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State Policies Related to Substance Use in Pregnancy Wheels

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

YearTargeted ProgramPriority AccessProtected from discriminationPunitiveReportingTesting
20002115812124
20082218820206
201622211125237

Policies in effect in 2000 per state

StateTargeted ProgramPriority AccessProtected from discriminationPunitiveReportingTesting
Alabama000000
Alaska000000
Arizona010010
Arkansas110000
California100010
Colorado100000
Connecticut100000
Delaware010000
District of Columbia010000
Florida111110
Georgia010000
Hawaii000000
Idaho000000
Illinois111110
Indiana000100
Iowa001111
Kansas011000
Kentucky100001
Louisiana111000
Maine000000
Maryland110100
Massachusetts000000
Michigan000010
Minnesota000111
Mississippi000000
Missouri011000
Montana000000
Nebraska100000
Nevada000000
New Hampshire000000
New Jersey000000
New Mexico000000
New York100000
North Carolina100000
North Dakota000000
Ohio111000
Oklahoma011110
Oregon100000
Pennsylvania100000
Rhode Island000011
South Carolina100000
South Dakota000100
Tenneessee100000
Texas110100
Utah000010
Vermont000000
Virginia100110
Washington100100
West Virginia000000
Wisconsin110110
Wyoming000000
Totals2115812124

Policies in effect in 2008 per state

StateTargeted ProgramPriority AccessProtected from discriminationPunitiveReportingTesting
Alabama000100
Alaska000010
Arizona010010
Arkansas110100
California100010
Colorado100100
Connecticut100000
Delaware010000
District of Columbia010110
Florida111110
Georgia010000
Hawaii000010
Idaho000000
Illinois111110
Indiana000100
Iowa011111
Kansas011000
Kentucky100001
Louisiana111101
Maine010010
Maryland110100
Massachusetts000000
Michigan000010
Minnesota100111
Mississippi000000
Missouri011000
Montana000010
Nebraska100000
Nevada000110
New Hampshire000010
New Jersey000000
New Mexico000000
New York100000
North Carolina100000
North Dakota000111
Ohio111000
Oklahoma011110
Oregon100000
Pennsylvania100000
Rhode Island000011
South Carolina100100
South Dakota000100
Tenneessee100000
Texas110100
Utah010010
Vermont000000
Virginia100110
Washington100100
West Virginia000000
Wisconsin110110
Wyoming000000
Totals2218820206

Policies in effect in 2015 per state

StateTargeted ProgramPriority AccessProtected from discriminationPunitiveReportingTesting
Alabama011100
Alaska000010
Arizona010110
Arkansas110100
California100010
Colorado100100
Connecticut100000
Delaware010000
District of Columbia010110
Florida111110
Georgia010000
Hawaii000000
Idaho000000
Illinois111110
Indiana100101
Iowa011111
Kansas011000
Kentucky111011
Louisiana111111
Maine010010
Maryland110110
Massachusetts000010
Michigan000010
Minnesota100111
Mississippi000000
Missouri011100
Montana000010
Nebraska000000
Nevada000110
New Hampshire000000
New Jersey000000
New Mexico000000
New York100000
North Carolina100000
North Dakota000111
Ohio111000
Oklahoma011110
Oregon100000
Pennsylvania100010
Rhode Island000111
South Carolina100100
South Dakota000100
Tenneessee111100
Texas110100
Utah010110
Vermont000000
Virginia100110
Washington100100
West Virginia000000
Wisconsin110110
Wyoming000000
Totals22211125237

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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