Dr Mary Hepburn isn't surprised her patients take drugs. What surprises her is that some don't. "If I lived in these awful circumstances, I would use drugs," she says. Most of the expectant mums she sees are deprived and profoundly socially excluded.

"If I had been brought up in a broken home, within a dysfunctional family, where there was a lot of violence and where you may well have been subjected to mental, physical or sexual abuse . . . In these circumstances, anything that makes life more pleasant is going to be welcome."

Hepburn is a consultant obstetrician and runs Glasgow Women's Reproductive Health Service, a maternity service for women who have a range of social problems: they include drug addicts, alcoholics, and people with mental health issues and learning difficulties.

Hepburn is vehemently opposed to draconian proposals to stop addicts having children; ideas such as contraception being added to methadone and forcing them to sign contracts agreeing not to have children. She calls such measures fascist, unethical and immoral.

But there's a huge question mark over the alternative to such extreme measures in an atmosphere of considerable public and political concern over the plight of children affected by their parents' addiction.

Now Hepburn is leading a major new piece of research backed by prominent figures including Glasgow's new director of public health, Linda de Caestecker, which could produce that alternative.

Poverty, Hepburn feels, is to blame for these patients' self-destructive lifestyle choices. They need to be helped and supported, she argues, not subjected to further punishment. The £300,000 study will uncover the best ways to channel that support, she hopes.

The study, to be launched in a couple of months, will find out what happened to 400 children born to drug-abusing mothers in Aberdeen and Glasgow in 2000 and 2001: are they healthy, do they attend school, are they achieving normally, are they in contact with social services, are they on the at-risk register?

The study has been in the pipeline for a number of years and is the brain child of Hepburn, de Caestecker and Dr Jean Herbison, Greater Glasgow clinical director for child protection.

It has taken a while to get off the ground because there were doubts that it woud be possible to track down addicts and their families. A feasability study carried out in 2003 showed, however, that they are happy to help, says Hepburn.

"Forty out of the 50 were desperately keen to take part because they felt it might help provide good services in the future," she says.

Lack of knowledge of the people involved contributes to the easy stereotyping of addicts. A few postcards are pinned to a noticeboard on the wall of Dr Mary Hepburn's office. They are from patients, although Hepburn doesn't get many - and the women who sent these are all dead, she explains, shockingly. "Drug overdoses, violence, heart attacks."

This triggers a pang of sympathy for the women who have, in recent times, become public enemy No 1 - the addicts who choose drugs over their children - following a series of high-profile cases of neglect.

But Hepburn sees little point in blaming the women for their addiction. This detracts from the real problem, which she believes is the poverty and disadvantage they are forced to cope with every day.

The vast majority of an estimated 51,000 drug users in Scotland live in areas of low employment and economic inactivity.

"If you see it as the women's choice to use and not come off drugs, then that allows you to adopt a blame culture; it's up to her to make the changes. But if poverty is the issue, that's society's responsibility. It's still up to her to take responsibility and make changes, but it's society's job to support her."

The mass removal of children from addict parents, as hinted at by First Minister Jack McConnell, who said that in the future more would be taken from drug abusing parents, is not only wrong but wholly impossible, says Hepburn.

According to the Association of Directors of Social Work, there are roughly 5000 places in residential and foster care in Scotland but an estimated 50,000 children in the country who live with parents addicted to hard drugs.

"We can't remove these children at birth because there is such a large number of them and there is nowhere for them to go," she says.

Hepburn favours less drastic action. She believes just as women with conditions such as diabetes can be advised not to have children until such a time as their medical condition improves, this should also be the case for drug-abusing women. At the moment, this does not happen routinely.

"In our experience, the women welcome information. If you make it punitive - saying, for example, you are not a fit mother, therefore we are not going to allow you to have children - clearly, they don't take kindly to that and it does not encourage them to come to services."

When the women do become pregnant, she would like to see them supported. Universal parenting classes would be a start: "Again, when the idea of parenting classes has been raised they've made it a punitive thing: let's force these mothers to go or we'll take the child off them."

But Hepburn would also like to see the development of a system that would identify families that are going to need extra support and ensure they are checked-up on.

"Often the women are fairly stable when they leave us because of all the support they receive during their pregnancy. Then a lot of the support ceases and only re-starts if things get worse and back to being a crisis again. By that time the child has probably already been harmed."

Hepburn has been working with socially disadvantaged women since the 1980s when she and a midwife hit the streets of Possilpark looking to discover why women in deprived areas weren't attending ante-natal care. Sometimes they found it was because services were geographically hard to reach or that the women - due to their chaotic lifestyles - weren't signed up to a GP and had no route in.

But frequently they found it was because they had so many other things in their lives to deal with: sorting out housing, seeing their social worker, going to the DSS. "These things were not necessarily viewed as being more important but as more urgent, so they often missed the clinic," Hepburn explains. She came to the conclusion, therefore, that medical and social problems had to be dealt with in the same setting.

In 1990 her idea went city-wide when the Glasgow Women's Reproductive Health Service was set up. Here, a multi-disciplinary group of midwives, social workers, health visitors and addiction workers assess each mother's ability to care for a child and provide her with ongoing support.

For her work, Hepburn was nominated for The Evening Times Scotswoman of the Year awards in 2003. By 2005, 400 women were making use of the service annually. Hepburn estimates that half of them were drug abusers or alcoholics or both. Irrespective of their ability to parent, addicts are more likely to have their children removed, says Hepburn, than, for instance, mothers with mental health problems.

"We are certainly aware that the threshold for removing a child from drug-using mothers is lower than mothers with other socially related problems," she says. "Yet problems such as mental illness can compromise parenting skills just as much. It should not be about whether or not you're a drug user but about your parenting skills."

However, she acknowledges there is a dilemma: do you take the child at birth to prevent harm or do you leave it in a situation where it could be harmed? Hepburn dismisses both and reiterates the need to ensure that vulnerable families are supported.

"At the moment, social work is having to withdraw when they would prefer not to because there are not sufficient resources."

The result is that the cycle continues and Hepburn is now treating the babies she delivered in the 1980s. They have followed in the footsteps of their mothers.

"We are seeing the same problems going on in each generation."

SOCIETY is available to read here