Emilie Bruzelius, PhD, links punitive drug laws to reduced prenatal care

New research led by Emilie Bruzelius, PhD, postdoctoral fellow at Columbia University, highlights significant concerns about state policies that criminalize drug use during pregnancy.^1,2

According to the study, punitive laws intended to protect infants may instead discourage essential prenatal care and hospital-based deliveries—potentially increasing risks for both parent and child. Bruzelius explained that the research focused on 2 key outcomes: prenatal care utilization and delivery settings.

The findings showed consistent adverse impacts on prenatal care from criminal laws, particularly early care initiated in the first trimester. Early prenatal engagement is critical for monitoring pregnancy health, managing complications, and connecting patients with needed services. When individuals fear legal consequences, however, they may delay or avoid care altogether.

The study also uncovered evidence that criminalization may reduce hospital-based birth rates. Clinicians have increasingly raised concerns that pregnant people using substances may avoid hospitals because of fears of drug testing, child welfare involvement, or criminal charges.

The new data offer some of the first empirical support for those observations. While more research is needed to understand the specific contexts in which this avoidance occurs, the findings suggest that punitive policies may redirect some births to non-hospital settings—where emergency resources and maternal support may be limited.

Although lawmakers often adopt these policies with the intent of protecting infants, Bruzelius emphasized that research shows they do not deter prenatal drug use. Instead, they deter engagement with the health care system itself.

Given the growing evidence of harm, Bruzelius outlined 2 critical next steps. First, clinicians and public health professionals should be aware of their state’s reporting requirements and share their real-world observations with lawmakers. Advocating for repeal or reform of punitive laws could help reduce barriers to care and improve maternal health outcomes.

Second, she underscored the need to expand non-punitive strategies proven to support pregnant individuals with substance use disorders. These include increasing access to treatment—such as medications for opioid use disorder (MOUD)—as well as broader resources such as naloxone, mental health services, and social supports. Currently, about half of pregnant patients with opioid use disorder receive no MOUD, despite its status as the gold standard treatment.

Bruzelius noted that while evidence shows what doesn’t work, more research is needed to identify effective policy approaches that promote prenatal care utilization and support healthy pregnancies.

No relevant disclosures.

References

1. Punitive drug laws may deter prenatal care and hospital-based delivery. Columbia University Mailman’s 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. Social Science & Medicine. 2025;387. doi:10.1016/j.socscimed.2025.118716