GROUNDS FOR REVIEW

Review is “necessary to secure uniformity of decision” and “to settle an important question of law.” Rules of Court, Rule 8.500(b)(1). Trial courts have generally rejected prosecutions of women who have experienced pregnancy loss under Penal Code §187. See People v. Jaurigue (Super. Ct. San Benito County, 1992, No. 18988); People v. Jones, No. 93-5 (Super. Ct. Siskiyou County,1993, No. 93-5). Penal Code §187 has never been interpreted by to authorize prosecution of a woman in relationship to her own pregnancy or any outcome of a woman’s pregnancy.

Yet, Petitioner Chelsea Becker has been incarcerated in pretrial detention for over a year because she is unable to afford bail on the murder charge she faces under Penal Code § 187 for experiencing a stillbirth that the District Attorney claims was caused by methamphetamine use during pregnancy. Ms. Becker’s conduct cannot be the basis for a homicide conviction under California law. She is entitled to reasonable bail as a matter of right under Penal Code §1271, but particularly given that no crime has been committed, she should be released immediately. Review is needed in this case to ensure uniformity and resolve the question of whether Penal Code § 187 authorizes prosecutions of women for the results of their pregnancies.

Despite amendments, the California legislature has never expanded Penal Code §187 in the manner suggested by the prosecution, in keeping with the scientific evidence and recommendations of medical societies and medical and public health experts who have counseled policy makers nationwide against the establishment of criminal sanctions related to pregnancy and substance use. The unequivocal consensus among amici and every other medical or public health organization to address the issue in the United States is that use of controlled substances during pregnancy is a medical and public health issue, not an issue that should be subject to criminal intervention and control. For the reasons set forth below, the undersigned respectfully urges the Court to grant the petition for review.

I. MEDICAL AND PUBLIC HEALTH EXPERTS UNEQUIVOCALLY OPPOSE PUNITIVE RESPONSES TO PREGNANCY AND SUBSTANCE USE BECAUSE THEY THREATEN WOMEN’S AND CHILDREN’S HEALTH

Major medical and public health organizations in California and throughout the country oppose criminally prosecuting pregnant women who use controlled substances. Authorities agree that criminal law approaches are inappropriate and can harm the health of women, fetuses, and newborns by detaining pregnant women, separating them from their homes and families, subjecting them to stress, incarcerating them, denying them prenatal and medical care and access to appropriate treatment, and eroding the doctor-patient relationship.

A. Punitive Criminal Justice Responses to Women in Relationship to Their Pregnancies Directly Inflict Substantial Harm on Women and their Children

Facing threat of and being subject to arrest, prosecution, and incarceration is associated with negative health outcomes, both physical and psychological. These harms are exacerbated for pregnant women, who must contend with the physical aspects of pregnancy and added concerns for pregnancy outcomes, autonomy to make medical decisions for themselves and their pregnancies, and prospects of retaining parental authority. Stress, both chronic and acute, is associated with increased rates of infant mortality, low birthweight, preterm birth, hypertension, developmental delays, and congenital heart defects.

The adverse effects of criminally prosecuting women for purported risk of harm to their pregnancies continue to affect parents, their newborns, and their other children long after the pregnancy ends, especially where parents remain incarcerated or lose temporary or permanent custody of their children.6 Young children separated from their parents experience traumatic stress with lifelong consequences, even if they are eventually reunified. Throughout the United States children of incarcerated parents have increased risk of mental health conditions, higher rates of chronic disease, decreased success in school, and increased likelihood of drug use, criminal justice involvement, homelessness, and poverty. Thus, the direct harms of criminalizing pregnant women are serious and apparent.

B. The Threat of Prosecution Deters Pregnant Women from Securing Treatment and Prenatal Care

Access to early and comprehensive prenatal care is one of the most effective tools for improving birth outcomes, whether or not the pregnant woman has a substance use disorder. However, pregnant women who desire drug treatment and prenatal care are dissuaded from seeking it when faced with the threat of prosecution and its attendant harms for themselves, their pregnancies, their future children, and their families. Studies consistently show that “fear of being reported to the police or child welfare authorities [is] related strongly to a lack of prenatal care.”

