"Fetal Rights, Women's Wrongs"
by Katha Pollitt

from Reasonable Creatures:  Essays on Women and Feminism
 
 

Some scenes from the way we live now:

        In New York City, a pregnant woman orders a glass of wine with her restaurant meal.  A stranger comes over to her table.  "Don't you know you're poisoning your baby?" he says angrily, pointing to a city-mandated sign warning women that drinking during pregnancy can cause birth defects.

In California, Pamela Rae Stewart is advised by her obstetrician to stay off her feet, to eschew sex and "street drugs," and to go to the hospital immediately if she starts to bleed.  She fails to follow this advice and delivers a brain-damaged baby who soon dies.  She is charged with failing to deliver support to a child under an old criminal statute that was intended to force men to provide for women they have made pregnant.

In Washington, D.C., a hospital administrator asks a court whether it should intervene and perform a cesarean section on Angela Carder, seriously ill with cancer, against her wishes and those of her husband, her parents and her doctors.  Acknowledging that the operation would probably shorten her life without necessarily saving the life of her twenty-five-week-old fetus, the judge nonetheless provides the order.  The cesarean is performed immediately, before her lawyers can appeal.  Angela Carder dies; so does her unviable fetus.  That incident is subsequently dramatized on "L.A. Law," with postfeminist softy Ann Kelsey arguing for the hospital; on TV the baby lives.

In the Midwest, the U.S. Court of Appeals for the Seventh Circuit, ruling in _UAW v. Johnson Controls_, upholds an automotive battery plant's seven-year-old "fetal protection policy" barring fertile women (in effect, all women) from jobs that would expose them to lead.  The court discounts testimony about the individual reproductive lives and plans of female employees (many in their late forties, celibate and/or with completed families), testimony showing that no child born to female employees had shown ill effects traceable to lead exposure and testimony showing that lead poses a comparable danger to male reproductive health.  The court accepts testimony that says making the workplace safe would be too expensive.

All over the country, pregnant women who use illegal drugs and/or alcohol are targeted by the criminal justice system. They are "preventively detained" by judges who mete out jail sentences for minor crimes that would ordinarily result in probation or a fine; charged with child abuse or neglect (although by law the fetus is not a child) and threatened with manslaughter charges should they miscarry; and placed under court orders not to drink, although drinking is not a crime and does not invariably (or even usually) result in birth defects.  While state legislatures ponder bills that would authorize these questionable practices by criminalizing drug use or "excessive" alcohol use during pregnancy, mothers are arrested in their hospital beds when their newborns test positive for drugs.  Social workers increasingly remove positive-testing babies into foster care on the presumption that even a single use of drugs during pregnancy renders a mother ipso facto an unfit parent.

What's going on here? Right now the hot area in the developing issue of "fetal rights" is the use of drugs and alcohol during pregnancy. We've all seen the nightly news reports of inner-city intensive care units overflowing with crack babies, of Indian reservations where one in four children is said to be born physically and mentally stunted by fetal alcohol syndrome (F.A.S.) or the milder, but still serious, fetal alcohol effect.  We've read the front-page stories reporting studies that suggest staggering rates of drug use during pregnancy (11 percent, according to _The New York Times_, or 375,000 women per year) and the dangers of even moderate drinking during pregnancy.

But drugs and alcohol are only the latest focus of a preoccupation with the fetus and its "rights" that has been wandering around the Zeitgeist for the past decade.  A few years ago the big issue was forced cesareans.  (It was, in fact, largely thanks to the horrific Angela Carder case -- one of the few involving a white, middle-class woman -- that the American College of Obstetricians and Gynecologists condemned the practice, which nonetheless has not entirely ceased.) If the Supreme Court upholds the _Johnson Controls_ decision, the next battleground may be the workplace.  The "save the babies" mentality may look like a necesssary, if troubling, approach when it's a matter of keeping a drug addict away from a substance that is, after all, illegal.  What happens if the same mentality is applied to some fifteen to twenty million highly paid unionized jobs in heavy industry to "protect" fetuses that do not even exist? Or if the list of things women are put on legal notice to avoid expands to match medical findings on the dangers to the fetus posed by junk food, salt, aspirin, air travel and cigarettes?

