Vol. 8 No. 5 (May 1998) pp. 236-238.

MISCONCEIVING MOTHERS: LEGISLATORS, PROSECUTORS, AND THE POLITICS OF PRENATAL DRUG EXPOSURE by Laura E. Gomez. Philadelphia: Temple University Press, 1997. 207 pages. $59.95 (cloth), $19.95 (paper). ISBN 1-56639-558-5.

Reviewed by Michelle Donaldson Deardorff, Department of Political Science, Millikin University.

Laura E. Gomez's MISCONCEIVING MOTHERS fills an interesting gap in the academic literature surrounding pregnancy discrimination. While most research in this area either looks at workplace-oriented fetal protection laws and policies, this text investigates the criminal prosecution of women accused of harming their children through prenatal drug exposure. Gomez has written an interesting, quick reading text in which she examines California legislation in this policy realm. Unfortunately, while this research investigates a widely neglected area of political science and law, her approach limits the thoroughness of the study.

Structured as a case study of California policy making, this project is framed around several objectives. First, it examines "how prenatal drug exposure moved from wide-spread popular recognition to institutionalization in the state apparatus that responds to social problems. This process is essentially political, in the sense that it engages political actors and institutions in a power struggle, I accordingly focus on two areas in which politics is played out and policy is made: the state legislature (as the law-making body) and local prosecutorial offices (as the gateway to the criminal justice system). . . . These two arenas provide contrasting political contexts in which to trace the development of attitudes about and responses to prenatal drug exposure" (4). Secondly, the research investigates the development of stereotypes and images profiling "crack babies" and their mothers, and the media pressures and political environment (the "war on drugs" and the heightened abortion debate) through which these perspectives are analyzed. Finally, the book seeks to be a careful analysis of all of the participants and the implications of the process by which contemporary social problems become public policy. It is in meeting her first goal that she is the most successful, and her primary weakness is in the development of her third objective.

Gomez initially investigates the source of the perceived "crack babies problem" and, concomitantly, the larger issue of how social problems emerge in the public forum and where the pressure to find political solutions to social concerns develops. Gomez argues that this particular issue was constructed from the nexus of media reports and first generation medical research. She concludes that "[m]edical science, as reported in the news media, had provided 'evidence' of high prevalence rates and severe outcomes, and newspapers and television news shows had provided a steady diet of powerful images of inner-city neighborhoods with emaciated crack addicts and nurseries filled with premature infants screaming and shaking from cocaine withdrawal" (25). Emerging from this barrage of media images is public pressure for a policy solution for this problem. The primary issue of contention in the California legislature, according to Gomez, was not whether this issue should be addressed, but how. Gomez argues throughout the book that this was a nonissue in terms of magnitude and availability of political solutions. "Lawmakers debated the level of funding from treatment and prenatal care programs; they wrangled over whether to create new state offices to deal with the problem and then having done so, dickered over which state agency would house the new entity; they argued about whether the problem was better viewed as a crime or a public health issue; and they passed many measures to 'study' the problem" (29). While tha author does not utilize the political science literature, she independently finds that legislators rely on media coverage, and the significant involvement of lobbyists and interest groups, to determine the views and interests of constituencies. .In this case the abortion issue politicized the fetal protection concern.

Subsequently, Gomez turns to attempts by the California Legislature to regulate this social problem; 57 bills were presented between 1983 and 1996. However, "[n]one of the punitive bills won passage or even made it through a major policy committee. The bills that won passage addressed the social problem by providing funding for public education, health care (especially prenatal care), and a range of social services for mothers and children at risk for prenatal drug exposure" (41). She discovers two phases of prenatal drug exposure policy making in which "early legislative responses took a harder line (either in proposing a punitive response or couching the provision of services in inflammatory rhetoric about the social problem) consistent with the media and medical research representations of the issue" (41). In response to these initial legislative reactions, a number of "claims makers" became involved in the policy making process: feminists, service providers, medial professionals, and others. From the examination of the various interest groups, she determines that the nature of the policy is transformed from its initial construction by the media as a social catastrophe requiring punitive measures into a health problem demanding social assistance. Gomez concludes, "[o]ne of the central principles of this book is that the effort to institutionalize the problem is at least as fraught with contestation as the discovery phase; thus, the social problem may emerge from this stage looking quite different from the way it looked at first" (62).

