Although they were presumably designed to help pregnant women stay healthy, many state-level policies regulating alcohol and drug use during pregnancy are actually doing more harm than good, according to a new study published this week. Specifically, researchers found that such policies that exist in 43 states are causing a greater number of preterm births and cases of low birthweight, which in turn has increased public health costs.
The study — conducted by researchers from the Alcohol Research Group (ARG) and Advancing New Standards in Reproductive Health (ANSIRH) — came to these findings by looking at 44 years of birth certificate data (between 1972 to 2015) and "estimates" of how much it costs to care for an infant born preterm or with a low birthweight for their first year of life. According to the new research, there are eight types of policies in place across the country that target pregnant women who drink or use drugs and researchers found that four of those were "significantly" linked to more infants born with low birthweight and an increased number of preterm births.
The study, published in PLOS One, detailed the policies linked to worse health outcomes as follows:
- Mandatory warning signs in places where alcohol is sold
- Giving pregnant women priority for substance use disorder treatment
- Limits on criminal prosecutions related to alcohol use during pregnancy
- Defining substance use during pregnancy as child abuse/neglect
But why aren't these policies and efforts, many of which have been in place for decades, helping? As Vox reported, researchers believe they might "discourage women from seeking prenatal care," perhaps out of fear of legal punishment or judgement.
Senior author of the study, Sarah Roberts, DrPH, Associate Professor at ANSIRH, said in a press release of the findings:
The harmful effects of policies that coerce, stigmatize or punish pregnant women using alcohol or drugs align with previous research showing that these women may avoid prenatal care because they fear being reported to Child Protective Services (CPS). Other policies were inspired by advocacy around the War on Drugs rather than traditional public health-based policymaking. Before expanding any of these policies to new substances or adopting existing policies in new states, policymakers should be mindful of their harmful consequences, as demonstrated by our research.
And those are valid fears. According to the Guttmacher Institute, while some states have made efforts to provide pregnant women with easily accessible and readily available drug treatment, "the Supreme Courts in Alabama and South Carolina have upheld convictions ruling that a woman’s substance use in pregnancy constitutes criminal child abuse." What's more, as ProPublica reported in 2015, some state laws have resulted in women losing their children or facing jail time even if the drug they were found to be using was prescribed to them.
Co-author of the study, Meenakshi Sabina Subbaraman, PhD, Biostatistician and Co-Director Of Statistical and Data Services at ARG, expanded on this point in the press release, saying that it's "crucial" policymakers "consider the potential adverse impacts of specific policies they develop in response to these challenges and the reasons why these policies may be harmful."
"Our findings reinforce the importance of conducting rigorous research on the impact of current state-level policies targeting alcohol and drug use during pregnancy, rather than assuming that the policies currently in place will have their intended effects," Subbaraman continued. "This type of research can also help identify new policy approaches that are based in public health evidence and will not result in the damage caused by the policies we studied."
The dangers of drug and alcohol use during pregnancy have long been known by medical experts and acknowledged by policymakers. According to the U.S. Centers for Disease Control and Prevention, drinking alcohol during pregnancy can cause "miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities." And use of some drugs during pregnancy can lead to complications such as birth defects, low birthweight, premature birth, and SIDS, according to the National Institutes of Health.
The risks are present and finding the best solution is a challenge, but some approaches to help pregnant women suffering with addiction, specifically ones where the law is involved, are flawed. As the American College of Obstetricians and Gynecologists said in a 2011 statement:
Seeking obstetric–gynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing. These approaches treat addiction as a moral failing... The use of the legal system to address perinatal alcohol and substance abuse is inappropriate.
Moving forward, with new and existing research in mind, the authors behind this recent study want policymakers to consider the potential and serious "adverse public health impacts" of such policies targeted at alcohol and drug use during pregnancy. Addiction is a disease and treatment options are available, but research appears to suggest that the policies in place only deter pregnant women from seeking the help they need and are, in turn, doing more harm than good.