Critics of the punitive approach to pregnant drug and alcohol users point out the ironies inherent in treating a public-health concern as a matter for the criminal justice system: the contradiction, for instance, of punishing addicted mothers-to-be when most drug treatement programs refuse to accept pregnant women.  Indeed, Jennifer Johnson, a Florida woman who was the first person convicted after giving birth to a baby who tested positive for cocaine, had sought treatment and been turned away.  (In her case the charge was delivering drugs to a minor.) The critics point out that threats of jail or the loss of their kids may drive women away from prenatal care and hospital deliveries, and that almost all the women affected so far have been poor and black or Latina, without private doctors to protect them.  In Florida, nonwhite women are ten times as likely to be reported for substance abuse as white women, although rates of drug use are actually higher for whites.

These are all important points.  But they leave unchallenged the notion of fetal rights itself.  What we really ought to be asking is, How have we come to see women as the major threat to the health of their newborns, and the womb as the most dangerous place a child will ever inhabit? Why is our basic model "innocent" fetuses that would be fine if only presumably "guilty" women refrained from indulging their "whims"? The list of dangers to the fetus is, after all, very long; the list of dangers to children even longer.  Why does maternal behavior, a relatively small piece of the total picture, seem such an urgent matter, while much more important factors -- that one in five pregnant women receive no prenatal care at all, for instance -- attract so little attention?

        Here are some of the strands that make up the current tangle that is fetal rights:

** The assault on the poor.  It would be pleasant to report that the aura of crisis surrounding crack and F.A.S. babies -- the urge to do *something*, however unconstitutional or cruel, that suddenly pervades society, from judge's bench to chic dinner party to six o'clock news -- was part of a massive national campaign to help women have healthy, wanted pregnancies and healthy babies.  But significantly, the current wave of concern is not occurring in that context.  Judges order pregnant addicts to jail, but they don't order drug treatment programs to accept them, (many, citing insurance risks, refuse to accept pregnant women) -- let alone order landlords not to evict them, or obstetricians to take uninsured women as patients, or the federal government to fully fund the Women, Infants, and Children supplemental feeding program, which reaches only two-thirds of those who are eligible.  The policies that have underwritten maternal and infant health in most of the industrialized West since World War II -- a national health service, paid maternity leave, direct payments to mothers, government-funded day care, home health visitors for new mothers, welfare payments that reflect the cost of living -- are still regarded in the United States by even the most liberal as hopeless causes, and by everyone else as budget-breaking giveaways to the undeserving, pie-in-the-sky items from a mad socialist's wish list.

The focus on maternal behavior allows the government to appear to be concerned about babies without having to spend any money, change any priorities or challenge any vested interests.  As with crime, as with poverty, a complicated, multifaceted problem is construed as a matter of freely chosen behavior.  We have crime because we have lots of bad people, poverty because we have lots of lazy people (Republican version) or lots of pathological people (Democratic version), and tiny, sickly, impaired babies because we have lots of women who just don't give a damn.

Once the problem as been defined as original sin, coercion and punishment start to look like hardheaded and commonsensical answers. Thus, syndicated columnist and _New Republic_ intellectual Charles Krauthammer proposes locking up pregnant drug users en masse.  Never mind the impracticality of the notion -- suddenly the same Administration that refuses to pay for drug treatment and prenatal care is supposed to finance all that plus nine months of detention for hundreds of thousands of women a year.  Or its disregard of real life -- what, for example, about the children those women already have? Do they go to jail, too, like the Dorrit children? Or join the rolls of the notorious foster care system? The satisfactions of the punitive mind-set sweep all such considerations aside.  (Nor are liberal pundits immune from its spell.  Around the same time Krauthammer was calling for mass incarceration, Mary McGrory was suggesting that we stop wasting resources -- *what* resources? -- on addicted women and simply put their babies in orphanages.)
 
