Comparing policies on drug and alcohol use by pregnant women

Contemporary OB/GYN JournalVol. 64 No. 09
Volume 64
Issue 09

State policies targeting drug and alcohol use during pregnancy have increased in number and have become more punitive, but findings show that these policies may not encourage women to seek the needed care.


State policies targeting drug and alcohol use during pregnancy have increased in number since 1974 and have become more punitive over time, according to a recent study of all statutes and regulations in the United States that pertain to the use of drugs or alcohol by pregnant women.

This study, conducted by the Pacific Institute for Research and Evaluation (PIRE) and the University of California, San Francisco, examined data from 1970 through 2016. Trends in individual types of policies were defined, as well as overall trends in policies state-to-state. The results of these studies were then compared to one another to build a more complete picture of the policy environment in the United States pertaining to pregnant women and substance use.

Policy types

There were several policy types defined as part of the study. Punitive policies seek to control the behavior of the pregnant woman. Proponents of these policies maintain that restricting a woman’s access to drugs or alcohol is the best way to ensure the health of the pregnancy and the fetus, that the state has a duty to prevent the lifelong problems that affected children may experience including, if necessary, separating children from their parents.

Supportive policies seek to provide support services to pregnant women and families and do not attempt to threaten or coerce. Services might include education, early intervention, support or treatment. Mixed policies contain aspects of both punitive and supportive interventions. 

To define policy types, researchers identified a group of variables by which policies were rated. The variables were used to analyze individual policies and the overall policy environment for each state. The variables included:

  • Requirements for mandatory warning signs, mostly aimed at retail cannabis establishments.
  • Priority treatment policies, either for pregnant women only or for both pregnant women and women with children.
  • Prohibitions on using the results of medical testing as a part of criminal prosecution related to health of a fetus or child.
  • Mandatory involuntary commitment of a woman to a treatment facility or to the care of the state because of her substance abuse. 
  • Reporting requirements, either to Childrens Protective Services (CPS)to assess risks of child abuse or neglect, or for data and treatment purposes only.
  • Presence of statues or regulations that define the rules related to child abuse or neglect.

In 1980 only one state had a drug and pregnancy policy; by 10 years later that number had risen to 16 states. By 2000, 31 states had at least one policy, and by 2016 the number had climbed to 43.

Key findings
After all data were analyzed, several key findings were identified:

  • By 2016 almost 85% of states had policies regarding drug use during pregnancy.
  • Policies regarding drug use during pregnancy have become less supportive over time.
  • Policies regarding drug use during pregnancy are often punitive, while most policies regarding alcohol use during pregnancy are supportive.

Also noted was that punitive policies place a disproportionate burden on low-income women and women of color, as such policies appear to deter women from seeking needed care. Even supportive care policies that provide direct services or support are not always readily available to disadvantaged women, further compromising their health and the health of their children. 


Missing from this study and a possible area of focus for future studies is the lack of ethnographic data as well as interactions between the policies and the overall social environments of the women in the different states. Further research may also focus on the reasons why some policies were enacted rather than others, and how states have enforced these policies. 

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