Pregnant Women with Substance Use Disorders — The Harm Associated with Punitive Approaches

Pregnant women with substance use disorders (SUDs) face significant health risks, yet punitive state policies—such as criminalizing prenatal substance use or mandating reporting to child welfare authorities often deter them from seeking care. This article highlights the unintended consequences of such policies, including increased maternal isolation, avoidance of prenatal care, and worsened health outcomes for both mothers and infants. Between 2006 and 2017, the prevalence of SUDs among commercially insured pregnant women in the U.S. doubled, with coexisting mental health conditions more than tripling. Despite evidence that punitive approaches fail to reduce neonatal abstinence syndrome and may disproportionately harm marginalized communities, 26 states had enacted such laws by 2017. The authors advocate for evidence based alternatives, including expanded Medicaid coverage, improved access to treatment (e.g., telehealth, pharmacotherapy), and federal policies like the Black Maternal Health Mommibus Act. They emphasize that treating SUDs as a medical rather than criminal issue aligns with successful models for other chronic conditions and could mitigate the maternal mortality crisis.

Pregnant women with substance use disorders (SUDs) face significant health risks, yet punitive state policies—such as criminalizing prenatal substance use or mandating reporting to child welfare authorities often deter them from seeking care. This article highlights the unintended consequences of such policies, including increased maternal isolation, avoidance of prenatal care, and worsened health outcomes for both mothers and infants. Between 2006 and 2017, the prevalence of SUDs among commercially insured pregnant women in the U.S. doubled, with coexisting mental health conditions more than tripling. Despite evidence that punitive approaches fail to reduce neonatal abstinence syndrome and may disproportionately harm marginalized communities, 26 states had enacted such laws by 2017. The authors advocate for evidence based alternatives, including expanded Medicaid coverage, improved access to treatment (e.g., telehealth, pharmacotherapy), and federal policies like the Black Maternal Health Mommibus Act. They emphasize that treating SUDs as a medical rather than criminal issue aligns with successful models for other chronic conditions and could mitigate the maternal mortality crisis.