A photo of a pregnant woman sitting on a couch looking at a syringe in her hand with a belt around her arm

Punitive policies for substance use in pregnancy linked to worst obstetric care

According to a cross-sectional study, women who lived in states where policies punished women for substance use during pregnancy received worse prenatal and postpartum care.

Patients in states that viewed substance use during pregnancy as a form of child abuse, or required providers to report pregnant women who used substances, began prenatal care at a later gestational age than women who lived in states without any politics, reported Anna Austin, PhD, of the University of North Carolina at Chapel Hill, and her colleagues.

Additionally, women in states with these policies were less likely to receive adequate prenatal care or have a postpartum visit within 4 to 6 weeks of delivery, Austin and co-authors reported in JAMA Pediatrics.

Researchers found a higher percentage of births to black women in states with a child abuse policy (19.6%), a mandatory reporting policy (16.3%) or both (15%) compared to states that had no policy (5.9%).

A 2019 CDC report found that only two of 12 states were exploring strategies to address the legal, ethical, and social factors — including child abuse and mandatory reporting policies — that affect pregnant women with related disorders. to substance use, noted Austin and colleagues.

“Our findings underscore the importance of considering these strategies more broadly, particularly strategies that take a more supportive, non-stigmatizing approach to meeting the needs of pregnant women who use substances,” the researchers wrote.

In an accompanying editorial, Brownsyne Tucker Edmonds, MD, MPH, MS, of Indiana University School of Medicine at Indianapolis, pointed out that the higher percentage of births to black women in the states where child abuse or mandatory reporting policies in this study raise concerns. .

“Although rates of perinatal substance use are similar among black and white women, black and indigenous women are more likely to be screened for illicit substance use in prenatal care,” Tucker Edmonds wrote, adding that this can lead to loss of kinship. rights and, in some cases, incarceration.

Instead, policy efforts should focus on expanding equitable educational opportunities, improving access to treatment, creating affordable housing, providing parental leave, etc., Tucker Edmonds suggested. . As evidenced by this study, “policies that induce fear, blame and punishment appear to be drivers of greater harm to children, not greater protection of children,” she said. writing.

Currently, 26 states and the District of Columbia have either child abuse policies or mandatory reporting policies (or both) for women who use substances during pregnancy, the Austin group said. Using the Pregnancy Risk Assessment Surveillance System database, researchers examined the relationship between these policies and antenatal and postpartum care.

They included 4,155 women over the age of 18 who reported using prescription opioids, marijuana or synthetic marijuana, heroin, amphetamines, cocaine, tranquilizers or hallucinogens during pregnancy between 2016 and 2019 in their analysis. They studied women in 23 states, including six states with child abuse policies, four with mandatory reporting policies, seven with both policies, five states with no policies at all, and one that moved from a mandatory reporting only to the two policies in 2019.

Approximately 34% of women gave birth in states with only one child abuse policy, 16% in states with only a mandatory reporting requirement, 33% in states with both policies, and 17 % in states with no policy. Nearly 70% of participants were white, 15% were black, and 7% were Hispanic. Most of the participants were between 18 and 29 years old.

Women who lived in states with child abuse or mandatory reporting policies began prenatal care later than those who lived in states with neither. Those in states with child maltreatment policies began antenatal care at a mean gestational age of 2.6 months (95% CI 1.6-3.5); those in states with mandatory reporting policies started at 2.4 months (95% CI 1.7-3.2). Women in states with no policy started at 2.1 months (95% CI 1.3-3.0).

Women in States with Child Abuse Policies (Risk Ratio [RR] 0.85, 95% CI 0.79-0.91), mandatory reporting policies (RR 0.85, 95% CI 0.79-0.91) or both (RR 0.95, CI 95% 0.89-1.03) were less likely to receive adequate prenatal care.

Child maltreatment policies (RR 0.89, 95% CI 0.82-0.96), mandatory reporting policies (RR 0.89, 95% CI 0.80-0.98) or both (RR 0.92, 95% CI 0.83-1.02) were also associated with lower odds of receiving a postpartum health care visit.

Austin and colleagues noted that the data they used on substance use relied on self-reported information from pregnant patients between 2 and 6 months postpartum, which may have limited their conclusions. Additionally, they were unable to analyze antenatal and postpartum care by type of substance.

The researchers also acknowledged that while many states implement similar policies regarding substance use during pregnancy, there are variations in state laws that may have influenced the results.

  • Amanda D’Ambrosio is a reporter on the business and investigative team at MedPage Today. She covers obstetrics and gynecology and other clinical news, and writes about the US healthcare system. Follow


This study was funded in part by the CDC’s National Center for Injury Prevention and Control.

Austin and his colleagues have disclosed no potential conflicts of interest. Tucker Edmonds also reported no conflicts.

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