Criminalized For Surviving: Parenthood Under Surveillance

Narrative MattersCommunity Voices Health AffairsVol. 44, No. 9 Criminalized For Surviving: Parenthood Under SurveillanceMeghann Perry AffiliationsMeghann Perry (email protected) is a former drug user and a certified addiction recovery coach who fuses arts and health to deliver impactful programs and help people harness the power of their voice to uplift marginalized communities. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4. 0) license, which permits others to distribute this work provided the original work is properly cited, not altered, and not used for commercial purposes. See https: //creativecommons. org/licenses/by-nc-nd/4. 0/. PUBLISHED: September 2025Open Accesshttps: //doi. org/10. 1377/hlthaff. 2025. 00647AboutSectionsView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits Abstract For people who use substances, pregnancy and parenthood can be filled with fear, stigma, and isolation. TOPICSSubstance usePharmaceuticalsMethadoneTreatmentNursesAccess to careWithdrawalMedication for opioid use disorderHarm reductionJail-involved populationOpioid use disorderIllustration by Brett Ryder It was 2000 when I sat on the dirty toilet seat in my peach-colored bathroom, pants around my ankles and heart on the floor as I watched the two pink lines crawl across the window of the plastic pregnancy test. A singular and devastating piece of information was slowly coming into focus, plunging me into one of the worst decades of my life. The realization hit, and then the panic. I could barely survive on my own. How was I going to make sure a tiny, helpless baby did, too? I'd struggled with serious mental health challenges and problematic substance use since my early teens. Because of the anxiety, depression, and trauma I experienced as a young person, using substances had become a matter of survival, making it tolerable for me to inhabit my body and mind. I hadn't gone more than a few days or weeks without using a substance since age fifteen. But by the time I became pregnant at age twenty-seven, I'd been on methadone for a year and had almost fully quit using heroin. When we found out I was pregnant, my husband and I desperately wanted our child's life to be much different—and better—than ours. We knew that methadone offered a steady and safe dose of opioids, but we still didn't want her to be dependent on it like her parents. I begged the methadone clinic to start tapering me off immediately. I was met with a formidable wall of refusal—told that it wasn't safe for the baby to stop taking it. I didn't dare fight them. Six weeks later, I was indicted on a felony indictment for trafficking heroin. I'd sold 40 of heroin to my heroin dealer long before becoming pregnant, and the Drug Enforcement Administration had finally come knocking on my door. A cold fist of terror snuck into the deepest part of my belly and curled up against my daughter's growing heart and brain, making itself a permanent home. It stayed there well into the next decade, only just unfurling itself and evaporating into smoke years after my last encounter with the carceral system, long after she was grown. I found myself five months pregnant and sitting in jail with no bail, a two-year prison sentence looming. Each morning the entire unit would get locked in their cells so that a nurse could deliver my methadone. The other inmates peered through the reinforced glass windows in their cell doors to watch me get dosed—often with envy, always with disapproval. The nurse refused to look at my face or meet my gaze. She checked the plastic bracelet I wore with my inmate number and photo, and handed me the bottle. Her disdain—or maybe it was disgust—was clear. I felt the same way about myself. I was more alone than I'd ever been. A Year That Felt Like War I eventually went home on a special bail contract while waiting to begin drug court, hoping to avoid a prison sentence. I gave birth to my daughter, Sophie Grace, two months later. She was scrunchy and beautiful and special, a prominent red strawberry birthmark rising up between delicate wisps of ginger hair on her mostly bald head. I remember one thing distinctly in the blurry first days: the voice deep inside me that spoke clearly and loudly above the chaos, a voice that kept rising up with the primal urge to breast-feed. I begged the nurses and doctors to let me, but was met with another wall of refusal: My milk held the "poison" methadone, which would prolong Sophie's pain and make her withdrawal longer. The voice inside grew smaller and smaller, until it faded to nothing. Sophie started showing symptoms of neonatal opioid withdrawal syndrome on the third day after her birth and was carted off to the neonatal intensive care unit. There, she became like an alien on another planet to me: foreign and unreachable inside her plastic spaceship of tubes and wires. I reached anyway, with a stubbornness that kept me showing up every day, trying