Women who do seek prenatal care are likely to be discouraged from truthfully discussing their drug use by fear that they will be prosecuted. Open communication is especially critical for women who do seek, or who would otherwise seek, treatment for a substance use disorder. By contrast, threats of criminal sanctions have been shown to increase women’s stress and thereby increase their risk of relapse. The District Attorney’s prosecution disregards the medical evidence and scientific research on this issue. These types of prosecutions directly threaten pregnant women’s physical and psychological wellbeing, as well as the pregnancy itself, and indirectly discourage women from obtaining prenatal care. They would also exacerbate economic and racial disparities that are already pervasive in health care, criminal justice, and child welfare systems by increasing scrutiny of negative pregnancy outcomes, which vary widely by race and socioeconomic status.

II. NO MEDICAL OR SCIENTIFIC EVIDENCE JUSTIFIES A PUNITIVE, NON-THERAPEUTIC APPROACH TO PREGNANT WOMEN WHO USE DRUGS

Preeminent health care organizations agree that drug use during pregnancy is a medical and public health issue that calls for non-punitive and family-centered responses and, if necessary, voluntary treatment. Science does not support the assertion that drug use during pregnancy results in unavoidably devastating consequences. It does, however, support treating substance use disorders as chronic health conditions where relapse is to be expected.

A. Medical and Scientific Evidence Does Not Show that Substance Use During Pregnancy Causes Uniquely Certain or Severe Harms

Medical consensus does not identify a safe level of use of alcohol and other substances during pregnancy, but scientific studies have failed to prove that in utero exposure to controlled substances, including methamphetamine, is the clear cause of any severe or certain harms. Many pregnancy complications and adverse outcomes experienced by women who have used substances during pregnancy may be attributable to risk factors other than the substance use, including social determinants and environmental factors such as poverty, lack of access to medical care, malnutrition, or chronic stress, each of which may cause fetal and maternal harm.

Courts are now recognizing that prosecutions based on alleged harm to pregnancies due to drug use cannot be sustained by untested, and now disproven, assumptions about the harms of drug use during pregnancy. For example, the Supreme Court of South Carolina unanimously overturned the conviction of a woman charged with causing a stillbirth based on evidence of cocaine use. McKnight v. State, 661 S.E.2d 354 (S.C. 2008). The court held that the woman’s counsel provided ineffective assistance of counsel when she failed to educate the jury about “recent studies showing that cocaine is no more harmful to a fetus than nicotine use, poor nutrition, lack of prenatal care, or other conditions commonly associated with the urban poor.” Id. at 358 n.2. The conviction could not stand given the “reasonable probability” that the jury relied on “apparently outdated scientific studies” suggesting that cocaine use caused the death of her fetus, which the defendant’s counsel had failed to rebut. Id. at 360-61.

Drug use during pregnancy is a medical and public health concern requiring the attention of medical providers. Extraordinary law enforcement measures, which risk harm to pregnant women, their pregnancies, and family, cannot be justified on the unfounded belief that drug use causes universal and uniquely devastating harms to fetal development.

B. Substance Use Disorders are Chronic Health Conditions

Substance use disorders are chronic health conditions influenced by sociocultural, economic, biological, and psychological factors.18 Studies have increasingly found that, even when a person experiencing a substance use disorder pursues treatment, relapses are a normal part of recovery. Due to the nature of addiction, even women who seek out treatment for substance use disorders during pregnancy, and who achieve abstinence, often cannot do so totally and immediately. In one study of women receiving treatment for substance use during pregnancy, the average amount of time needed to achieve abstinence from cocaine and marijuana was approximately five months.

As a matter of both law and medicine, people suffering from a substance use disorder “may be unable to abstain even for a limited period.” National Treasury Employees Union v. Von Raab, 489 U.S. 656, 676 (1989). “[T]he inability to control drug use regardless of consequences is a key feature of substance and alcohol use disorders.” People grappling with addiction may “compulsively have urges to abuse and they are remarkably unencumbered by the memory of negative consequences of drug taking.” An instance of drug use by a pregnant woman therefore does not necessarily reflect a decision about how to treat her own body or her pregnancy but should instead be understood to reflect a symptom of a chronic health condition that can and should be managed as such. Therefore, criminal interventions are inappropriate and ineffective. Negative health outcomes are most effectively avoided or diminished with medical and public health strategies.

