Why We Need to Center Pregnant and Parenting Folks in Harm Reduction Work
by Arlo Narva
A few months ago I was asked to contribute to a session for a Black Maternal Mental Health Summit organized by Quatia Osorio, founder of the Urban Perinatal Education Center in Pawtucket, RI. Q asked me to present on comorbidities with addiction, based on my prior work and my current role as director of programs at a harm reduction organization.
When chatting about the session, Q asked me, “What are you guys doing for Black Maternal Health? What services or programs do you provide?”
And I told her the truth, something I have been sitting with, and thinking about in the years I’ve worked at different harm reduction orgs: “Nothing.”
“Okay,” said Q, “Then talk about that.”
My Journey in Harm Reduction
I moved a year ago from Philly, where I worked for the City of Philadelphia Department of Health, leading a Title V funded doula program. The doula program specifically supports pregnant and postpartum parents who use drugs. State funders wanted a doula program at the City, because doulas are trendy now, for better and worse, particularly when implemented as agents of the state – but that is a whole other blog post.
The health commissioner wanted a program that addressed the rates of babies being born with Neonatal Abstinence Syndrome (NAS), the diagnosis an infant receives when they are experiencing withdrawal symptoms and require admittance to the NICU. The goal: lessening these rates. To say the least, there’s lots to unpack here.
Firstly, doulas can’t prevent or lessen NAS. It doesn’t make sense as an idea, but of course how NAS is diagnosed is another area in which institutions punish and control parents rather than support keeping families together.
The biggest downside of working at the City was that I couldn’t speak honestly in public. I was not able to contribute to change in the systems that parents who use drugs/have substance use disorder navigate. Inside the city bureaucracy, there is only more surveillance.
When I got written up for speaking out about DHS (child welfare) mistreatment of parents, I knew it was time to go.
Harm Reduction and Reproductive Justice
So when Q asked me to talk about why our harm reduction organization has no maternal health, let alone Black Maternal Health programs or initiatives, I was so grateful for the opportunity to think and speak on it. This is the upside of working in harm reduction. We’re already the rejects, the radicals, the black sheep in spaces we enter. But there’s downsides too, of course.
In both Philly and Rhode Island, but certainly around the country, harm reduction organizations have no specific services for pregnant or postpartum people. This is fascinating to me as a phenomenon. How could this be? There is a massive gap in services. So many people these organizations serve are parents, people who have given birth, people with children in the system, people who were children in the system.
I find so much grounding and purpose in the ways that the principles of harm reduction and birth/doula work align. And particularly when considering Black maternal health and the fight for reproductive justice and freedom. There is so much at this intersection that weaves together the core tenets of harm reduction.
In both my work as a doula and as a harm reductionist I am often listening and speaking about safety, autonomy, non-judgment, and informed consent.
Both harm reduction and reproductive justice uplift the leadership of impacted folks, center community expertise and respect peoples’ autonomy to make choices, even if and when we wouldn’t make the same ones ourselves.
I’ve come to learn that so much of this overlap is because the War on Drugs is a war on people and families. Harm reduction doula work is a response to this war; we create frameworks for understanding historical harm and trauma, and places where we have permission to honor the dignity of all people, no matter what other systems determine about them.
Including Parents in Harm Reduction Work
So why then don’t harm reduction organizations have services for pregnant and parenting people? Where are the sessions or tracks at harm reduction conferences? Why, especially, isn’t there more explicit space for pregnant and postpartum folks navigating child welfare, or, what Dorothy Roberts calls the Family Policing System?
Peer support is a cornerstone of harm reduction, so why don’t organizations include peer support among parents whose families are being investigated or separated by the state, that does not include partnership with, nor funding from, the child welfare system?
Why is this the one place where so often even harm reductionists cannot turn towards and throw down for perhaps the most stigmatized people of our society: the pregnant person using drugs?
I think the basic reasons are: racism, stigma and the War on Drugs.
But I credit so much of my learning to when I first heard Erin Miles Cloud and Lisa Sangoi of Movement for Family Power speak at Ancient Song's Decolonizing Birth Conference in 2018. I remember Erin answering this question I’ve posed above: it’s because, of course, there are children involved.
Our culture, emboldened by the insidious stigma towards all people who use drugs, has a valid fear for childrens’ safety and goal of preventing their death above all else.
This often results in separating children from their parents, families and communites, causing catastrophic trauma to their brains and bodies.
But as with all policing, we have bought into the magical thinking that there are people “taking care of it,” when we fear for the safety of a child, and those people are the child welfare workers. But abolition work must include ending the policing of families. Some cops are called case workers, as Joyce Macmillan says.
But not only that. Our system of mandated reporting deputizes all citizens as agents of the state to participate in this system. Given all of this, I’d like to pose some questions for reflection:
Can we really parse out the stigma of a person who uses drugs, let alone a person who is trying to parent a child, from our beliefs around what children and families need to be whole and held?
How can we include pregnant folks and parents in our work to end the War on Drugs, but also, how can we uphold the principles of harm reduction and reproductive justice in how we care for these parents and families?
Celebrating The Ways We are Doing This Work
The good news is that there are so many truly incredible people doing this work. And “this work” is rich, deep and unfolding, as it is devastating and urgent.
The parents, providers, community members, and scholars who are organizing and politicizing and sharing their brilliance with the world are doing holy, holy work.
A sliver of this work can be found in the resource guide I made for the BADT course I co-taught with MaryNissi Lemon; you can find Reproductive Support for People Who Use Drugs and In Recovery CE Course here!
Another resource I have to uplift is the Pregnancy and Substance Use Toolkit created by the Academy of Perinatal Harm Reduction. This toolkit is mindblowing. It is beyond thorough, it is beautiful, it is stunning; and it should be required reading for anyone doing this work, anyone whose work touches families in any way, which is, I think, everyone.
We must reimagine safety and support for families. And we must follow the leadership of Black mothers who are at its center. The work is hard and filled with grief and it is never ending. I find my place within it when I remember that another world is possible.
“We see you, see ourselves and know
That we must take the utmost care
And kindness in all things.”
- Joy Harjo (Eagle Poem)
Arlo Narva (she/they) is a white, queer, anti-zionist Jew, living on Narragansett land, also known as Rhode Island. She arrives to this work with deep love and respect for pregnant people, birthing people, parents, caregivers and families. Arlo is a harm reductionist, full spectrum doula and community organizer. She loves drugs and the people who use them. Arlo spends her time in the ocean, growing flowers, reconnecting with her ancestral new england roots, nurturing queer family and currently serves as director of programs at a harm reduction organization.
You can reach her at: ariellenarva@gmail.com