Policies towards Pregnancy and Addiction: Sticks without Carrots

Chavkin, Wendy; Wise, Paul H.; Elman, D

doi:10.1111/j.1749-6632.1998.tb09750.x

Cited by 27 publications

(20 citation statements)

References 7 publications

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“…The finding that children were a primary motivating factor for participation in the New Choices program is congruent with others' suggestions that pregnancy and childrearing are main incentives for engagement in treatment for addictions [7,30,31]. Many of the women were involved in child protection services.…”

Section: Discussionsupporting

confidence: 77%

"New Choices" for women with addictions: perceptions of program participants

2004

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Background: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement.

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Section: Discussionsupporting

confidence: 77%

"New Choices" for women with addictions: perceptions of program participants

2004

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“…Controlling for relevant political and socio-economic variables, the only significant predictor of whether a state adopted a supportive policy (defined in that paper as a policy furthering women's autonomy) was the proportion of women in the state legislature. Although this finding is meaningful, it does not directly address an important question about whether policies targeting alcohol use during pregnancy are intended to be effective public health policies likely to reduce harms from alcohol use during pregnancy or whether they are intended primarily to restrict women's reproductive autonomy or rights, a key question raised by scholars (Gomez, 1997;Chavkin et al, 1998;Thomas et al, 2006). Drabble et al (2014) examined alcohol and pregnancy policy environments [defined as primarily punitive, primarily supportive or mixed approaches (including both punitive and supportive policies)] and found significant variation in policy environments across states.…”

Section: Introductionmentioning

confidence: 93%

“…Scholars have divided responses to substance use during pregnancy into supportive versus punitive or those that are supportive versus those that restrict women's autonomy (Gomez, 1997;Chavkin et al, 1998;Drabble et al, 2014;Thomas et al, 2006). Following our approach in a previously published analysis (Drabble et al, 2014), we created a four category categorical variable characterizing policy environments for each state and year as 'supportive only' (one or more of warning signs, priority treatment, reporting requirements for data or treatment purpose, and limitations on criminal prosecution and no punitive policies), 'punitive only' (one or more of civil commitment, reporting requirements for CPS purposes, and child abuse/neglect and no supportive policies), 'mixed supportive and punitive' (one or more supportive and one or more punitive policies), and 'no policy'.…”

Section: Alcohol and Pregnancy Statute And Regulationsmentioning

confidence: 99%

Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women’s Reproductive Rights?

Roberts

Thomas

Treffers

et al. 2017

Alcohol and Alcoholism

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Aims: Alcohol consumption during pregnancy remains a public health problem despite >40 years of attention. Little is known about how state policies have evolved and whether policies represent public health goals or efforts to restrict women's reproductive rights. Methods: Our data set includes US state policies from 1970 through 2013 obtained through original legal research and from the National Institute for Alcohol Abuse and Alcoholism's (NIAAA)'s Alcohol Policy Information System. Policies were classified as punitive to women or supportive of them. The association between numbers of punitive policies and supportive policies in 2013 with a measure of state restrictions on reproductive rights and Alcohol Policy Effectiveness Scores (APS) was estimated using a Pearson's correlation. Results: The number of states with alcohol and pregnancy policies has increased from 1 in 1974 to 43 in 2013. Through the 1980s, state policy environments were either punitive or supportive. In the 1990s, mixed punitive and supportive policy environments began to be the norm, with punitive policies added to supportive ones. No association was found between the number of supportive policies in 2013 and a measure of reproductive rights policies or the APS, nor was there an association between the number of punitive policies and the APS. The number of punitive policies was positively associated, however, with restrictions on reproductive rights. Conclusion: Punitive alcohol and pregnancy policies are associated with efforts to restrict women's reproductive rights rather than effective efforts to curb public health harms due to alcohol use in the general population. Future research should explore the effects of alcohol and pregnancy policies. Short Summary: The number of states with alcohol and pregnancy policies has increased since 1970 (1 in 1974 and 43 in 2013). Alcohol and pregnancy policies are becoming increasingly punitive. These punitive policies are associated with efforts to restrict women's reproductive rights rather than policies that effectively curb alcohol-related public health harms.

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“…It is important to point out that for many advocates of the sanction approach, treatment is included. The two approaches may not agree on issues such as the nature of addiction, autonomy of the pregnant woman, status of the fetus, and utility of punitive measures; they do agree that treatment is an essential component of the policy response [135]. …”

Section: Policy Optionsmentioning

confidence: 99%

“…Lower doses that would not produce withdrawal in the infant increase the risk that the methadone will be less effective and the pregnant woman return to street drugs. As another example, both managed care and welfare reform have resulted in sanctions that reduce services to drug using mothers, such as when drug users are not eligible for benefits [135]. The irony is that such policies are based on concern for the child ant not only create a rift between advocates for women and advocates for children, but also mean that mother and child face poverty without public assistance or the child enters the foster care system.…”

Section: Policy Issues and Recommendationsmentioning

confidence: 99%

Substance use during pregnancy: time for policy to catch up with research

2004

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The phenomenon of substance abuse during pregnancy has fostered much controversy, specifically regarding treatment vs. punishment. Should the pregnant mother who engages in substance abuse be viewed as a criminal or as someone suffering from an illness requiring appropriate treatment? As it happens, there is a noticeably wide range of responses to this matter in the various states of the United States, ranging from a strictly criminal perspective to one that does emphasize the importance of the mother's treatment. This diversity of dramatically different responses illustrates the failure to establish a uniform policy for the management of this phenomenon. Just as there is lack of consensus among those who favor punishment, the same lack of consensus characterizes those states espousing treatment. Several general policy recommendations are offered here addressing the critical issues. It is hoped that by focusing on these fundamental issues and ultimately detailing statistics, policymakers throughout the United States will consider the course of action that views both pregnant mother and fetus/child as humanely as possible. Overview and nature of the problem IntroductionThe purpose of this review is to summarize policy research findings in the area of maternal prenatal substance abuse to (1) inform and advance this field, (2) identify future research needs, (3) inform policy making and (4) identify implications for policy. As a review, this is a systematic analysis of existing data (findings) on maternal drug use during pregnancy for determining the best policy among the alternatives for dealing with drug using mothers and their children. We will address issues of efficacy (which policies work?), economics (how much does it cost?) and politics (who is it for or against?). For new policies we will also consider how they fit with existing policies or laws, the social impact, ethical issues and the feasibility of implementation and administration.

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Policies towards Pregnancy and Addiction: Sticks without Carrots

Cited by 27 publications

References 7 publications

"New Choices" for women with addictions: perceptions of program participants

"New Choices" for women with addictions: perceptions of program participants

Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women’s Reproductive Rights?

Substance use during pregnancy: time for policy to catch up with research

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