Pregnant Addicted Women in Manitoba

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Caroline Tait

After the "Ms G" Supreme Court decision in September 1997, Manitoba Health commissioned the Prairie Women’s Health Centre of Excellence (PWHCE) to manage a research study exploring the experiences of pregnant women who seek, participate with and complete addictions treatment, and of their recovery. It also examines current services and programs to determine if they meet the needs of the target population, and to define the characteristics of those that are effective.

Representatives from PWHCE and Manitoba Health (Addictions), a research consultant, a university professor and the principle investigator made up the PWHCE Project Working Group. Representatives from five addictions agencies, from Health Canada, Manitoba Health (Addictions and Aboriginal Health), and Manitoba Family Services and Housing formed the Project Advisory Committee. These two groups oversaw the research.

Taking a holistic view of variables affecting health and well-being, the study uses the Determinants of Health approach. A series of in-depth open-ended interviews were conducted with seventy-four service consumers with experiences of substance use during pregnancy. Data was also collected through consumer focus groups, community meetings, educational material from service providers and a questionnaire. First Nations on-reserve services were not included, nor were the experiences of First Nations women in accessing non-reserve services.

The report, The Service Needs of Pregnant Addicted Women in Manitoba (or the ‘PAW study’), contains forty-nine recommendations, seven of which are key.

1. That Manitoba Health support mentor programs like STOP FAS for high-risk women in regions of the province outside Winnipeg, and mentor programs that address other substance addictions, particularly the use of inhalants.
   
   
   
   
2. That Manitoba Health, with addiction and outreach service providers, improve after-care services available to women, fostering increased communication among service providers and effective follow-up services to connect women with positive supports in their home communities.
   
   
   
   
3. That Manitoba Health develop the service capacity of gender-sensitive outreach services that women identify as supportive and trustworthy, especially those for specific high-risk populations and in communities with widespread substance use, and that these services work with other agencies like addiction treatment programs and Child and Family Services to support women to build healthy support networks, and decrease or cease their use of substances before, during and after pregnancy, creating stable home environments and expanding their education and employment options.
   
   
   
   
4. That Manitoba Health recognize Aboriginal agencies, such as Metis Child and Family Services, Friendship Centres and the Aboriginal Health and Wellness Centre in Winnipeg, are in key positions to work directly with high-risk pregnant women and with the communities they serve, and are in the best position to create meaningful programs and services for Aboriginal women, and to work with off-and on-reserve addiction services.
   
   
   
   
5. That Manitoba Health develop services for pregnant women who present when intoxicated, including those who are detained by police under The Intoxicated Persons Detention Act.
   
   
   
   
6. Recognizing the central role of Child and Family Services in the lives of women with substance use problems, whose children have been apprehended or will be apprehended at birth, that Manitoba Health work collaboratively with CFS and addiction treatment programs to find ways for them to provide meaningful service options for women when an order of apprehension is made.
   
   
   
   
7. That Manitoba Health, together with a wide range of service providers and addictions treatment programs, ensure that women at risk of using substances while pregnant feel safe and secure to access services meaningful to them that can best support them in reducing or ceasing the use of substances.

Tim Sale, Manitoba Family Services and Housing Minister and Chair of the Healthy Child Committee of Cabinet, in December 2000 announced the expansion of the STOP FAS program to Thompson and The Pas, funded by $264,000 from Healthy Child Manitoba. The Minister noted this as one of the key recommendations of the PAW study, which is also posted on the Manitoba Health website.

The willingness of women to improve their quality of life, along with the positive momentum created by provincial service providers and a strong commitment from governmental ministries could well translate into practical health benefits for at-risk women and their families.

Moving the recommendations of the PAW study forward or indicating how they have been or are being addressed is the focus of the Strategy Development Committee, comprised of members of the PAW Project Advisory Committee, the Employment and Income Assistance Division of Family Services and Housing, and private child welfare agencies.

Caroline Tait is a Metis woman from Saskatchewan, a Fulbright Scholar currently completing her Ph.D. at McGill University. She is recognized as taking the lead in research into FAS and FAE in Aboriginal communities.

The Service Needs of Pregnant Addicted Women in Manitoba is available on-line at: www.gov.mb.ca/health/documents. A print copy may be ordered from the Prairie Women’s Health Centre of Excellence by calling (204) 982-6630 or by visiting their web site at www.pwhce.ca.

Who was "Ms G"?

"Ms G" was a 23-year-old First Nations woman from Winnipeg who was ordered into treatment by the court when five months pregnant with her fourth child.

Behind the legal action was Winnipeg Child and Family Services (CFS), with the charge that "G"’s unwillingness to stop sniffing glue was harming her fetus. Although the original ruling was overturned by Manitoba Court of Appeal, "Ms G" decided to get treatment of her own accord. CFS still sought the power to order substance-using pregnant women into treatment, even against their will, and looked to the highest court in the land to authorize it.

The question before the Supreme Court was whether the state has the right to force pregnant substance users into treatment programs. If the Court agreed, declaring a woman legally owes a ‘duty of care’ to her fetus, the door could be opened to a wide range of actions to control the behaviour of expectant women.

Chances are such power would be used most harshly against the poorest and the most marginalized women among us. Giving legal rights to a fetus could also curtail the reproductive freedom of all women, including our hard-won access to abortion.

To protect women’s right to autonomy, a strong campaign was mounted by health care providers, community groups and researchers to convince the Court that legal force is the wrong way to handle this complex social problem. The coalition argued that substance use is a health issue best addressed by services sensitive to women’s needs, not by the law.

Intervening on behalf of "Ms G" were the Women’s Health Rights Coalition—comprised of Women’s Health Clinic, Métis Women of Manitoba, Native Women’s Transition Centre and Manitoba Association of Rights and Liberties—along with the Women’s Legal Education and Action Fund, Canadian Abortion Rights Action League and the Canadian Civil Liberties Association.

Taking a closer look at the dangers of simplistic and individualistic approaches, the coalition cited five reasons why the Court should rule against mandatory addictions treatment for pregnant women. The ineffectiveness of forced treatment has been well documented. Women at risk tend to steer clear of services fearing they and their children will be apprehended, and thus are driven underground, deprived of necessary care.

Forced treatment laws may be applied unfairly. Studies from other countries show the majority of women confined against their will are poor and/or members of racial minorities.

A law and order response is a quick fix that fails to deal with the systemic and social causes of substance use including violence, sexual abuse, poverty, low self-esteem and lack of control. Racism and other forms of discrimination worsen the situation for women from marginalized groups.

Further, if fetuses are granted a legal right to care, the court could extend the power to institute control over any behaviour of all women of child-bearing age.

Finally, granting such authority to the child and family service system causes much concern, particularly over the conflict created by the competing priorities of doing prevention work with families as well as having the legal responsibility of supervising and apprehending children at risk.

In the end seven out of nine Supreme Court Judges said that the court does not have the right to force pregnant substance users into treatment programs.

While the Women’s Health Rights Coalition was pleased with the decision of the Court, it would have preferred the financial resources spent on the case could have been used to meet the urgent needs of pregnant women who use substances. The coalition was also saddened that the court did not more strongly remind governments of their positive duties and responsibilities to provide them with appropriate care, ensuring women-friendly treatment and support programs are available to all who seek them.

This synopsis is excerpted by Lynnette D’anna from the Special Report in the Winter 1997 issue of Network, which provides a thorough analysis of the potent mix of challenges posed by the “Ms G” case. Back issues of Network can be ordered from the Canadian Women’s Health Network.