of Maine’s children and families. We are writing, however, to ensure that Maine’s policies regarding pregnant women and newborns is informed by science and that they do not inadvertently increase danger to the health of babies.

  • As this letter from leading medical experts makes clear, referring to newborns prenatally exposed to opiates as “addicted” is medically inaccurate and dangerously stigmatizing to newborns. We believe that being mislabeled as “addicted” at birth is no way to start life.

  • More than 40 years of research confirms that when babies show evidence of neonatal withdrawal, these symptoms are readily treatable, and there is no empirical evidence suggesting any long-term adverse consequences. There is no need for these newborns to “suffer” if medical staff are properly trained in the provision of care to pregnant women and newborns. In fact, leading national and international experts, including the federal Substance Abuse and Mental Health Services Administration, the World Health Organization, and the American College of Obstetricians and Gynecologists encourage opioid-dependent pregnant women to continue treatment, like methadone or buprenorphine, throughout their pregnancy.

  • Pain does not disappear when a woman becomes pregnant, and for women who are living with severe and chronic pain, opioid painkillers have been relied upon as the safest alternative. Denying pregnant women adequate pain treatment would not only be inhumane, but untreated pain during pregnancy would certainly present as a major stressor for pregnant women and their fetuses.

  • Cost estimates from the cited JAMA study are misleading. The study did not evaluate whether those providing care were properly trained or whether they were following the well-supported protocols of rooming in and breastfeeding, both of which decrease the occurrence and severity of NAS. One study showed that only 11% of babies who boarded with their mothers required treatment of NAS compared to more than four times as many who were placed in a NICU.

  • In order to be effective, policies addressing pregnant women and opioid use must include consideration of the medical, social, and economic factors that influence such use, as well as access to effective treatment for it.

  • Policies that are not rooted in science may result in denying pregnant women access to appropriate treatment for pain, creating barriers to medically approved and federally recommended opioid treatment, and increasing punitive and counterproductive child welfare interventions that undermine, rather than protect, children and families in Maine.

  • The Snuggle ME Project was developed by Maine healthcare providers throughout the state specifically to improve outcomes for babies born to women who use or who are being prescribed opiates as part of medical treatment. It provides evidence-based guidelines for effective care of both mother and newborn.
  • We would very much like to join your efforts to ensure maternal, fetal, and child health in the state. To that end, we would be happy to provide you with access to national and international experts in the field of addiction treatment and we request the opportunity to meet with you to discuss this important issue.

    Sincerely yours,

    Kelly Bentley, Community Health, University of Maine-Farmington*

    Tanya Ann Kennedy, Associate Professor of Women's and Gender Studies, University of Maine-Farmington*

    Mark Publicker, M.D.

    Connie Adler, M.D.

    Mabel Wadsworth Women's Health Center

    Family Planning Association of Maine

    Gaelyn Aguilar, Assistant Professor of Anthropology, University of Maine-Farmington*

    Sarah Brasslett, Bangor, ME

    Lorrayne Carroll, Associate Professor of English, Women’s and Gender Studies Faculty, University of Southern Maine*

    Chelsea Castonguay, Academic Support Coordinator, University of Maine-Orono*

    Wendy Chapkis, Professor of Sociology and Women & Gender Studies, University of Southern Maine*

    Lucinda Cole, Director of Women's and Gender Studies, University of Southern Maine*

    Jen Jack Giesing, New Media and Data Visualization Specialist, Bowdoin College*

    Nancy Gish, University of Southern Maine*

    Sandra S. Haggard, Associate Professor of Biological Sciences UMA-Bangor

    Allison Hepler, Professor of History, University of Maine-Farmington*

    Andrea Irwin, Esq.

    Polly Kaufmann, Department of History, University of Southern Maine*

    Nicole Kellett, Assistant Professor of Anthropology, University of Maine-Farmington*

    Susan K. Riley, Advocacy Committee, Mabel Wadsworth Women’s Health Center

    Ann Schonberger

    Lauren Webster, University of Southern Maine*

    Shana Youngdahl, University of Maine-Farmington*

    Members of Maine Grandmas for Reproductive Rights (GRR!)
    Julia G. Kahrl
    Janice Miranda
    Beedy Parker
    Kitty Wheeler
    Jay McCreight
    Lucy Stinson

    ACLU of Maine

    National Advocates for Pregnant Women

    *I join this letter as an individual, and provide my title and work information for identification purposes only.