to connect with her. I existed in survival mode, rendering me unable to reach the place inside of me where love and nurturing lived. The inside of my body felt hollowed out, leaving only fear and empty space. I mothered not out of nobility or love but out of obligation, pride, and even spite. I would not let the bastards get me down—the ones who didn't believe in me, who didn't think I deserved my child. I would not let everyone be right about substance-using mothers. The totality of my life remained in chaos. Drug court loomed and probation surveilled, lurking around every corner, waiting for me to slip up. My husband of six years remained an undocumented immigrant; the paperwork and process to get him citizenship were too expensive and difficult for us. We risked Immigration and Customs Enforcement (ICE) showing up at any moment, ripping away the life we'd built, taking my husband with them on their way out the door. He continued to use substances, unable to access treatment or health care without documentation. I stayed abstinent by sheer force of will; went to all my required appointments; and spent the remaining time at the hospital with Sophie, going to the Ronald McDonald House nearby just to sleep at night. The nurses kept me at arm's length, suspicious and untrusting of this scrawny, hollow-eyed woman attempting to mother the child she caused such pain. I felt judged: unwanted and unwell, yet still expected to perform the role of mother, and resented for not doing so in a way that satisfied the nurses. I persisted in trying, weakly, with my resolve lessening each day in the face of their scorn. Still, at times I used the feisty voice my mother gave me, advocating for Sophie as she struggled to eat, screaming in hunger and rage at the bottle while my heart screamed in my chest and I pleaded with the nurses to do something. They insisted that it was just withdrawal. It wasn't until she was three months old that she finally got a diagnosis of severe gastroesophageal reflux and a medication that resolved the problem immediately. I struggled to bond with Sophie, trying desperately to connect with the soft and tender mother I knew must be inside me somewhere. At the nurses' suggestion, I sat in an empty room, curtain pulled around on its clacky metal rings, a hospital johnny tied loosely around my shoulders as I held her tiny, half-naked body against my bare chest. She kept finding her way to my breast, her puckered mouth reaching for the forbidden nipple. I pulled her away over and over until I couldn't stand it anymore and put her back in her crib, reattaching the wires from her body to the beeping machines. I walked out with my heart in shambles, full of shame. A person cannot be expected to nurture another in the face of such circumstances. And I didn't. I didn't love my daughter the way that is expected of a mother, or that I wanted to. I didn't feel the deep amazement and profound connection to my baby that society teaches us is sacred and universal. The deep feelings of unworthiness, the lack of control over everything, the fear of making one wrong move and being in the hands of ICE, the carceral system, or child welfare, kept me frozen and distant. I couldn't let my guard down enough to allow the tender, soft part of me to give her anything. All I had to offer was steely resolve and feist. After seven weeks in the hospital, during which Sophie was slowly weaned off the morphine used for her withdrawal, we took her home. We found ourselves suddenly alone with her, full of doubt and a nearly empty toolbox. We hadn't had a proper chance to learn how to care for her. We went from the hospital providing intensive, 24/7 care of our daughter, with little need for our involvement, to being totally on our own apart from a handful of pediatrician visits. Fear of engaging with the systems left us alienated and isolated. Surveillance from drug court felt traumatic and terrifying. Sophie slept poorly, flinched when touched, screamed in the bath, and refused to eat. We hadn't learned to soothe her sensory overload, swaddle to console her, or overcome her rage at the bottle. My husband worked and tried to help at night. I stayed home, still abstinent and grappling with my untreated anxiety and depression and years of trauma, trying not to go mad, trying to treat this untamed and profoundly needy being as she deserved—as I thought a mother should—and feeling like a failure. When Sophie was three months old, the carceral system suddenly gave me twelve weeks to wean myself off methadone before starting drug court. I did my best to taper down quickly, but I found myself in handcuffs on the first day I reported to court, six-month-old Sophie in the car seat on the sidewalk next to me, waiting for my husband to find a ride to pick her up so that I could be taken to jail for not quite getting off that last 5 milligrams of methadone. I'd tried so hard to taper down by myself, but trying didn't count for anything; all that