State Legislation on Prenatal Drug Screening Participation

In 2018, Drs. Beth McGinty, Sachini Bandara, Alex McCourt, and former postdoctoral fellow Esita Patel studied the impact of state laws regarding drug use during pregnancy on participation in prenatal drug screenings.   

  

With support from the Bloomberg American Health Initiative, the researchers mapped the effective dates and specific provisions of state prenatal drug use laws from 1974-2019. Utilizing a qualitative method, the team interviewed 96 policy leaders throughout the country who understood how the laws were being implemented and enforced. They also analyzed data from 2016-2018 which contained information from 103,608 women participating in the Pregnancy Risk Assessment Monitoring System. The researchers were particularly interested in understanding the percentage of individuals asked by a healthcare worker about substance use during a prenatal care appointment. They then examined differences in the prevalence of screening segmented by state prenatal substance use policies.  

The researchers found that many states have enacted laws that may disincentivize treatment-seeking among pregnant people who use drugs, as many are afraid it could lead to family separation. They also found that states with laws designating prenatal drug use as child abuse or neglect had a lower prevalence of screening. Finally, when looking at the effects of prenatal drug use laws in Alabama, Maryland, and Utah on child welfare reporting, both Maryland’s law that required provider reporting of prenatal substance use and Utah’s law that deemed prenatal substance use as child maltreatment were associated with decreased child welfare reporting. Qualitative data suggested that these laws increased stigma towards pregnant people who used drugs and may deter treatment seeking due to fear of child welfare reporting. 

To craft effective state laws and support their implementation, state policymakers and practitioners need to take a treatment-oriented approach to prenatal substance use.  

These findings are published in the American Journal of Obstetrics & Gynecology Maternal Fetal Medicine, The International Journal of Drug Policy, The Milbank Quarterly, and Women’s Health Issues. It was also presented at the annual APHA annual research conference in 2021.