    November 18, 2013

    Media Advisory: Video and Panel Explores the Drug War’s Impact on Pregnant Women and Families

    For Immediate Release
    November 13, 2013

    Patrick Gallahue: 917-328-0709
    Laura Huss: 212-255-9252

    Video and Panel Explores the Drug War’s Impact on Pregnant Women and Families

    Consequences Include Arrests, Forced Detentions, Child Welfare Interventions,
    and Limited Drug Treatment Options

    Open Society Foundations are proud to host National Advocates for Pregnant Women (NAPW) for a groundbreaking event on November 19th in New York City that will explore the drug war’s impact on pregnant women and families.

    Drug war propaganda is increasingly being used to justify repressive policies toward pregnant women and new mothers, including non-consensual drug testing, child welfare interventions, arrests, and detentions of women who become pregnant and use any amount of a controlled substance. These policies act as barriers to appropriate and effective drug treatment for pregnant women and families who need it.

    The extreme stigmatization of women who use drugs—as well as those who are in treatment or who have used drugs in the past—is reinforced by a private organization, known as Project Prevention, that pays current or former drug-using women $300 to get sterilized or to use long- acting birth control.
    These policies, and programs have a number of dangerous consequences, including driving women away from health care services, redirecting funding that could be used for drug treatment or other services to fund punitive measures, and unnecessarily separating families (particularly low-income and families of color).

    The event will begin with a screening of NAPW’s short video, Project Prevention: Mothers and Children Speak Out, confronting the drug war’s influence on the civil child welfare system and how private initiatives like Project Prevention are undermining the health and well-being of pregnant women and families. The film will be followed by an expert panel discussing Project Prevention’s reach nationally and internationally and the implications of the war on drugs on pregnant women and families:

  • Parent Advocates Dinah Adames & Sabra Jackson

  • Lynn Paltrow, JD, Executive Director of National Advocates for Pregnant Women

  • Emma Ketteringham, JD, Managing Attorney, Family Defense Practice of The Bronx Defenders

  • Kasia Malinowska-Sempruch, MSW, Director, Global Drug Policy Program, Open Society Foundations

  • Carl Hart, PhD, Associate Professor, Columbia University

  • Robert Newman, MD, MPH, President Emeritus, Beth Israel Medical Center

  • Where: Open Society Foundations, 224 West 57th Street, 1st Fl., Room 1 ABC, New York, NY 10019
    When: Tuesday, November 19, 6:00 – 8:00 pm
    To RSVP: http://www.opensocietyfoundations.org/events/project-prevention-child-welfare-and-junk-science

    November 15, 2013

    New York Appeals Court Affirms the Rights of Pregnant Women

    Please see below a press release about yesterday's significant victory in the New York Appeals Court that affirmed the rights of pregnant women. Additionally, we hope you will read this important commentary published today on RH Reality Check, "Are Pregnant Women Persons After 20 Weeks' Gestation?," about 20-week abortion bans and the pending ballot measure vote in Albuquerque, New Mexico on Tuesday, November 19.


    November 14, 2013

    Sarah E. Burns: (845) 820-1671
    Lynn M. Paltrow: (212) 255-9252
    Katharine Bodde: (212) 607-3372


    New York (November 14, 2013): Today, the New York Supreme Court Appellate Division, First Judicial Department, rejected a lower Family Court’s finding that a woman’s decision to move from California to New York while pregnant was so “reprehensible” that it could bar New York courts from hearing her child custody case. National Advocates for Pregnant Women (NAPW), the New York Civil Liberties Union (NYCLU), and the NYU School of Law Reproductive Justice Clinic, who filed an amicus brief with other women’s rights and advocacy organizations, applaud today’s judgment.

    In May, the lower Family Court found that petitioner Sara McK’s relocation during her pregnancy—to attend Columbia University on the GI Bill—was tantamount to “appropriation of the child while in utero.” On the basis of that characterization, the New York Family Court referee departed from the statute that controls which state is supposed to hear custody proceedings. The statute makes clear that, typically, custody issues should be resolved in the child’s “home state”—in this case, New York, where the child was born.

    “The referee’s decision had far-reaching implications for pregnant women, effectively stripping them of fundamental constitutional rights,” said Sarah Burns, Professor of Clinical Law at NYU Law and Director of the Reproductive Justice Clinic. Burns and her clinical students, joined by NAPW, the NYCLU, and nine other organizations, filed a brief in the case detailing how the referee’s interpretation of the relevant statute placed unconstitutional constraints on a woman’s basic life decisions, such as where she lives, works, and attends school while pregnant.