Moving from the construction of public policy to its implementation, the author transfers her focus from the legislative branch to the criminal justice system, more specifically to the prosecutor. "My intention has been to focus on the political dynamics that institutionalize a problem in the state bureaucracy, but thus far I have examined only the most overtly political setting, the legislature. By turning to a less explicitly political arena, we can compare legislators' and prosecutors' patterns of second-round claims-making" ( 62). This comment highlights one of my primary critiques of MISCONCEIVING MOTHERS, Gomez' assumption that prosecutors' offices are less explicitly political than the legislature demonstrates her lack of understanding of both the policy making process and the significance of implementation to the process. While she sees herself correcting a misunderstanding, her ignorance of the literature hinders her analysis. In her exploration of prosecutors, Gomez examines the decision of prosecutors to indict through actual cases and through interviews exploring this decision in both the real and the abstract. This section is the freshest and most insightful of the text; she portrays the prosecutorial response as one of extremes ("very punitive" versus "inaction"). The lack of middle ground indicates for Gomez that this issue became one of "symbolic politicking." She does not explore the parameters, implications, or significance of such symbolic decision making for the criminal justice system.

The discrepancy between the public rhetoric and the actual policy creation and implementation is explained through the testing of several hypotheses. Gomez finds that "[s]uch broad-scale economic changes as a prolonged downturn or a shift in the dominant sector . . ." (97) when combined "with a tremendous population growth, which dramatically changed . . . racial composition" (101) best explained prosecutorial willingness to prosecute. Inactiveness in the prosecutorial office was elucidated by the offices' unwillingness to invest resources in cases made weak by virtue of a lack of evidence or public support, legislative inaction, the unwillingness of appellate courts to sustain such verdicts, or the lack of cooperation from other state agencies. Gomez concludes her analysis of the policy making impact of prosecutors by noting the obvious: "local prosecutors [are] constrained by institutional features beyond their individual control" (115).

The conclusion of Gomez' study reflects the schizophrenic nature of her thesis and her multiple foci. She finds that the media coverage reflected societal fears and impressions of both racial minorities and of the poor. The changing nature of the institutionalized policy showed the means through which policies could become redrafted in response to the involvement of various "claims makers." I did not find compelling this argument that any policy became institutionalized, her evidence seemed to reject any notion of a clearly institutionalize policy, but instead demonstrated clearly localized policies.

Finally, the author concludes her analysis by stating "[I]n order to successfully oppose criminalization, the feminist coalition had to recast the social problem as affecting all women, rather than the subset of drug-addicted women (or poor women of color presumed to be candidates for drug addiction). This was the crucial step in converting the problem from one that fell under the jurisdiction of the criminal justice system to one that more properly belonged in the medical-public health domain. . . . Part of the strategy to medicalize rather than criminalize prenatal drug exposure, then, depended on recasting it as a more generic women's problem rather than as one limited to a subset of women presumably more apt to be viewed as having criminal propensities" (122).

In conclusion, while Gomez provides a nicely nuanced analysis of an under-examined issue, her lack of knowledge of and reliance on the political science literature often leaves her stating the obvious, without providing new insights. An examination of her sources and evidence reveals a clear knowledge of and careful reference to sociological, health, legal, and some feminist sources, but there is a clear dearth of the political science literature. The clear strength of this book is found in Gomez' analysis of this specific issue as a valid policy concern. Her examination of the arguments surrounding the criminalization of prenatal drug exposure is thorough and her evidence compelling. It is for her insights surrounding the political, ideological, and philosophical tensions involved in the development and implementation of this policy that this book is worth reading. I only wish that this policy had been the central theme of the text.