For the foregoing reasons, amici request that this Court grant the petition for review in Chelsea Becker v. Superior Court, Supreme Court Case No. S265209 (Court of Appeal No. F081341, Superior Court No. 19CM-5304 (Kings County)).

Grounds for Review

The Court's review is necessary to ensure legal consistency and to address a significant legal question. Trial courts have generally not prosecuted women for pregnancy loss under Penal Code §187, and this law has never been interpreted to apply to a woman's pregnancy or its outcomes.

Nevertheless, Chelsea Becker has been held in pretrial detention for over a year. She faces a murder charge under Penal Code §187 after experiencing a stillbirth, which the District Attorney attributes to methamphetamine use during pregnancy. Such conduct is not considered a basis for a homicide conviction under California law. Ms. Becker is legally entitled to reasonable bail and should be released immediately, especially as no crime has been committed. Review of this case is crucial to resolve whether Penal Code §187 authorizes prosecuting women for pregnancy outcomes. The California legislature has not expanded §187 to cover such cases, aligning with medical and public health experts who advise against criminalizing substance use during pregnancy. These experts universally view substance use during pregnancy as a medical and public health issue, not a criminal matter. Therefore, the Court is urged to grant the petition for review.

Medical and Public Health Experts Oppose Punitive Responses

Leading medical and public health organizations across the United States consistently oppose the criminal prosecution of pregnant individuals who use controlled substances. Authorities agree that using criminal law in these situations is inappropriate. Such approaches can significantly harm the health of women, fetuses, and newborns. Detaining pregnant individuals, separating them from their families, subjecting them to stress, and denying them essential prenatal and medical care can erode the crucial doctor-patient relationship.

The threat of arrest, prosecution, and incarceration is linked to negative physical and psychological health outcomes, which are worsened for pregnant individuals. These harms include heightened stress, which has been associated with increased rates of infant mortality, low birth weight, and preterm birth. Furthermore, the adverse effects of criminalizing pregnant individuals extend to their children, who may experience traumatic stress, mental health conditions, and various social disadvantages if their parents are incarcerated or lose custody.

The risk of prosecution also discourages pregnant individuals from seeking necessary medical treatment and prenatal care. Fear of being reported to authorities often prevents women from disclosing substance use, hindering open communication with healthcare providers. This fear undermines efforts to improve birth outcomes and can increase stress, potentially leading to relapse. Such prosecutions disregard medical evidence and scientific research, ultimately threatening the wellbeing of pregnant individuals and exacerbating existing health and social disparities.

No Scientific Evidence Supports Punitive Approaches

Prominent healthcare organizations affirm that substance use during pregnancy constitutes a medical and public health concern, advocating for non-punitive, family-centered responses and voluntary treatment. Scientific evidence does not support the claim that substance use during pregnancy inevitably leads to devastating consequences. Instead, it supports understanding substance use disorders as chronic health conditions where relapse is a recognized aspect of recovery.

While no level of substance use during pregnancy is deemed safe, scientific studies have not conclusively demonstrated that in utero exposure to controlled substances causes uniquely certain or severe harms. Many adverse pregnancy outcomes often attributed to substance use may instead result from other factors, such as socioeconomic conditions, inadequate access to medical care, malnutrition, or chronic stress. Courts are increasingly recognizing this lack of definitive evidence; for example, a past conviction for causing a stillbirth was overturned due to reliance on outdated scientific assumptions about substance effects. Such cases underscore that extraordinary law enforcement measures are not justified by unproven beliefs about universal harm.

Substance use disorders are complex, chronic health conditions influenced by various biological, psychological, and sociocultural factors. Relapse is a common component of the recovery process, and individuals grappling with addiction may experience difficulty maintaining abstinence even when actively seeking treatment. The inability to control substance use despite negative consequences is a hallmark of these disorders. Therefore, an instance of substance use by a pregnant individual should be understood as a symptom of a treatable health condition, rather than a criminal act. Effective management and improved outcomes are best achieved through medical and public health strategies, not criminal intervention.