    The Appellate Division’s decision today recognized that the child custody statute must conform to common sense and constitutional law. As a general rule, it made explicit that courts cannot hear custody matters that are filed prior to birth. As applied to Ms. McK’s case, it went further to underscore that her relocation should not have been relevant to New York State’s jurisdiction. Otherwise, the First Department reasoned, putative fathers could limit the movement of pregnant women, and, “[p]utative fathers have neither the right nor the ability to restrict a pregnant woman from her constitutionally-protected liberty.”

    Lynn Paltrow, Executive Director of amici NAPW, was pleased to see the decision address and protect the constitutional rights implicated. “This decision affirms that women who become pregnant may not be penalized for exercising their rights to travel and to seek an education,” she said. Katharine Bodde of amici the NYCLU concurred, adding, “Pregnant women are often denied their rights and dignity. Today's decision recognizes important constitutional principles including a woman's right to liberty, equal opportunities under the law, and reproductive freedom.”

    Amici: National Advocates for Pregnant Women, New York Civil Liberties Union, MotherWoman, Inc., National Organization for Women in New York City, Choices in Childbirth, Service Women’s Action Network, Planned Parenthood of New York City, NOW-New York State, Law Students for Reproductive Justice, Backline, Every Mother is a Working Mother Network, and the California Chapter of National Organization for Women.

    Read Brief of Amicus Curiae NAPW, NYCLU and others together with Family Court Referee’s decision here: http://tinyurl.com/puddnk8

    Read decision of the Appellate Division, First Department, here: http://www.nycourts.gov/reporter/3dseries/2013/2013_07554.htm

    November 14, 2013

    Coalition of Scientists & Advocates Call on FDA to Protect Women & Fetal Health

    November 13, 2013

    CONTACT: Anais Duran


    National Advocates for Pregnant Women (NAPW) along with a coalition of researchers and advocates filed a Citizen Petition (FDA-2013-P-1288) as well as a Petition for Stay of Action (FDA-2013-P-1289) to the Food and Drug Administration (FDA) calling on the agency to refrain from implementing new labeling changes that are medically inaccurate and dangerous to maternal and fetal health.

    On September 10, 2013, the FDA announced labeling changes for extended-release/long-acting (ER/LA) opioid analgesics. Opioid analgesics are a class of drugs used to alleviate moderate to severe pain—from the management of cancer-related pain to labor pain. One of the label changes would require a boxed warning—the strongest warning required by the FDA and one that indicates significant risks associated with a drug—stating: “For patients who require opioid therapy while pregnant, be aware that infants may require treatment for neonatal opioid withdrawal syndrome [NOWS]. Prolonged use during pregnancy can result in life-threatening neonatal opioid withdrawal syndrome.”

    The petitions specifically challenge the claim that NOWS is “life-threatening.” According to the petitions this labeling is false and misleading, unsupported by medical and scientific evidence, and inconsistent with leading national and international expert opinion on opioid use and treatment during pregnancy. Dr. Robert Newman, a leading expert on addiction treatment explained, “there is no support for the claim that prolonged use results in a neonatal opioid withdrawal syndrome that is ‘life-threatening.’” Specifically addressing opioid substitution therapy, Dr. Newman added: “More than 40 years of research confirms that when babies show evidence of neonatal withdrawal, these symptoms can be readily treated, and there is no empirical evidence suggesting any long-term adverse consequences.” The petitions also urge the inclusion of appropriate, evidence-based treatment options for pregnant women using opioids, including opioid substitution therapy.

    The FDA is charged with a crucial role in safeguarding the healthcare of the American public, yet despite NAPW’s urgent petitions, it announced on October 25, 2013, that the newly approved drug Zohydro ER will be the first ER/LA opioid analgesic to have the inaccurate labeling.

    Kylee Sunderlin, Soros Justice Fellow at NAPW, explained “the proposed FDA changes would likely result in pregnant women being denied adequate pain treatment, discourage opioid-dependent pregnant women from seeking and being offered potentially life-saving methadone and related treatments, and will almost certainly result in an increase in unwarranted child welfare proceedings against pregnant women who receive such treatment.” Such predictions are well grounded. On October 18, 2013, the New Jersey Supreme Court announced that it would review a state appellate court decision holding that a pregnant woman’s participation in medically recommended and supervised methadone treatment constituted a form of civil child abuse.