mattered was negative or positive, "clean" or "dirty, " and I was dirty. I spent a week in jail, and in the first eighteen months of Sophie's life, I served another four jail sentences for minor violations. I spent my very first Mother's Day behind bars, and many more days after that, leaving her behind each time, alone with my husband and his precarious status in this country. And so I spent months going through my own long, protracted, painful withdrawal process after my last dose of methadone, just months after Sophie's last dose, our pain overlapping. The first year of her life felt like war, draining every bit of warmth and love and humanity from me as I tried to stay afloat and keep us all alive. We spent our days together rocking and crying, trying to eat, sleep, and breathe—to find moments of stasis. Her Rubenesque rolls of fat, her gummy grin and baby giggles, her fairy hair floating in a halo around her head offered glimpses of joy, flickers of light in my heart, but deep down I stayed in constant fear. Nothing nurtured me, and I couldn't nurture her. I hated myself, resented my husband, and in many moments wished I didn't have a baby. The Dangerous Consequences Of Criminalization My experience of motherhood with substance use is not unique. People from all walks of life have all kinds of relationships with licit and illicit substances in many different contexts, including pregnancy and parenting, and substance use occurs on a broad spectrum, from beneficial to harmful. The lines we draw between substance use that's legal and socially acceptable and use that is stigmatized and villainized are arbitrary, based more on morality and politics than science and evidence. Certainly, there are serious health consequences for fetuses from some types of prenatal substance use. However, many of the policies and practices that purport to avert such harm to fetuses and newborns can often exacerbate the conditions that instead push pregnant people into carceral-minded systems such as child welfare, criminal courts, and even some forms of treatment for substance use disorder that are meant to support parent and child health but often end up doing the opposite. These systems view all substance use as a criminal act or a moral failing, missing an opportunity to address problematic or potentially harmful substance use as the health condition that it is, and to support holistic wellness. Further, we encourage discrimination against pregnant and parenting people through policy and law, despite clear evidence of its harm. Perinatal Substance Use: A Harm Reduction Toolkit, from the Academy of Perinatal Harm Reduction and National Harm Reduction Coalition, explains how stigmatizing policies and behaviors are harmful to the care and health of patients. When exposed to stigmatizing treatment, behaviors, and policies for long enough, recipients internalize the judgment and come to believe the negative narratives told to and about them. They make decisions about their health that reflect this disvalued narrative, leading many pregnant women who use substances to avoid engaging with providers and routine prenatal care—care that is known to be critical to healthy babies. This is especially compounded when those providers have historically treated the person poorly, resulting in a missed opportunity for a compassionate, respectful response that can support the person's desire to be a good parent. This pervasive stigma and criminalization faced by women like me who use substances during pregnancy causes irreparable and long-lasting damage to families. The trauma and suffering are unnecessary and, most important, avoidable. The stigma extends to medications for opioid use disorder (MOUD), such as methadone and buprenorphine, despite ample evidence that these medications are the gold-standard treatment for opioid use disorder. This includes MOUD for pregnant people, which has been shown to improve maternal and infant outcomes. These attitudes are not only socially acceptable but also written into law, policy, and practice. Some examples of these harmful policies within health care, child welfare, and criminal justice are reporting substance use to criminal justice without weighing the potential harm or benefit; forcing parents into treatment under threat of losing custody or facing jail; mandated reporting for positive drug tests, even when MOUD is prescribed; dismissing parental input in care decisions for substance-exposed newborns; denying housing or food benefits because of current or former substance use or criminal justice involvement; and excessive monitoring and surveillance and burdensome MOUD rules (for example, daily dosing, frequent drug tests, and mandatory group attendance) that disrupt daily life. Also of great concern is the postpartum period, which, according to the Centers for Disease Control and Prevention, is one of the most dangerous times in a mother's life, especially for mothers with trauma and mental health