National survey of the states: policies and practices regarding drug-using pregnant women.

Abstract

OBJECTIVES: This study assessed the impact of national policy shifts on state policies and practices regarding substance-using mothers. METHODS: A 1995 telephone survey of substance abuse and child protective services directors in all 50 states and the District of Columbia was compared with a similar 1992 survey. RESULTS: There have been significant increases in state interventions for drug-using pregnant women (e.g., criminal prosecution, toxicology testing of women and neonates). Federal resources for treatment and oversight are being replaced by state control of reduced funds for treatment. CONCLUSIONS: The earlier policy of expanding treatment for addicted women is being replaced by reduction of services and increased state intervention.

Substance abuse treatment for women: Changes in the settings where women received treatment and types of services provided, 1987–1998

“…By 1988, amid vivid media depictions of the problems of drug-exposed infants and policymakers' focus on the national war on drugs, Congress doubled the women's set-aside funds to 10%. 6 In 1990, the General Accounting Office (GAO) called for an urgent national response to the thousands of drug-exposed infants born each year in the United States. 7 Subsequently, Congress enacted legislation that funded demonstration grants for prenatal and infant care services through the Medicaid program.…”

Cocaine and Opioid Use During Pregnancy: Prevalence and Management

“…1 No state has a law specifically criminalizing substance abuse in pregnancy, but approximately 30 states have prosecuted pregnant substance users through a state-by-state interpretation of "reckless endangerment" and "giving drugs to a minor" laws. 68 In at least 1 state, studies of reporting patterns showed that indigent women were more likely to be reported, though this did not correlate with greater access or referral to treatment. 69 Reporting guidelines are unclear and do not fall neatly under the mandatory reporter guidelines that exist for the physical, sexual, or verbal abuse of children, the elderly, and the handicapped.…”

“…However, the standard of care for reporting currently includes (at a minimum) the involvement of social work services at any facility that manages the pregnancy as well as a report to the local child protective services agency (to plan for care of the infant after delivery and, where possible, to provide a timeline whereby the mother may regain custodial rights by going through a course of drug treatment and rehabilitation if she is motivated). 68 Even for motivated women, obtaining treatment is not always straightforward. The scarcity of specialized treatment centers has already been noted.…”

Maternal Substance Abuse and Infant Health: Policy Options across the Life Course

“…In addition, maternal drinking is explicitly considered in child protective hearings in several other states (Madden 1993). Sixty-one percent of states require mandatory reporting of positive toxicology results for pregnant women, and 65 percent require such reporting for positive results among neonates (Chavkin, Breitbart, Elman, et al 1998). Chavkin and colleagues recently noted that legal intervention against pregnant substance users is occurring more frequently.…”