    Filed NAPW Citizen Petition
    Filed NAPW Petition for Stay of Action

    November 8, 2013

    Media Breakthrough - How Anti-Abortion Measures Harm All Pregnant Women

    As many of you know, The New York Times recently ran a front page story about the Alicia Beltran case that NAPW helped to file with lead counsel, Wisconsin Attorney Linda S. Vanden Heuvel, and the Reproductive Justice Clinic at NYU School of Law. This case has inspired a great deal of thoughtful media coverage, including an NBC News story, "Shackled and pregnant: Wis. case challenges 'fetal protection' law;" a Wisconsin Public Radio interview with NAPW that included a chilling call-in from another woman threatened with arrest in Wisconsin; a Thom Hartmann Show segment featuring NAPW, Why is the GOP Inserting Gov. into a Women's Uterus?; and an entire segment on the case with specific reference to NAPW's work and perspectives on Melissa Harris-Perry's show on MSNBC.

    Many of the stories inspired by Ms. Beltran's case reference and link to our published, peer-reviewed research in the Journal of Health Politics, Policy and Law and American Journal of Public Health. These stories expand on our message - that anti-abortion and related measures supported by so-called "right to life" organizations undermine the rights and humanity of all pregnant women. For example, Salon's story, "The right's war on pregnant women," makes this point the focus of their coverage:

    It is no secret that this has been a banner year for laws attempting to recriminalize abortion. During the first six months of 2013, states adopted 43 provisions to ban abortion, impose medically unnecessary restrictions on providers or otherwise regulate the procedure into nonexistence.

    But framing the current assault on reproductive rights exclusively in terms of abortion rights erases another, equally dangerous reality faced by women who intend to carry their pregnancies to term: laws that establish personhood for fertilized eggs, embryos and fetuses aren't just a threat to women's access to abortion - they are also being used to criminalize and incarcerate pregnant women.

    From the forced detention of pregnant women suspected of substance dependence to the use of "fetal homicide" laws against women who experience miscarriages and stillbirths, anti-choice lawmakers and groups like National Right to Life - so long the self-declared "champions" of motherhood - are waging a war on women hoping to become mothers.

    The New Republic piece, "How the 'Crack Baby' Scare Armed the Pro-Life Cause," exposes how anti-abortion activists have used the drug war to advance their agenda against pregnant women. As the story explains:

    But the Wisconsin law was ushered through legislatures in 1997 by anti-abortion lobbyists, not drug crusaders. It missed the war on cocaine by almost a decade, and was written after the idea that drug abuse was uniquely damaging to fetuses had been roundly debunked. . . . Rather, the law Beltran is challenging - along with others of its kind - was a sidelong way of codifying the argument that a fetus is a person with rights separate from its mother's. And that's exactly what happened in Beltran's case: The New York Times reported that Wisconsin appointed a legal guardian for her fetus when it called her to court - but not for Beltran. "I didn't know unborn children had lawyers," she said recently.

    The media attention about the case has also prompted Wisconsin Legislator Chris Taylor to speak out against the law and consider efforts to repeal it, "Wisconsin Lawmaker Seeks Change to 'Fetal Protection' Law."

    NAPW knows that both truth and persistence matter. Laura Huss, NAPW's Program Associate and Kylee Sunderlin, NAPW's Soros Justice Fellow, have created a media campaign to call out journalists who advance junk science about pregnant women and drug use. This campaign was launched in response to a misleading story entitled "How To Save A Newborn Drug Addict." The journalist listened, responded with a story correcting her mistakes, and credited NAPW for bringing them to her attention:

    But after the story aired I got a message from the National Advocates for Pregnant Women. They feel my story stigmatizes women who use methadone or prescription drugs during pregnancy. That women are advised to use methadone to treat addiction during pregnancy. Having seen these sweet little babies suffer, I just couldn't believe it. But I was sent a list of dozens of doctors from around the country who have done research on the subject. So I decided to put my emotions aside and look into the facts...

    What follows is an excellent story that includes this important observation by a methadone treatment provider: As far as stigmatizing these women for using drugs during pregnancy, Micki thinks it's important to point out that these mothers love their babies just like any mother does.

    Thank you for your support and expect more positive reporting and successes to come!

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