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

Abstract

This article describes U.S. state policies related to alcohol use during pregnancy, using data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Policy Information System (APIS). Specifically, this study examines trends in policies enacted by states over time and types of policies enacted across states in the U.S., with a focus on whether laws were supportive or punitive toward women. Findings revealed substantial variability in characteristics of policies (19 primarily supportive, 12 primarily punitive, 12 with a mixed approach, and 8 with no policies). Findings underscore the need to examine possible consequences of policies, especially of punitive policies and “mixed” approaches.

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

“…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'.…”

“…'Civil commitment' includes policies that allow for mandatory involuntary commitment to treatment or the care of the state to prevent harm to a child due to a pregnant woman's alcohol use. Per recent research (Drabble et al, 2014), reporting requirements is divided into two: 'Reporting requirements for Child Protective Services (CPS) purposes' includes mandatory or discretionary reporting to CPS for purposes of assessing risk of child abuse/neglect and 'Reporting requirements for data and treatment purposes' includes mandatory or discretionary reporting for purposes of data collection/surveillance or assessing need for substance abuse treatment. The 'Child Abuse/Neglect' policy includes states that have adopted statutes and/or regulations that clarify the rules for evidence of prenatal alcohol exposure in child welfare proceedings, such as those alleging child abuse, child neglect, child deprivation or child dependence, or concerning termination of parental rights.…”

“…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. This research also found that, between 2003 and 2012, most types of policies targeting alcohol use during pregnancy increased.…”

“…Previous research has described state-level policies targeting alcohol use during pregnancy and categorized them as focused on punishing pregnant women who drink alcohol during pregnancy or as supportive of pregnant women (Thomas et al, 2006;Drabble et al, 2014). Punitive policies seek to control pregnant women's behavior by civilly committing them, mandating reporting of pregnant women who use or are suspected of using alcohol to law enforcement and/or child welfare agencies, and initiating child welfare proceedings to temporarily remove children from mothers or terminate parental rights.…”

Criminalizing substance use in pregnancy: misplaced priorities

“…This controversial law was the first to criminalize substance use explicitly during pregnancy. While the law's expiration is a positive development, its enactment 2 years prior reflects a growing trend in pregnancy control measures in the United States, where there has been a dramatic increase in punitive policies toward women who use alcohol during pregnancy [1]. These measures are part of a broader surge in restrictive provisions regarding sexual and reproductive health; 30% of all such restrictions enacted since 1973 have been established only during the past 6 years [2].…”