 

** The new temperance.  While rightly sounding the alarm about the health risks and social costs of drugs, alcohol and nicotine, the various "just say no" crusades have so upped the moral ante across the board that it is now difficult to distinguish between levels and kinds of substance use and abuse and even rather suspect to try.  A joint on the weekend is the moral equivalent of a twenty-four-hour-a-day crack habit; wine with meals is next door to a daily quart of rotgut.  The stigmatizing of addicts, casual users, alcoholics, social drinkers and smokers makes punitive measures against them palatable.  It also helps us avoid uncomfortable questions about why we are having all these "substance abuse" epidemics in the first place.  Finally, it lets us assume, not always correctly, that drugs and alcohol, all by themselves, cause harm during pregnancy, and ignore the role of malnutrition, violence, chaotic lives, serious maternal health problems and lack of medical care.
 
 

** Science marches on.  We know a lot more about fetal development than we did twenty years ago.  But how much of what we know will we continue to know in ten years? As recently as the early 1970s, pregnant women were harassed by their doctors to keep their weight down.  They were urged to take tranquilizers and other prescription drugs, to drink in moderation (liquor was routinely used to stop premature labor), to deliver under anesthesia and not bother to breast-feed.  Then, too, studies examined contemporary wisdom and found it good.  Today, those precepts seem the obvious expression of social forces: the wish of doctors to control pregnancy and delivery, a lack of respect for women and a distaste for female physiological processes.  It was not the disinterested progress of science that outmoded these practices.  It was another set of social forces: the women's movement, the prepared-childbirth movement and the natural-health movement.

What about today's precepts? At the very least, the history of scientific research into pregnancy and childbirth ought to make us skeptical.  Instead, we leap to embrace tentative findings and outright bad science because they fit current social prejudices.  Those who argue for total abstinence during pregnancy have made much, for example, of a recent study in _The New England Journal of Medicine_ that claimed women are more vulnerable than men to alcohol because they have less of a stomach enzyme that neutralizes it before it enters the bloodstream. Universally unreported, however, was the fact that the study included alcoholics and patients with gastrointestinal disease.  It is a basic rule of medical research that results cannot be generalized from the sick to the healthy.

In a 1989 article in _The Lancet_, "Bias Against the Null Hypothesis: The Reproductive Hazards of Cocaine," Canadian researchers reported that studies that found a connection between cocaine use and poor pregnancy outcome had a better than even chance of being accepted for presentation at the annual meeting of the Society for Pediatric Research, while studies that found no connection had a negligible chance -- although the latter were better designed.  While it's hard to imagine that anyone will ever show that heavy drug use or alcohol consumption is good for fetal development, studies like this one suggest that when the dust settles (because the drug war is officially "won"? because someone finally looks at the newborns of Italy, where everyone drinks moderate amounts of wine with food, and finds them to be perfectly fine?) the current scientific wisdom will look alarmist.
 
 

** Media bias.  The assumptions that shape the way researchers frame their studies and the questions they choose to investigate are magnified by bias in the news media.  Studies that how the bad effects of maternal behavior make the headlines, studies that show no bad effects don't get reported and studies that show the bad effects of paternal behavior (alcoholic males, and males who drink at conception, have been linked to lower I.Q. and a propensity to alcoholism in offspring) get two paragraphs in the science section.  So did the study, briefly mentioned in a recent issue of _The New York Times_, suggesting that housewives run a higher risk than working women of having premature babies, stillbirths, underweight babies and babies who die in the first week of life.  Imagine the publicity had it come out the other way around! Numbers that back up the feeling of crisis (those 375,000 drug-taking pregnant women) are presented as monolithic, although they cover a wide range of bahavior (from daily use of cocaine to marijuana use during delivery, which some midwives recommend, and for which one Long Island woman lost custody of her newborn for eight months), and are illustrated by dire examples of harm that properly apply only to the most hard-core cases.
 
