Childhood Lead Poisoning and Other People’s Children

This chapter examines childhood lead poisoning, which causes severe and irreversible cognitive and nervous system impairment, as well as behavioral problems, in more than half a million American children each year. While the United States has addressed some causes of lead poisoning, a core group of children, concentrated in poor, urban areas in the Northeast and Midwest, remains at high risk. In nearly every state, manufacturers of lead paint and other lead products have not been held responsible for this harm, even though they were aware of the risks of lead poisoning since the nineteenth century. Many landlords in lead poisoning cases succeed in shifting the blame from themselves to the tenants, arguing that mothers are the actual cause of harm to the child. Because the American legal system has traditionally preferred to find a single cause of harm that cuts off others’ responsibility, many children injured by exposure to lead fail to receive compensation and treatment for their injuries.

The “Good Mother” and Crimes of Omission

This chapter looks at mothers who are prosecuted for failing to protect their children from an abuser. Mothers are more likely than fathers to face criminal charges when an abusive partner harms the parent’s child. Although the legal principles governing such cases are ostensibly neutral, unconscious psychological processes result in prosecutors, juries, and judges finding mothers guilty, even though the mothers are often themselves the victims of violence from the child’s abuser. Prosecutors ask, “Why didn’t she leave?” rather than “Why didn’t he stop beating the child?” The way to protect children from abuse is to expand support to victims of family violence, not to punish mothers.

Caught in the Crossfire

This chapter examines the current breastfeeding debate, demonstrating how weak medical and scientific evidence can be easily distorted. The evidence that American children are at risk of serious childhood illness as a result of a lack of breastfeeding is, at best, extremely weak; nevertheless, many physicians and the federal government have endorsed breastfeeding as the sole way to nourish infants. This is troubling, given the myriad reasons why many women are unable to breastfeed easily—if at all. Structural obstacles prevent many women who would choose to breastfeed from doing so, particularly the lack of maternity leave and financial and other support for breastfeeding. The Affordable Care Act has improved the situation but not enough.

Drug Use by Pregnant Women

This chapter examines the use of drugs—both legal and illegal–by pregnant women, noting increased medical and legal supervision of pregnancy and women’s substance use and abuse. Many states require health care professionals to report pregnant women who admit to, or are suspected of, using alcohol or other drugs. The result can be involuntary detention commitment for “treatment.” Women have been prosecuted for homicide after they suffer a stillbirth despite weak evidence that the stillbirth was caused by drug use. Prosecution of these women is counterproductive, because it drives pregnant drug users underground, away from both prenatal care and drug treatment.

Moving beyond Blame

This chapter considers the comprehensive risks to children’s health, which are complex and often interconnected. Only by taking collective responsibility to protect children’s health will the real risks to children’s health be reduced. It is time to embrace the precautionary principle. Instead of addressing children’s health problems by scapegoating mothers, society would be better served by addressing broader risks to childhood health, especially those related to poverty and living in poor inner-city neighborhoods. Offering voluntary medical and social services to mothers is the key to improving children’s health.

Are Mothers Hazardous to Their Children’s Health?

This chapter challenges the prevailing narrative that mothers are risky to their children’s health, discussing the myriad ways in which mothers are portrayed as dangerous to their children’s health—and are often held legally responsible for it. This often occurs simultaneously with society’s failure to acknowledge the significant contributions to children’s health made by fathers and other men, as well as more distant, but equally significant, social, economic, and physical factors. The chapter introduces the role of unconscious psychological processes in influencing the decisions of key legal players.

The Vaccination Paradox

This chapter addresses risk construction in the context of mandatory vaccination laws. Vaccines prevent contagious disease outbreaks by achieving vaccination levels that protect the public through “herd immunity.” Yet vaccines have become a victim of their own success. Today, childhood immunization rates are falling nationwide, increasing the likelihood of disease outbreaks in communities where vaccination “exemptors” cluster. Vaccination is the one area of children’s health in which mothers who choose not to provide medical care to their children are neither condemned nor prosecuted. The construction of risk in the vaccine context shows how important racial and class stereotypes are in affecting our view of risk.

Conceptions of Risk

This chapter addresses the intense surveillance placed upon American women during pregnancy. Given the dynamic connections between medical, media, and political attitudes toward pregnancy and a view that pregnant women are obligated to promote fetal life at all costs, it is little surprise that civil and criminal consequences abound for these women. Frequently, pregnant mothers’ personal or religious objections and rights are overruled, leading judges to order caesarean sections and other medical treatment, including keeping pregnant women on life support to keep their fetuses alive. Criminal prosecutions against pregnant women are increasing.

How Healthy Are America’s Children?

This chapter notes that, in a historical context, American children are generally quite healthy. Nevertheless, when compared with other economically developed countries, today the United States falls short, especially in measures of infant mortality, preterm birth, and childhood injury and death. This can be attributed in large part to class- and race-based disparities, as well as to stressors, such as environmental hazards, physical and sexual abuse, domestic violence, and substance abuse and mental illness. The American legal system has largely taken a hands-off approach to many of these problems, and children have suffered as a result.

The Social, Psychological, and Legal Construction of Risk

This chapter explores the psychosocial process of risk construction, explaining general processes of risk perception, risk communication, and risk management. These unconscious and powerful processes create subliminal biases and stereotypes and affect the discretionary decisions of prosecutors, judges, and juries. Health care professionals wield tremendous power in deciding when to disclose confidential patient information to law enforcement if they believe that a patient, especially a pregnant woman, has engaged in “risky” behavior.