For these reasons, the Court is respectfully urged to grant the petition for review.

Grounds for Review

The legal system sometimes reviews cases to ensure consistent decisions and to clarify important legal questions. Historically, courts have not charged women with murder for pregnancy loss under Penal Code §187. This law has never been interpreted to allow the prosecution of a woman for her own pregnancy or its outcome. However, one woman, Chelsea Becker, has been in jail for over a year because she cannot afford bail. She faces a murder charge under Penal Code §187 after experiencing a stillbirth that prosecutors claim was caused by methamphetamine use during pregnancy. Her actions do not legally qualify as homicide under California law. She should be released, especially since no crime was committed. A review of this case is needed to ensure legal consistency and to clarify if Penal Code §187 can be used to prosecute women for pregnancy outcomes.

Medical and Public Health Experts Oppose Punitive Responses

Leading medical and public health organizations across the country disagree with criminally prosecuting pregnant women who use controlled substances. These experts believe criminal approaches are harmful to the health of women, fetuses, and newborns. Such actions can lead to detention, family separation, stress, incarceration, lack of medical care and treatment, and a breakdown in the doctor-patient relationship. Being arrested or jailed causes significant physical and psychological harm, especially for pregnant women. This stress increases risks like infant mortality, low birthweight, and other developmental issues. The threat of prosecution also stops pregnant women from seeking crucial prenatal care and treatment for substance use, even though early care is vital for healthy births. Women may hide their drug use from doctors, making open communication impossible.

No Medical or Scientific Evidence Justifies Punitive Approach

Healthcare organizations agree that substance use during pregnancy is a medical and public health matter, best handled with supportive, voluntary treatment, not punishment. Scientific evidence does not support the idea that drug use during pregnancy always leads to uniquely severe consequences. Many pregnancy complications linked to substance use can also be caused by other factors like poverty, poor nutrition, or lack of medical care. Courts have recognized that prosecutions based on alleged harm to pregnancies from drug use are often based on outdated science. Furthermore, substance use disorders are understood as chronic health conditions. Relapse is a common part of recovery, and it can take months for a person to achieve abstinence. An instance of drug use by a pregnant woman often reflects a symptom of this chronic condition, not a deliberate choice to harm her pregnancy. Therefore, criminal interventions are inappropriate and ineffective; medical and public health strategies are more effective.

For these reasons, the Court is urged to grant the petition for review in the case of Chelsea Becker.

Grounds for Review

Legal review is needed to ensure decisions are consistent and to settle important legal questions. Courts have generally not allowed criminal charges against women who have experienced pregnancy loss under Penal Code § 187. This law has never been interpreted to permit the prosecution of a woman for anything related to her own pregnancy or its outcome.

Despite this, Chelsea Becker has been held in jail before trial for over a year. She cannot afford bail for a murder charge under Penal Code § 187. Prosecutors claim her stillbirth was caused by methamphetamine use during pregnancy. However, Ms. Becker's actions cannot be the basis for a murder conviction under California law. She has a right to reasonable bail, but since no crime has been committed, she should be released immediately. A legal review of this case is necessary to ensure consistent decisions and to answer whether Penal Code § 187 allows women to be prosecuted for the results of their pregnancies.

The California legislature has made changes to Penal Code § 187 but has never broadened it in the way prosecutors suggest. This aligns with scientific evidence and advice from medical and public health experts across the country. These experts have warned against creating laws that punish people for pregnancy and substance use. There is a clear agreement among supporting groups and all other medical and public health organizations that substance use during pregnancy is a medical and public health issue, not one for criminal charges and punishment. For these reasons, this Court is respectfully asked to agree to review the case.

Experts Oppose Criminalizing Pregnancy and Substance Use

Major medical and public health organizations in California and nationwide oppose bringing criminal charges against pregnant women who use controlled substances. Experts agree that using criminal laws is wrong and can hurt the health of women, developing babies, and newborns. This happens when pregnant women are jailed, kept from their families, stressed, denied medical care and treatment, and when trust between doctors and patients is broken.