 

** The "pro-life" movement.  Antichoicers have not succeeded in criminalizing abortion but they have made it inaccessible to millions of women (only sixteen states pay for poor women's abortions, and only 18 percent of counties have even one abortion provider) and made it a badge of sin and failure for millions more.  In Sweden, where heavy drinking is common, relatively few F.A.S. babies are born, because alcoholic women have ready access to abortion and it is not a stigmatized choice.  In America antichoice sentiment makes it impossible to suggest to a homeless, malnourished, venereally diseased crack addict that her first priority ought to be getting well: Get help, then have a baby.  While the possibility of coerced abortions is something to be wary of, the current policy of regulation and punishment in the name of the fetus ironically risks the same end.  Faced with criminal charges, pregnant women may seek abortions in order to stay out of jail (a Washington, D.C., woman who "miscarried" a few days before sentencing may have done just that).

As lobbyists, antichoicers have sought to bolster their cause by interjecting the fetus-as-person argument into a wide variety of situations that would seem to have nothing to do with abortion.  They have fought to exclude pregnant women from proposed legislation recognizing the validity of "living wills" that reject the use of life support systems (coma baby lives!), and have campaigned to classify as homicides assaults on pregnant women that result in fetal death or miscarriage.  Arcane as such proposals may seem, they have the effect of broadening little by little the areas of the law in which the fetus is regarded as a person, and in which the woman is regarded as its container.

At a deeper level, the "pro-life" movement has polluted the way we think about pregnancy.  It has promoted a model of pregnancy as a condition that by its very nature pits women and fetuses against each other, with the fetus invariably taking precedence, and a model of women as selfish, confused, potentially violent and incapable of making responsible choices.  As the "rights" of the fetus grow and respect for the capacities and rights of women declines, it becomes harder and harder to explain why drug addiction is a crime if it produces an addicted baby, but not if it produces a miscarriage, and why a woman can choose abortion but not vodka.  And that is just what the "pro-lifers" want.
 
 

** The privileged status of the fetus.  Pro-choice activists rightly argue that anti-abortion and fetal-rights advocates grant fetuses more rights than women.  A point less often made is that they grant fetuses more rights than two-year-olds -- the right, for example, to a safe, healthy place to live.  No court in this country would ever rule that a parent must undergo a medical procedure in order to benefit a child, even if that procedure is as riskless as blood donation and the child is sure to die without it.  (A Seattle woman is currently suing the father of her leukemic child to force him to donate bone marrow, but she is sure to lose, and her mere attempt roused _Newsday_ science writer B. D. Holen to heights of choler unusual even for him.) Nor would a court force someone who had promised to donate a kidney and then changed his mind to keep his date with the organ bank.  Yet, as the forced-cesarean issue shows, many of us seem willing to deny the basic right of bodily integrity to pregnant women and to give the fetus rights we deny children.

Although concern for the fetus may look like a way of helping children, it is actually, in a funny way, a substitute for it.  It is an illusion to think that by "protecting" the fetus from its mother's behavior we have insured a healthy birth, a healthy infancy or a healthy childhood, and that the only insurmountable obstacle for crack babies is prenatal exposure to crack.

It is no coincidence that we are obsessed with pregnant women's behavior at the same time that children's health is declining, by virtually any yardstick one chooses.  Take general well-being: In constant dollars, welfare payments are now about two-thirds the 1965 level.  Take housing: Thousands of children are now growing up in homeless shelters and welfare hotels.  Even desperately alcoholic women bear healthy babies two-thirds of the time.  Will two-thirds of today's homeless kids emerge unscathed from their dangerous and lead-permeated environments? Take access to medical care: Inner-city hospitals are closing all over the country, millions of kids have no health insurance and most doctors refuse uninsured or Medicaid patients.  Even immunization rates are down.  Whooping cough and measles are on the rise.
 
