Criminalizing prenatal drug use linked to reduced prenatal care

Pregnant people may be discouraged from seeking medical care in states that criminalize prenatal drug use, according to a recent study published in Social Science & Medicine.¹

Laws addressing pregnancy-related substance use have been implemented in multiple states, with some categorizing this action as a felony or misdemeanor offense. The new data highlights potential health consequences from these practices, especially among patients with high-risk pregnancies.¹

“These laws were often originally intended to encourage treatment by including provisions to exempt those already in care from prosecution,” said Silvia Martins, MD, PhD, senior author and professor at Columbia Mailman School of Public Health. “However, emerging evidence suggests the opposite effect.”¹

Assessing prenatal care and delivery outcomes

The study was conducted to determine the impact of explicit criminalization policies in Tennessee, South Carolina, and Alabama on population-level prenatal care and facility-based delivery.² Birth certificate records from 1989 to 2019 were assessed for relevant outcome data.

Rates of prenatal care and facility-based delivery were reported as primary outcomes. Secondary outcomes included dimensions of prenatal care quality, including timeliness and adequacy. Associations were analyzed using 2-way fixed effects models.²

Overall, a decline of 4396.29 fewer births per 100,000 patients receiving any prenatal care was reported in states with explicit prenatal drug criminalization. A drop of 1847.99 fewer facility-based deliveries was also reported.²

While no significant changes in rates of timely or adequate care were observed by criminalization, the data indicated potential decreases in timeliness.¹ Investigators also highlighted reduced overall and first-trimester care initiation.

Findings suggest fear of legal repercussions

These results indicated reduced prenatal care and facility-based deliveries. The study included over 124 million births across 83,300 county-years and was the first to empirically test the impact of fear about legal repercussions on the prevalence of women with drug disorders giving birth outside of health care settings.¹

Based on this data, investigators drew a parallel to behaviors observed in other contexts, such as immigrants fearing deportation. Emilie Bruzelius, PhD, first author and postdoctoral fellow at Columbia Mailman School of Public Health, concluded that the gap between receiving crucial prenatal care between drug users and nonusers may worsen by this increase in avoidance.¹

“Formal laws do make a difference, and efforts to repeal these types of laws would go a long way to better support maternal and neonatal health,” said Bruzelius. “Future research should pinpoint which policies most discourage care and guide reforms that protect, rather than punish, pregnant people.”¹

Importance of specialized care

Prior research has highlighted the value of specialized care to improve outcomes in high-risk pregnancies, as discussed by Angela Bianco, MD, a maternal-fetal medicine expert and director at Mount Sinai Health System, in an interview with Contemporary OB/GYN.³ Bianco highlighted how maternal-fetal medicine specialists can support high-risk pregnancies.

According to Bianco, the US has one of the most significant maternal mortality rates, with a disparity between White women and Black women. However, maternal-fetal medicine specialists can address these disparities and support women with risk factors such as cardiovascular disorders.³

Bianco also highlighted the need for establishing trust early in a patient-provider relationship. Patient outcomes are improved through engagement with the health care system and receiving necessary resources for both physical and mental health.³

References

1. Punitive drug laws may deter prenatal care and hospital-based delivery. News release. Columbia University Mailman School of Public Health. October 29, 2025. Accessed November 3, 2025. https://www.eurekalert.org/news-releases/1103880
2. Bruzelius E, Prins SJ, Bates LM, Underhill K, Jarlenski M, Martins SS. Prenatal drug use criminalization and health system avoidance: evidence from births in Alabama, South Carolina, and Tennessee, 1989-2019. Soc Sci Med. Published online October 25, 2025. doi:10.1016/j.socscimed.2025.118716
3. Krewson C. How maternal fetal medicine specialists improve outcomes for high-risk pregnancies. Contemporary OB/GYN. February 3, 2025. Accessed November 3, 2025. https://www.contemporaryobgyn.net/view/how-maternal-fetal-medicine-specialists-improve-outcomes-for-high-risk-pregnancies