Many women who use drugs face legal consequences, such as loss of their children and/or incarceration. Drug-using women are presumed guilty without proof of harm to their fetus or proof of poor parenting skills. Despite numerous conditions that may cause harm to the fetus, developing law focuses almost exclusively on illegal drug use among the women already most vulnerable to state control--low-income women, especially African-American and Latina women. A majority of pregnant women engage in a variety of harm reduction efforts to reduce their drug use and compensate for the presumed detrimental effects of any ongoing use. There are many ways to increase the options and ability of women to act on the concern they have for their born and future children. Some of these options are ensuring that women can access prenatal care without fear of arrest or loss of parental rights; preserving provider-patient confidentiality; and reversing the severe shortage of treatment programs available to pregnant and parenting women. There are an estimated 675,000 pregnant women in need of drug treatment per year, and less than 11 percent of them will receive it. Policies of welfare and criminalization must be held accountable for the role that they play in perpetuating conditions of vulnerability for women and their children. “Holding women responsible” includes reversing the policies that pit a mother’s needs against her children’s. Current policy separates families by targeting individuals for their drug use in a social environment that offers no support to end poverty. 18 notes