Drug paraphernalia and bleach stains surrounded Rachel Lankford as she sat in the bathroom of her ex-boyfriend’s single-wide trailer. He stood over her as she took her ninth pregnancy test in three days.
He still didn’t believe her, despite the previous six tests. All were positive but one.
Now she was on the last stick in the three-pack she had picked up from a dollar store — she’d already taken two in front of him, one result was unclear and one positive.
It was positive. Again.
She walked through the graffiti-laden hallway and showed the plus symbol to his mother. Both of them encouraged Lankford, then 20, to get an abortion.
But she knew that was not an option. She had already been to the Planned Parenthood in Chapel Hill earlier that day, her paperwork signed and everything in place to get an abortion. Lankford already had two abortions, one when she was 13 and the other at 19. When she made her appointment, she figured this time around would be no different.
She was high on prescription painkillers when she walked into the clinic with her mother. She stepped into the doctor’s office and undressed from the waist down for the ultrasound. The technician turned to her.
“You’re 21 weeks and five days pregnant,” she said. “You’re not having an abortion.”
In the corner, her mother sobbed. Lankford was five months pregnant and weighed 84 pounds.
Her words racing — an effect of the opioids — she pleaded with the technician, told her she was a drug addict, that she couldn’t have a child. But nothing could be done.
Though she had doubts, she wanted to believe that her ex-boyfriend would be there for her and her future child, so she drove to his house after her appointment. When she told him that she tried to have an abortion but couldn’t, he said matter-of-factly that the baby wasn’t his.
She became enraged at the accusation that she had cheated on him. Yelling and swearing at him, she insisted that the baby was his. He asked her to leave.
She felt heartbroken and desolate. She was too afraid to tell her father, and her mother still lived in Virginia at the time. Without anyone to help her, she lived in her car for a few weeks.
Four years later, Lankford, now 24, loves Marleigh, the healthy, energetic baby girl she so desperately didn’t want that day.
“She’s my whole wide world,” Lankford said, “but she wasn’t at first.”
Women and the crisis
As the opioid crisis devastates American communities, women are among the most vulnerable. Between 1999 and 2015, the rate of deaths from prescription opioids increased by 471 percent among women, compared to 218 percent among men, according to the U.S. Department of Health and Human Services.
While research is still emerging on gender disparities in opioid addiction, studies have shown that women are more likely to be prescribed pain relievers and become addicted more quickly.
Pregnant women are particularly at risk, as the substance abuse can harm both the mother and her child. Between 2007 and 2012, an annual average of 21,000 pregnant women aged 15 to 44 across the United States had misused opioids in the past month, according to the Substance Abuse and Mental Health Services Administration.
Marleigh had no complications when she was born, despite Lankford’s continued drug use when she was pregnant. But many children are not so lucky: every 25 minutes, a baby is born in withdrawal from opiates, a condition known as neonatal abstinence syndrome that can cause seizures, a low birth weight, breathing problems and other complications.
Yet, as overall opioid use rates surpass capacity rates for treatment centers in most states, options are particularly limited for pregnant women, who often travel far and face waiting lists to access programs like UNC Horizons, a drug treatment program for pregnant and parenting women and their children.
“I think there’s still this underlying belief that pregnant women should be able to just walk away from substances fairly easily,” said Elisabeth Johnson, director of health services at Horizons.
A coping mechanism
The trauma from Lankford’s parents’ divorce, especially after her father remarried, drove her to use alcohol and marijuana at just 13. She first tried Vicodin after her wisdom teeth surgery at 16, and her addiction to prescription painkillers didn’t take long to develop.
Lankford was in several abusive relationships during and after her substance use. During her pregnancy with Marleigh — but before she was aware of it — she fought with her ex-boyfriend constantly. But because he was her supplier, she was stuck.
When the two would use opiates together, it often exacerbated the physical abuse. She’s recovered from her addiction, but the abuse still haunts her.
“I guess I feel like that’s what I deserve because of what I went through in my past, and I’m damaged goods, and no decent person would ever love me,” she said. “And then I challenge myself with that all the time.”
Johnson said around 80 percent of the women who enter Horizons report having experienced trauma at some point.
“Women often end up using drugs because they’ve got no other coping mechanism,” said Hendrée Jones, executive director of Horizons. “They’ve grown up being told that they’re nothing more than dirt.”
Access to care
After 120 days sober in a treatment program — when Marleigh was around 6 months old— Lankford returned home, determined to turn her life around. She enrolled at Alamance Community College and got a job.
But it wasn’t easy to stay sober in a college filled with childhood friends she used to get high with. In a span of two weeks, she relapsed and picked up two felonies for stealing both her mother’s credit card and money from her job at Goodwill. She lost her job, dropped out of school and lost custody of Marleigh.
She was devastated. For two months she slept in her Honda and on people’s couches. She got high.
“I didn’t know how to live,” she said. “My whole world from when she was born was to take care of her and then when she was gone, what do you do?”
She had weekly meetings with her social worker and Marleigh, but the one hour wasn’t enough.
“I wouldn’t use before I would see her, and I’d walk out that door and go get high,” she said. “Because leaving her was just ... It was awful.”
During a 30-day period in jail, Lankford assessed her options for treatment. She wanted to participate in Horizons so she could stay with Marleigh, but the program was full.
Just 20 percent of treatment services offer programs for pregnant or postpartum women, according to a survey of providers from the Substance Abuse and Mental Health Services Administration.
Only 12 of North Carolina’s 100 counties have state-funded programs specifically for pregnant and parenting women and their children, according to the North Carolina Department of Health and Human Services.
“We have women who drive an hour and a half to two hours to come to their prenatal visit from other parts of the state just because they cannot find in their area a provider who has experience dealing with women who are pregnant,” said Kim Andringa, director of research and evaluation at Horizons.
Among programs that do serve pregnant women, many don’t allow children to live with their mothers. Horizons’ residential program allows children up to 12.
“You may have a mom who comes into treatment who has to choose of her three or four kids who she’s bringing with her and who she’s going to leave with someone at home,” Johnson said.
Facing a four-month wait for Horizons, Lankford’s only option to get out of jail was a facility in Asheville, but she couldn’t bring Marleigh.
When she returned, Marleigh had been in foster care for six months. She finally regained custody of her daughter, and the two started the Horizons program together.
Though she struggled initially, she hasn’t let her go since.
In July, she’ll be three years sober. Last year, 266 women received treatment at Horizons, where Lankford now works.
“I might not have stopped right away and I might have screwed up a lot in her first year and a half of her life," she said.
"But I feel like I’m here now, and I feel like I’m a good mom."
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