Reciprocal Obligations

Managing Policy Responses to Prenatal Substance Exposure

Published in: The Milbank Quarterly, v. 81, no. 3, Sep. 2003, p. 475-497

Posted on RAND.org on January 01, 2003

by Peter Jacobson, Gail L. Zellman, C. Christine Fair

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The policy debate over prenatal substance exposure (PSE) is highly contentious and polarized. This article presents a new approach, called the reciprocal obligations framework, which is designed to reconcile the state's legitimate interest in birth outcomes with a pregnant woman's personal liberties and privacy rights. According to this framework, both the state and the pregnant woman have reciprocal obligations to the fetus and to each other that shape the limits of the state's intervention and the pregnant woman's response. If a pregnant woman decides to carry her pregnancy to term, both she and the state are obligated to act in the fetus's best interests. The framework shifts the debate away from the maternal-fetal conflict to the mutual obligations of the pregnant woman and the state.

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