The pregnancy was a turning point for L. She was in an abusive relationship. "He actually hit me when I was pregnant," she says. "I was like, 'Well, if that's not gonna stop him, then nothing is.'"
NPR is not using her full name — just her initial — out of concern for L's safety.
She considered abortion, but even if she'd wanted one, it was impossible. Abortion is illegal in Texas, and she didn't have the means to go to another state. The closest clinic is at least an eight-hour drive from her home in San Antonio. L also had another child, a 4-year-old boy, and couldn't leave him.
The only thing she had the power to do was to quit her relationship. She just needed a place to go to.
There was another complication, though. L is in recovery. She has struggled with substance use disorder in the past and was taking methadone — a drug that helps mitigate the side effects of opioid addiction — when she got pregnant. She needed to find a place to go to that would be supportive and understanding.
That's when she found Casa Mía, a program in San Antonio that provides housing and support for pregnant women and new mothers struggling with addiction.
L received medical treatment for addiction as well as mental health care. She gave birth to a healthy baby boy, who's now 2 months old, despite her history of substance abuse. Had she not found Casa Mía, she says, her life would look much different.
"Oh, both my kids would've been taken away permanently — for sure," she says. "I probably would've been out in the streets homeless."
Fear of losing their children to the state is one of the main reasons women who are both pregnant and struggling with substance abuse don't seek help. Experts say it's not unfounded. "There are certain states that will criminalize you for using substances and being pregnant," says Dana Sussman, acting executive director of Pregnancy Justice, a legal advocacy group for pregnant people.
In states like Texas, where a fetus has been granted equal rights to the mother, criminal charges can be steep. Not only does the criminal justice system punish women in these circumstances, says Sussman, but it also "provides you with no mechanism to seek help without the specter of criminal charges or the child welfare system."
Abortion restrictions are especially burdensome for the most vulnerable women
Since the Supreme Court overturned Roe v. Wade last summer, Americans are having fewer abortions. Some experts estimate that there have been tens of thousands fewer abortions across the country in the past year — at least 25,000 fewer in Texas, where much of the state is hundreds of miles from access to abortion.
These circumstances are especially burdensome for women who are already grappling with destabilizing forces. Those struggling with substance abuse are at greater risk of unplanned pregnancies; nearly 20% of women who seek an abortion are homeless, according to one study.
Babies who were exposed to opioids in the womb can have something called neonatal abstinence syndrome — and they are some of the most fragile. In the United States, a baby is given this diagnosis every 25 minutes.
Lisa Cleveland saw this firsthand working as a nurse in the neonatal intensive care unit at a Texas hospital. Often when babies are taken from their mothers at birth, she says, they are never reunited. She was tired of watching mothers lose their children to foster care. That's when she founded Casa Mía through the University of Texas Health Science Center at San Antonio.
The program is run out of a converted old house. Nine women live there now. Residents spend time working in a garden out back or playing in the backyard with their toddlers. Babies and cribs are around every corner.
Cleveland points to a row of battery-powered baby swings that line the wall in the living room. "So those work really, really great for babies who are experiencing withdrawal symptoms," she says.
The best medicine for babies with this condition, she says, is their parents.
"Mamas and babies go together," Cleveland says. "It's a two-pack, right? And so to think that you're gonna have healthy children raised by an unhealthy mother — that just doesn't work out."
Staff at Casa Mía prioritize helping mothers with recovery and destigmatizing substance abuse. These kinds of programs are rare. Casa Mía is funded through Texas Health and Human Services and has a long waiting list. Demand has grown significantly in recent years.
"We're really struggling as a nation dealing with opioid use disorder and pregnancy," says Stephen Patrick, director of the Center for Child Health Policy at Vanderbilt University.
Caring for these babies is expensive, he says. The U.S. spends nearly a half-billion dollars a year on treating babies with neonatal abstinence syndrome, Patrick says, and the majority of them still don't have adequate care.
"What we've been doing so far really isn't working," he says.
Criminalizing substance use disorder instead of treating it in pregnancy surfaces a larger issue. "I think time and time again, we see the needs of pregnant women and infants flying under the radar," Patrick says. "No one is owning the problem."
After much pressure, the state of Texas recently expanded its Medicaid benefit to postpartum mothers. Lower-income women can now receive health care for a year after they have a baby. But advocates say the state still has a long way to go toward supporting new parents.
Those who find this program say they feel lucky
Casa Mía is one of the few places where some of the most vulnerable moms can find support. Lorna Weis is another mom who lives there. Weis was in a master's program and working a full-time job when she started using methamphetamine.
"It was the miracle drug for a while," Weis says. Suddenly, she had enough energy to get through her busy schedule. But after six months, "it quickly consumed everything that I was and everything that I had."
Then she got pregnant. She, too, was in an abusive relationship. She started looking for a way out. Weis called as many social service agencies and shelters as she could find. There was nowhere to go. "I just was getting slammed doors in my face," she says.
It wasn't until after she had the baby that she hit rock bottom with a suicide attempt. Her son went into foster care. That's when she found Casa Mía.
"I don't think about it," Weis says of what might have happened had she not landed at Casa Mía. "I'm really big on law of attraction and bringing good things into your life and ... I just know that I was at the end of my rope."
After receiving treatment at Casa Mía, she's scheduled to be reunited with her baby in a few months. She points to a bulletin board covered in pictures of him. "He was born 4 pounds, 15 ounces, 19 inches long," she says. "It was all legs and feet."
Isaiah Phoenix is her son's name. She chose Phoenix, she says, because this baby was born of hope.
If you or someone you know might be considering suicide or be in crisis, call or text 988 to reach the Suicide & Crisis Lifeline. For suicide prevention resources from the Centers for Disease Control and Prevention, click here.
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