Reciprocal Obligations: Managing Policy Responses to Prenatal Substance Exposure

Abstract

Substance use during pregnancy poses substantial risks to the developing fetus and continues to generate considerable policy debate. Public policy responses to prenatal substance exposure (PSE) have varied depending in part on whether the substances in question are licit (e.g., tobacco and alcohol) or illicit (e.g., cocaine and heroin). The policy responses also have ranged from warning labels on the dangers to the developing fetus of using alcohol, to treating a pregnant woman's illicit substance use as child abuse. The most controversial case was Cornelia Whitner's criminal conviction in South Carolina for PSE after her newborn baby tested positive for cocaine metabolites. Although the conviction was upheld by the South Carolina Supreme Court, it is, to date, an isolated example (Whitner v. State of South Carolina, 492 S.E.2d 777 [S.C. 1997], cert denied, 523 U.S. 1145 [1998], but see Ferguson v. City of Charleston, 532 U.S. 67 [2001], and Ferguson v. City of Charleston, 308 F.3d 380 [4th Cir. 2002], ruling that PSE detection policies require the woman's informed consent).

State Responses to Alcohol Use and Pregnancy: Findings From the Alcohol Policy Information System

“…Although direct comparison with policies related to substances other than alcohol was beyond the purview of the current study, other research has noted that public policies often differ based on whether substances are licit or illicit, with greater negative consequences attached to illicit drug use than alcohol use (Frohna & Lantz, 1999; Jacobson et al, 2003; Lester, Andreozzi, & Appiah, 2004). Policies classified in our study as punitive, such as mandated reporting as child abuse, and defining substance use during pregnancy or prenatal substance exposure as child abuse or neglect are more likely to be employed by states in response to illicit drug use than alcohol use (Jacobson et al 2003; Lester et al, 2004).…”

“…Policies classified in our study as punitive, such as mandated reporting as child abuse, and defining substance use during pregnancy or prenatal substance exposure as child abuse or neglect are more likely to be employed by states in response to illicit drug use than alcohol use (Jacobson et al 2003; Lester et al, 2004). To our knowledge, these types of punitive policies have not been employed in relation to tobacco use during pregnancy.…”

“…From this perspective, one of the harshest uses of child welfare policies occurs in states that treat positive toxicology screens or other evidence of prenatal alcohol or drug exposure alone as sufficient evidence of child abuse, neglect, or its equivalent (Schroedel & Fiber, 2001). Others do not view reporting to CPS and removal of children as punishment (Barth, 2001; Ondersma et al, 2000); instead, they view CPS reporting as a strategy to ensure the provision of early intervention services for infants and substance abuse treatment for women (Ondersma et al, 2000) and as a possible pathway to treatment and other services (Goodman & Wolff, 2013; Jacobson, Zellman, & Fair, 2003; Young et al, 2009). …”

Paternal Alcoholism and Offspring ADHD Problems: A Children of Twins Design

“…The amount of drinking and smoking per trimester or over the course of the entire pregnancy was not determined. While these prenatal and offspring variables are retrospective, previous research assessing retrospective maternal reports of health behaviors during pregnancy (Jacobson et al, 2003; Heath, et al 2003; Reich, et al, 2003) and of offspring ADHD (Faraone et al, 1995; Faraone & Doyle, 2001) have been found to be reliable and valid.…”

Socioethical issues in Hospital Birth: Troubling Tales from a Canadian Sample

“…The feminist position also questions the "policing" of pregnancy and whether maternal behavior ought to be scrutinized. Those who attribute rights to the fetus from the moment of conception see fetal rights in competition with maternal rights and question whether the state may legitimately protect fetuses from the medical and behavioral choices of pregnant women (Bessner 1994;Burtt 1994;Callahan and Knight 1992;Jacobson, Zellman, and Fair 2003;Purdy 1996).…”