Pregnant Women with Substance Use Disorders

The Harm Associated with Punitive Approaches

Published in: The New England Journal of Medicine, Volume 384, No. 25, pages 2364–2367 (2021). doi: 10.1056/NEJMp2101051

Posted on RAND.org on August 31, 2021

by Rebecca Lee Haffajee, Laura J. Faherty, Kara Zivin

Read More

Access further information on this document at The New England Journal of Medicine

This article was published outside of RAND. The full text of the article can be found at the link above.

Evidence-based approaches to treating SUDs during pregnancy, including highly effective medications for OUD, have become increasingly available. The United States doesn't criminalize or punish pregnant women with other health conditions—such as diabetes, epilepsy, or obesity—that can affect them and their children. Rather, clinicians treat these conditions during routine prenatal care. States have also increasingly decriminalized substance use for the general population, such as the use of small amounts of marijuana and, in Oregon, the use of all controlled substances. Yet punitive laws still apply to pregnant women in most jurisdictions. Amid increasing rates of behavioral health conditions in this population, persistent adverse maternal health outcomes, and the Covid-19 pandemic (during which overdose deaths have spiked), we need policies that draw women into care and help them recover, not policies that push them away from care and into the criminal justice system. Punishing pregnant women with SUDs has been ineffective; it's time to prioritize approaches that support pregnant women and their families.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.