 

** The "duty of care." Not everyone who favors legal intervention to protect the fetus is antichoice.  Some pro-choicers support the coercion and punishment of addicts and alcoholics -- uneasily, like some of my liberal women friends, or gleefully, like Alan Dershowitz, who dismisses as absurd the "slippery slope" argument (crack today, cigarettes tomorrow) he finds so persuasive when applied to First Amendment issues.  For some years now bioethicists have been fascinated by the doctrine of "duty of care," expounded most rigorously by Margery Shaw and John Robertson.  In this view, a woman can abort, but once she has decided to bear a child she has a moral, and should have a legal, responsibility to insure a healthy birth.  It's an attractive notion because it seems to combine an acceptance of abortion with intuitive feelings shared by just about everyone, including this writer, that pregnancy is a serious undertaking, that society has an interest in the health of babies, that the fetus, although not a person, is also not property.

Whatever its merits as a sentiment, though, the duty of care is a legal disaster.  Exactly when, for instance, does the decision to keep a pregnancy take place? For the most desperately addicted -- the crack addicts who live on the subway or prostitute themselves for drugs -- one may ask if they ever form any idea ordinary people would call a decision, or indeed know they are pregnant until they are practically in labor. Certainly the inaccessibility of abortion denies millions of women the ability to decide.

But for almost all women the decision to carry a pregnancy to term has important, if usually unstated, qualifications.  What one owes the fetus is balanced against other considerations, such as serious health risks to oneself (taking chemotherapy or other crucial medication), or the need to feed one's family (keeping a job that may pose risks) or to care for the children one already has (not getting the bed rest the doctor says you require).  Why should pregnant women be barred from considering their own needs? It is, after all, what parents do all the time.  The model of women's relation to the fetus proposed by the duty-of-care ethicists is an abstraction that ignores the realities of life even when they affect the fetus itself.  In real life, for instance, to quit one's dangerous job means to lose one's health insurance, thus exposing the fetus to another set of risks.

It is also, even as an abstraction, a false picture.  Try as she might, a woman cannot insure a healthy newborn; nor can statistical studies of probability (even well-designed ones) be related in an airtight way to individual cases.  We know that cigarettes cause lung cancer, but try proving in a court of law that cigarettes and not air pollution, your job, your genes or causes unknown caused *your* lung cancer.

Yet far from shrinking from the slippery slope, duty-of-care theorists positively hurl themselves down it.  Margery Shaw, for instance, believes that the production of an imperfect newborn should make a woman liable to criminal charges and "wrongful life" suits if she knows, or should have known, the risk involved in her behavior, whether it's drinking when her period is late (she has a duty to keep track of her cycle), delivering at home when her doctor advises her not to (what doctor doesn't?) or failing to abort a genetically damaged fetus (which she has a duty to find out about).  So much for that "decision" to bear a child -- a woman can't qualify it in her own interests but the state can revoke it for her on eugenic grounds.

As these examples show, there is no way to limit the duty of care to cases of flagrant or illegal misbehavior -- duty is duty, and risk is risk.  Thus, there is no way to enshrine the duty of care in law without creating the sort of Romania-style fetal-police state whose possibility Dershowitz, among others, pooh-poohs.  For there is no way to define the limits of what a pregnant woman must sacrifice for fetal benefit, or what she "should have known," or at what point a trivial risk becomes significant.  My aunt advised me to get rid of my cats while I was pregnant because of the risk of toxoplasmosis.  My doctor and I thought this rather extreme, and my husband simply took charge of the litter box. What if my doctor had backed up my aunt instead of me? If the worst had happened (and it always does to someone, somewhere), would I have been charged with the crime of not sending my cats to the Bide-A-Wee?