How Criminal Justice Harms Women and Children

The threat and experience of arrest, criminal charges, and jail are linked to negative health outcomes, both physical and mental. These harms are worse for pregnant women. They must deal with the physical demands of pregnancy, worry about the pregnancy's outcome, lose the power to make medical choices for themselves and their pregnancy, and fear losing parental rights. Ongoing and sudden stress is linked to higher rates of infant death, low birth weight, early births, high blood pressure, slow development, and heart problems present at birth.

The negative effects of prosecuting women for claimed harm to their pregnancies continue to affect parents, their newborns, and their other children long after the pregnancy ends. This is especially true if parents remain in jail or lose custody of their children temporarily or permanently. Young children separated from their parents experience stress that can affect them for life, even if they are eventually reunited. Across the United States, children of incarcerated parents have a higher risk of mental health problems, more chronic illnesses, less success in school, and a greater chance of drug use, involvement with the legal system, homelessness, and poverty. Therefore, the direct harms of criminalizing pregnant women are serious and clear.

Prosecution Stops Women from Getting Care

Getting early and full prenatal care is one of the best ways to improve health for babies, whether or not the pregnant woman has a substance use disorder. However, pregnant women who want drug treatment and prenatal care are discouraged from seeking it when they face the threat of criminal charges and the harm it could bring to them, their pregnancies, their future children, and their families. Studies consistently show that a strong fear of being reported to police or child welfare services is linked to not getting prenatal care.

Women who do seek prenatal care are likely to avoid honestly talking about their drug use due to fear of prosecution. Honest talks are very important for women who seek, or would otherwise seek, treatment for a substance use disorder. In contrast, threats of criminal punishment have been shown to raise women's stress levels, which can increase their risk of relapsing. The District Attorney's prosecution ignores medical evidence and scientific research on this issue. These types of prosecutions directly threaten pregnant women's physical and mental wellbeing, as well as the pregnancy itself. They also indirectly discourage women from getting prenatal care. Such prosecutions would also make existing economic and racial inequalities worse in healthcare, criminal justice, and child welfare systems by bringing more attention to negative pregnancy outcomes, which differ greatly based on race and income.

No Scientific Basis for Punitive Approaches

Leading healthcare organizations agree that drug use during pregnancy is a medical and public health issue that requires responses that do not involve punishment and focus on the family, along with voluntary treatment if needed. Science does not support the claim that drug use during pregnancy always leads to terrible outcomes. However, it does support treating substance use disorders as long-term health problems where falling back into old habits is normal.

Science Does Not Prove Unique Harms from Substance Use

Medical experts do not agree on a safe amount of alcohol or other substances to use during pregnancy. Still, scientific studies have not proven that exposure to controlled substances, like methamphetamine, while in the womb is the clear cause of any severe or definite harms. Many problems during pregnancy and negative outcomes for women who used substances might be caused by factors other than the substance itself. These include social and environmental issues like poverty, not getting enough medical care, poor nutrition, or ongoing stress. Each of these can harm both the mother and the developing baby.

Courts are now recognizing that legal charges based on claimed harm to pregnancies from drug use cannot be supported by beliefs that were not tested and are now shown to be false. For example, the Supreme Court of South Carolina overturned the conviction of a woman charged with causing a stillbirth based on evidence of cocaine use. The court decided that the woman's lawyer did not do a good job by failing to tell the jury about recent studies. These studies showed that cocaine is no more harmful to a developing baby than nicotine use, poor nutrition, lack of prenatal care, or other problems often seen in poorer city areas. The conviction could not stand because there was a good chance the jury used "outdated scientific studies" that suggested cocaine caused the baby's death, and the defense lawyer had not argued against these studies. Extreme police actions, which could harm pregnant women, their pregnancies, and families, cannot be justified by the false belief that drug use always causes uniquely terrible harm to a developing baby.

