US policies targeting drug use during pregnancy have become more punitive

As more states legalize recreational marijuana and grapple with growing opioid use, it’s increasingly important to understand policies that target drug use during pregnancy. Little is known about the scope of these state policies, how they’ve evolved over time or how they overlap with policies targeting alcohol use and pregnancy.

A new paper from UCSF, Alcohol Research Group and Pacific Institute of Research and Evaluation breaks new ground in evaluating the landscape of policies around drug use and pregnancy. Their review of policies from 1970-2016 resulted in two main findings:

  • The number of states with one or more policy regarding drug use and pregnancy increased substantially. The first such policy appeared in one state in 1974; in 2016 there were 43 states with policies. Twelve states had a mostly supportive policy environment, with policies such as reporting drug use during pregnancy for the purpose of data collection and/or treatment for women. Ten had a punitive environment, focusing on policies like requiring reporting pregnant women who use drugs to child protective services or defining drug use during pregnancy as child abuse or neglect. Twenty-one states had a mix of supportive and punitive policies.
  • Drug use during pregnancy policies have become less supportive over time. Many states that started out with supportive policies only have become mixed by adding punitive policies.

This research raises several concerns. Previous studies have shown that alcohol policies discourage women from seeking health care and other services and do not improve birth outcomes, and the burden disproportionately falls on low-income women and women of color. It may be reasonable to infer the same for drug policies. More studies are needed to understand the effects of these policies on alcohol and drug use by pregnant women and outcomes for their children.