State Policies Related to Substance Use in Pregnancy

State Policies Related to Substance Use in Pregnancy

Types of policies covered

Treatment-supportive policies that…

1. create or fund targeted programs for pregnant and postpartum women with substance use disorders (SUDs) ("targeted program")
2. prioritize pregnant women's access to SUD treatment programs ("priority access")
3. prohibit discrimination against pregnant women in publicly funded SUD treatment programs ("protected from discrimination").

Punitive or potentially punitive policies that…

1. define substance use in pregnancy as child abuse or neglect, criminalize it, or consider it grounds for civil commitment ("punitive")
2. require reporting of suspected prenatal substance use to officials at local health and human services departments ("reporting")
3. mandate testing of infants with suspected prenatal substance exposure or pregnant women with suspected substance use ("testing").

Policy Trends

The policy wheels show the evolution from 2000 to 2015 of state policy environments related to substance use in pregnancy. The number of states that had no policies specific to substance use in pregnancy dropped from 16 in 2000 to 10 in 2015. Punitive or potentially punitive policies were more commonly enacted than were policies supporting treatment for pregnant women with SUD; overall, there was no clear geographic pattern. In 2015, 25 states considered SUD in pregnancy to be child abuse, grounds for civil commitment, or a criminal act — nearly double the number in 2000. In contrast, there was only a modest increase in the number of states (from 29 to 33) with at least one treatment-supportive policy; the increase occurred predominantly between 2008 and 2015 and was concentrated in the East South Central region.

By 2015, the number of states that had only punitive or potentially punitive policies had increased from 6 to 8, while the number of states that had only treatment-supportive policies had declined from 17 to 8. The number of states with both types of policies doubled, from 12 in 2000 to 25 by 2015.

Number of policies in effect per year

Policies in effect in 2000 per state

Policies in effect in 2008 per state

Policies in effect in 2015 per state

Methods and References

Information on these six policies, including effective dates, was obtained from the Guttmacher Institute,3 which annually reviews the LexisNexis database, routinely monitors state legislature and state agency websites, and conducts follow-up phone calls with policymakers, as needed. The RAND team supplemented these data with information from published studies, ProPublica, and the National Conference of State Legislatures.4-6

References

1. Laura J. Faherty, Ashley M. Kranz, Joshua Russell-Fritch, Stephen W. Patrick, Jonathan Cantor, and Bradley D. Stein, "Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome," JAMA Network Open, Vol. 2, No. 11, November 13, 2019, p. e1914078.

2. Zuguang Gu, Lei Gu, Roland Eils, Matthias Schlesner, and Benedikt Brors, "Circlize Implements and Enhances Circular Visualization in R," Bioinformatics, Vol. 30, No. 19, October 2014, pp. 2811-2812.

3. Guttmacher Institute, "State Policies in Brief: Substance Abuse During Pregnancy," 2020. As of February 7, 2020: https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy

4. Leticia Miranda, Vince Dixon, and Cecilia Reyes, "How States Handle Drug Use During Pregnancy," ProPublica, September 30, 2015. As of February 7, 2020: https://projects.propublica.org/graphics/ maternity-drug-policies-by-state

5. Steve Christian, "Substance-Exposed Newborns: New Federal Law Raises Some Old Issues," National Conference of State Legislatures Children's Policy Initiative, September 2004. As of February 7, 2020: https://www.ncsl.org/print/cyf/newborns.pdf

6. Marian Jarlenski, Caroline Hogan, Debra L. Bogen, Judy C. Chang, Lisa M. Bodnar, and Elizabeth Van Nostrand, "Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use," Women's Health Issues, Vol. 27, No. 3, May-June 2017, pp. 264-270.

This infographic describes research conducted in RAND Social and Economic Well-Being and RAND Health Care and documented in Laura J. Faherty, Ashley M. Kranz, Joshua Russell-Fritch, Stephen W. Patrick, Jonathan Cantor, and Bradley D. Stein, "Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome," JAMA Network Open, Vol. 2, No. 11, November 13, 2019, p. e1914078 (EP-68010, www.rand.org/t/EP68010). To view this infographic online, visit www.rand.org/t/IG148. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. RAND® is a registered trademark.

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