Epidemiologic surveys have been contradictory in reporting ethnic differences in substance use. In a probability sampling of all women who gave birth in California in 1992, African American women had the highest prevalence of total drug, alcohol, cocaine, and tobacco use (Vega, 1993). However, most drug exposures during pregnancy were among non-Hispanic white and Hispanic women. The National Household Survey on Drug Abuse in 1991 reported that 62% of cocaine users and 50% of crack users were white. Furthermore, the 1991 Youth Risk Behavior Survey ascertained that white and Hispanic students reported more alcohol and cocaine use than their African American counterparts. While most national surveys either report little ethnic variation in drug use or lower rates among African Americans, medical and criminal justice systems show significantly larger effects of drugs among non-whites, with African Americans having the highest drug-related morbidity and mortality. Although racial disparity in drug use continues in our society, this article focuses on the racial disparity existing in our policies that target non-white pregnant women and mothers and the consequences of the disparity.

A study conducted in 1989 among 715 pregnant women enrolled in prenatal care in Florida demonstrates the existence of racial reporting bias. The rates of illicit drug detection were similar among women seen in public clinic or private offices. Black women had more frequent evidence of cocaine use compared with the white women (7.5% vs. 1.8%), while whites had more numerous evidence of marijuana than the black women (14% vs. 6%) did. However, in Florida, both cocaine and marijuana detection during delivery legally compels reporting. Despite similar levels of illicit drug use among black and white women, black women were 10 times more likely to be reported to the authority than white women were and poor women were also more likely to reported. Thus, legally mandated reporting of drug use during pregnancy appears to vary by ethnicity and socioeconomic status. Social factors may bias screening procedures for newborn urine toxicology and reporting of the findings. These factors include the obvious lack of prenatal care, discretion of the hospital staff, and willingness of private physicians to perform the screening. Physicians at a hospital in South Carolina were accused of testing pregnant women, mostly African Americans, for drug use without consent (Hilts, 1994). Many women as a result were persecuted of the drug testing. Drug use may be perpetuated due to the insufficiency of drug treatment resources. The inadequate availability of prenatal care and substance treatment programs for pregnant women, particularly the poor, may further contribute to drug use among pregnant women. Regardless of lack of treatment resources, the numbers of minority women persecuted for drug use during pregnancy are escalating. The fear of persecution and the removal of their children may prevent high-risk women from seeking the necessary prenatal care.

The author believes that our current drug policy that targets minority women for illicit drug use during pregnancy diverts attention from the social ills confronting our society, such as high rates of infant mortality, particularly among blacks. Our economic and social abandonment directs minorities to seek out drugs. Furthermore, the media stereotyping of minorities as drug users perpetrates both despair and drug use among them. Thus, the author states that we should aim to "offer free treatment on demand to all addictions as part of universal health care, with special programs serving the need of women and mother" and also reduce criminal persecution for drug use. A major contention of the article is that there is very little data available on the adverse biological consequences of prenatal cocaine exposure. Furthermore, the author continues with the statement that "attributing childhood problems to the individual behavior of their drug using mothers appears to be more politically expedient than examining and remediating the social factors that lead to family dysfunction, persistent untreated addiction, and pervasive poverty." However, underestimating the health consequences of prenatal drug use does not serve to decriminalize drug use during pregnancy, but ignores the significant problem of drug afflicted infants.