Substance Use Disorders are Chronic Conditions

Substance use disorders are long-term health problems affected by social, cultural, economic, biological, and mental factors. Studies have increasingly found that, even when a person experiencing a substance use disorder pursues treatment, returning to drug use is a normal part of recovery. Due to the nature of addiction, even women who try to get help for substance use during pregnancy and stop using drugs often cannot do so completely and right away. In one study of women receiving treatment for substance use during pregnancy, it took about five months on average to stop using cocaine and marijuana.

Legally and medically, people with a substance use disorder "may not be able to stop using even for a short time." A main sign of substance and alcohol use disorders is not being able to control drug use, no matter the consequences. People struggling with addiction may have strong, uncontrollable urges to use drugs and might not remember the negative results of past drug use. Therefore, a pregnant woman's drug use does not necessarily show a choice about how to treat her body or pregnancy. Instead, it should be seen as a symptom of a long-term health problem that needs to be managed in a medical way. Criminal actions are wrong and do not work. Negative health outcomes are best prevented or lessened with medical and public health approaches.

For these reasons, the groups supporting this petition ask this Court to grant the request for review in the case of Chelsea Becker.

Grounds for Review

Courts often review cases to make sure decisions are fair and to answer important legal questions. Usually, courts have said no to charging women with a crime if they have a pregnancy loss. The law has never been used to punish a woman for her own pregnancy or its outcome. But Chelsea Becker has been in jail for over a year, unable to pay bail for a murder charge. This charge is under the same law, because she had a stillbirth. The prosecutor claims drug use during pregnancy caused it. Actions like hers are not considered murder under California law. She should be able to get bail, and many believe she should be released right away because no crime was committed. A review of this case is needed to make sure the law is used fairly and to settle if this law lets people charge women for what happens in their pregnancies. Lawmakers in California have not changed the law to allow such charges. This is in line with what doctors and health experts say; all medical groups agree that drug use during pregnancy is a health issue, not a crime.

Why Experts Oppose Punishing Pregnant Women

Leading medical and public health groups do not agree with charging pregnant women who use drugs. Experts believe that using criminal laws is wrong and can hurt women, unborn babies, and newborns. It can lead to pregnant women being jailed, taken from their homes, stressed, denied medical care, and unable to get help. Being arrested, charged, or jailed harms a person's physical and mental health, especially for pregnant women, and can lead to problems like babies being born too early or with health issues. These problems continue if parents stay in jail or lose their children, with long-lasting negative effects on children's health, schooling, and future. Also, the threat of prosecution stops pregnant women from getting the important medical care and treatment they need. They fear they will be charged with a crime, which discourages them from talking openly with doctors. This fear increases stress and can even lead to more drug use, making unfair differences in health care and justice worse.

No Scientific Reason for Punishment

Major health groups agree that drug use during pregnancy is a medical and public health issue needing supportive care, not punishment. Science does not show that drug use during pregnancy always causes terrible harm. There is no safe amount of drug use, but studies have not proven that specific drugs always cause severe harm. Many problems during pregnancy can also come from other factors like poverty, not enough medical care, or ongoing stress. Courts are now understanding that cases based on harm to pregnancies from drug use cannot rely on old, wrong ideas about how harmful drugs are. For example, a court once overturned a conviction for stillbirth caused by cocaine use, noting that newer studies show cocaine is no more harmful to a baby than smoking or poor nutrition. Drug use during pregnancy is a medical concern for doctors to handle. Using police and legal action, especially when based on untrue beliefs about harm, cannot be justified and risks harm to pregnant women and their families.

Addiction is a Health Condition

Drug use disorders are long-term health problems influenced by a person's background, money, body, and feelings. Studies show that even when a person tries to get help for drug use, sometimes using drugs again is a normal part of getting better. Because of how addiction works, people with drug use disorders may not be able to stop using, even for a short time. Not being able to control drug use, despite bad results, is a main sign of these disorders. So, if a pregnant woman uses drugs, it should be seen as a sign of a long-term health problem that needs to be managed with medical care. Using criminal laws is not the right approach and does not work. Medical and public health plans are the best way to help people avoid or lessen bad health outcomes.

The people writing this message ask the Court to review the case of Chelsea Becker.