Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward

Abstract

The rising prevalence of opioid use disorder (OUD) among those living in the United States has demanded a collaborative response from health care and policy spheres. Addressing OUD among pregnant women is especially difficult, given the controversies surrounding the medical and ethical balance between meeting maternal versus fetal/newborn needs. Most medical organizations discourage the criminalization of drug use in pregnancy due to the adverse public health outcomes of such an approach. Despite this recommendation, many states continue to use punitive law to address drug use in pregnancy. In 2014, the Fetal Assault Law in Tennessee (TN) became the first law in the United States to directly allow women to be prosecuted for drug use in pregnancy. Since its expiration in 2016, this law has been re-introduced several times to the TN legislature in support of permanent implementation. This article outlines the impact of the initial Fetal Assault Law on maternal/newborn health in TN and provides alternative immediate, short-term, and long-term health policy strategies through which health care providers and legislators can better advocate for the well-being of both mothers with OUD and their infants.

The Implementation of the Tennessee Fetal Assault Law and Its Association With Out-of-State Births Among Residents of Tennessee

“…Although the TFAL was allowed to sunset on July 1, 2016, efforts to revive the TFAL continue, and punitive laws related to substance use during pregnancy exist in 23 other states and the District of Columbia in 2021 (Darlington, Compton, & Hutson, 2021;Guttmacher Institute, 2021). The results of this study suggest that the TFAL may have discouraged some women from giving birth in-state, which likely increased their travel time and brought associated risks; given the focus of the law, those affected likely included pregnant people who use drugs.…”