Although duty-of-care theorists would impose upon women a virtually limitless obligation to put the fetus first, they impose that responsiblity *only* on women.  Philosophy being what it is, perhaps it should not surprise us that they place no corresponding duty upon society as a whole.  But what about Dad? It's his baby, too, after all.  His drug and alcohol use, his prescription medications, his workplace exposure and general habits of health not only play a part in determining the quality of his sperm but affect the course of pregnancy as well.  Cocaine dust and smoke from crack, marijuana and tobacco present dangers to others who breathe them; his addictions often bolster hers.  Does he have a duty of care to make it possible for his pregnant partner to obey those judge's orders and that doctor's advice that now has the force of law? To quit his job to mind the children so that she can get the bed rest without which her fetus may be harmed? Apparently not.

The sexist bias of duty of care has already had alarming legal consequences.  In the Pamela Rae Stewart case cited at the beginning of this article, Stewart's husband, who had heard the doctor's advice, ignored it and beat his wife into the bargain.  Everything she did, he did -- they had sex together, smoked pot together, delayed getting to the hospital together -- but he was not charged with a crime, not even with wife-beating, although no one can say that his assaults were not a contributing cause of the infant's injury and death.  In Tennessee, a husband succeeded in getting a court order forbidding his wife to drink or take drugs, although he himself had lost his driver's license for driving while intoxicated.  In Wyoming, a pregnant woman was arrested for drinking when she presented herself at the hospital for treatment of injuries inflicted by her husband.  Those charges were dropped (to be reinstated, should her baby be born with defects), but none were instituted against her spouse.

It is interesting to note in this regard that approximately one in twelve women is beaten during pregnancy, a time when many previously nonviolent men become brutal.  We do not know how many miscarriages, stillbirths and damaged newborns are due, or partly due, to male violence -- this is itself a comment on the skewed nature of supposedly objective scientific research.  But if it ever does come to be an officially recognized factor in fetal health, the duty of care would probably take yet another ironic twist and hold battered pregnant women liable for their partner's assaults.
 
 

_The Broken Cord_, Michael Dorris's much-praised memoir of his adopted F.A.S. child, Adam, is a textbook example of the way in which all these social trends come together -- and the largely uncritical attention the book has received shows how seductive a pattern they make.  Dorris has nothing but contempt for Adam's birth mother.  Perhaps it is asking too much of human nature to expect him to feel much sympathy for her.  He has witnessed, in the most intimate and heartbreaking way, the damage her alcoholism did, and seen the ruin of his every hope for Adam, who is deeply retarded.  But why is his anger directed only at her? Here was a seriously alcoholic woman, living on an Indian reservation where heavy drinking is a way of life, along with poverty, squalor, violence, despair and powerlessness, where, one might even say, a kind of racial suicide is taking place, with liquor as the weapon of choice.  Adam's mother, in fact, died two years after his birth from drinking antifreeze.

Dorris dismisses any consideration of these facts as bleeding-heart fuzzy-mindedness.  Like Hope on "thirtysomething," Adam's mother "decides" to have a baby; like the martini-sipping pregnant women he badgers in an airport bar, she "chooses" to drink out of "weakness" and "self-indulgence."

Dorris proposes preventive detention of alcoholic pregnant women and quotes sympathetically a social worker who thinks the real answer is sterilization.  Why do alcoholic Indian women have so many children? To up their government checks.  (In fact, Bureau of Indian Affairs hospitals are prohibited by law from performing abortions, even if women can pay for them.) And why, according to Dorris, do they drink so much in the first place? Because of the feminist movement, which has undermined the traditional temperance of reservation women.

