Report Publish Date: April 20, 2022
This journal article describes a study examining the effect on newborn health of state policies regarding prenatal substance use.
Illicit substance use during pregnancy increased 70% from 2010 to 2018. Being exposed to substances in the womb has been linked to poor birth outcomes such as birth defects, being born too soon and too small, and neonatal withdrawal syndrome. States have responded with a mix of policies, some that criminalize maternal substance use and define it as child maltreatment and others that give pregnant women priority in substance use disorder programs. The authors of this study wanted to know whether these policies affect newborns’ health.
The authors used birth outcomes data from the National Vital Statistics System Natality Files and the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. They collected information on state policies from Guttmacher Institute, the Administration for Children and Families, and other sources.
“Leading medical organizations including the American Congress of Obstetricians and Gynecologists and the American Medical Association oppose punitive [prenatal substance use policies].”
—Angélica Meinhofer and Yuhua Bao, Weill Cornell Medicine; Allison Witman, University of North Carolina Wilmington; and Johanna Catherine Maclean, Temple University
“Taken together, our findings suggest that punitive approaches may be associated with unintended adverse pregnancy outcomes, and that supportive approaches may be more effective for improving perinatal health,” the authors write.
The authors studied the effect of punitive and priority treatment policies relating to illicit substance use during pregnancy on the rate of neonatal drug withdrawal syndrome, low birth weight, low gestational age, and prenatal care use. Punitive policies criminalize prenatal substance use, or define prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for termination of parental rights. Priority treatment policies are supportive and grant pregnant women priority access to substance use disorder treatment programs. Our empirical strategy relies on administrative data from 2008 to 2018 and a difference-in-differences framework that exploits the staggered implementation of these policies. Authors found that neonatal drug withdrawal syndrome increases by 10%–18% following the implementation of a punitive policy. This growth is accompanied by modest reductions in prenatal care, which may reflect deterrence from healthcare utilization. In contrast, priority treatment policies are associated with small reductions in low gestational age (2%) and low birth weight (2%), along with increases in prenatal care use. Taken together, findings suggest that punitive approaches may be associated with unintended adverse pregnancy outcomes, and that supportive approaches may be more effective for improving perinatal health.
Health Economics, April 20, 2022. https://doi.org/10.1002/hec.4518
This study and report was conducted and created by the following people.