and substance use conditions. The American Medical Association's 2024 publication Improving Access to Care for Pregnant and Postpartum People with Opioid Use Disorder: Recommendations for Policymakers identifies overdose as one of the leading causes of death during this period. On leaving the hospital, parents often face a cliff edge—a complete dropoff in support. They may have little or no social resources of their own to draw on, and they can end up feeling abandoned, facing the challenge of caring for a new baby with complicated needs completely alone. In addition, the burdens of stigma and criminalization can cause alienation and separation between mother and baby, inhibiting healthy attachment and ultimately denying babies one of the most important things they need: a present, supported parent who is able to focus on loving them. A Healing Path For Parents Who Use Substances—And Their Children Imagine an alternative in which my daughter could have been born into stability, safety, and love instead of incarceration, trauma, and isolation. If I had been able to be consistently emotionally and physically present, and had been offered a chance to rebuild within a network of care where we both felt safe, nurtured, loved, and supported, and where my health was treated as essential to the health of my child. Imagine if health care settings could be safe havens offering comprehensive care under one roof for pregnant people who use substances, with providers who understand the spectrum of substance use and how to support people who use drugs. Where compassionate care, peer support, doulas, and extensive trauma services could be the norm, instead of our current reality of mandated reporting and criminalization. We can't eliminate all harm caused by perinatal substance use or the need for some children to be cared for by someone other than the birth parents. But we can offer compassionate, holistic, and routine care as a matter of course to all pregnant people, regardless of their relationship with substances. We can recognize their potential as parents and their hopes and dreams for their children, and offer them the chance to heal and succeed. We can put our hearts on the line to embrace these sometimes messy, sometimes challenging, and always beautiful people who love their babies, want the best for them, and show up in the most challenging circumstances and do the best they can. As for my experiences, drug court did nothing to resolve my problematic substance use or address the underlying causes, as healing could not occur for me within a system based on control and coercion. When Sophie was four, I returned to problematic substance use. I lost custody of her, my husband was deported, and I spent the next six years in homeless shelters, detoxes, and jails while a foster family and my parents cared for her. I eventually found my footing and regained custody of Sophie when she turned ten. We just barely made it out together. We thrive sporadically, tenuously, often by luck or privilege, and in spite of a system that's barely changed in twenty-five years. Now twenty-four, she's vibrant and alive and working on healing her trauma. We thrive sporadically, tenuously, often by luck or privilege, and in spite of a system that's barely changed in twenty-five years. The challenges we faced bonding with one another in those early years and the loss of both parents in her life at age four have not gone away. She has struggled with attachment to others, being overly sensitive to sensory signals, living with challenging mental health conditions, and not liking to be touched by most people, including me. I have also healed in many ways since her childhood and am learning how to better access that soft, tender mother-place in me and offer a deeper, softer love to her, but she doesn't feel safe in it, and she turns away. I long to reach out and hug her, hold her, and comfort her. Not being able to do so is an ache that lives deep in my body. I still hope for a chance to repair the damage. For me and many others, substance use is more than just a coping mechanism; it can be a survival strategy, and simply removing the substance from a person's life does not eliminate their other challenges. Focusing only on a parent's substance use denies them and their baby the compassionate, comprehensive care they most need. People who use substances love their children and want them to thrive. They want their children's lives to be better than their own, just like any other parent does. And they deserve unconditional support and the chance to succeed in doing so, just like everyone else. Loading Comments. . . Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 September 2025 InformationThis open access article is distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4. 0) license. PDF downloadRelated articlesThe Opioid Crisis: Scaling Up Treatment And Harm Reduction Programs To Reach More People Who Would Benefit02 Sep 2025Health Affairs