The women's movement has had about as much effect on impoverished reservation dwellers as it had on the slum-dwelling women of eighteenth-century London, whose heavy binge drinking -- and stunted babies -- appalled contemporary observers.  That Dorris pins the blame on such an improbable villain points to what fetal rights is really about -- controlling women.  It's a reaction to legalized abortion and contraception, which has given women, for the first time in history, real reproductive power.  They can have a baby, they can "kill" a baby, they can refuse to conceive at all, without asking permission from anyone. More broadly, it's an index of deep discomfort with the notion of women as self-directed social beings, for whom parenthood is only one aspect of life, as it has always been for men.  Never mind that in the real world, women still want children, have children and take care of children, often under the most discouraging circumstances and at tremendous emotional, economic and physical cost.  There is still a vague but powerful cultural fear that one of these days, women will just walk out on the whole business of motherhood and the large helpings of humble pie we, as a society, serve along with it.  And *then* where will we be?

Looked at in this light, the inconsistent and fitful nature of our concern about the health of babies forms a pattern.  The threat to newborns is interesting when and only when it can, accurately or fancifully, be laid at women's doorstep.  Babies "possibly" impaired by women's drinking? Front-page stories, a national wave of alarm.  But a _New England Journal of Medicine_ report that 16 percent of American children have been mentally and neurologically damaged because of exposure to lead, mostly from flaking lead paint in substandard housing? Peter Jennings looks mournful and suggests that "all parents can do" is to have their children tested frequently.  If the mother isn't to blame, no one is to blame.

In its various aspects, the doctrine of "fetal rights" attacks virtually all the gains of the women's movement.  Forced medical treatment attacks women's increased control over pregnancy and delivery by putting doctors back in the driver's seat, with judges to back them up.  Workplace fetal-protection policies contest the entry of women into high-paying, unionized, traditionally male jobs.  In the female ghetto, where women can hardly be dispensed with, the growing practice of laying off or shifting pregnant women around transforms women, whose rates of labor-force participation are approaching those of men, into casual laborers with reduced access to benefits, pensions, seniority and promotions.  In a particularly vicious twist of the knife, "fetal rights" makes legal abortion -- which makes all the other gains possible -- the trigger for a loss of human rights.  Like the divorce courts judges who tell middle-aged housewives to go out and get a job, or who favor the father in a custody dispute because to recognize the primary-caretaker role of the mother would be "sexist," protectors of the fetus enlist the rhetoric of feminism to punish women.

There are lots of things wrong with the concept of fetal rights. It posits a world in which women will be held accountable, on sketchy or no evidence, for birth defects; in which all fertile women will be treated as potentially pregnant all the time; in which courts, employers, social workers and doctors -- not to mention nosy neighbors and vengeful male partners -- will monitor women's behavior.  It imposes responsibilities without giving women the wherewithal to fulfill them, and places upon women alone duties that belong to both parents and to the community.

But the worst thing about fetal rights is that it portrays a woman as having only contingent value.  Her work, her health, her choices and needs and beliefs, can all be set aside in an instant because, next to child-bearing, they are all perceived as trivial.  For the middle class, the idea of fetal rights is mostly symbolic, the gateway to a view of motherhood as self-sacrifice and endless guilty soul-searching.  It ties in neatly with the currently fashionable suspicion of working mothers, day care and (now that wives are more likely than husbands to sue for it) divorce.  For the poor, for whom it means jail and loss of custody, it becomes a way of saying that women can't even be mothers.  They can only be potting soil.

The plight of addicted and alcohol-impaired babies is indeed a tragedy.  Finally, we are foced to look at the results of our harsh neglect of the welfare and working poor, and it's only natural that we don't like what we see.  We are indeed in danger of losing a generation. But what about the generation we already have? Why is it so hard for us to see that the tragedy of Adam Dorris is inextricable from the tragedy of his mother? Why is her loss -- to society, to herself -- so easy to dismiss?

"People are always talking about women's duties to others," says Lynn Paltrow, the A.C.L.U. lawyer who successfully led the Pamela Rae Stewart defense, "as though women were not the chief caregivers in this society.  But no one talks about women's duty of care to *themselves*.  A pregnant addict or alcoholic needs to get help for *herself*.  She's not just potentially ruining someone else's life.  She's ruining her own life.

"Why isn't her own life important? Why don't we care about her?"

[1990]