USA: The Problem With Penalizing Women Who Drink While Pregnant


A new study, published today in Alcohol and Alcoholism, is the first published piece in a large-scale project examining state-level policies regarding alcohol use during pregnancy. Researchers looked at the prevalence of these policies, the different kinds of policies that exist, their correlation to reproductive rights laws, and will eventually put together a comprehensive analysis of when and how policies can effectively combat the public health crisis of alcohol use during pregnancy.

One key element of the research was separating these policies into two categories; punitive policies (designed to punish women for drinking while pregnant by civilly committing them, mandating reporting of those who use alcohol to law enforcement and/or child protective services, or initiating child welfare proceedings to remove children from the mother’s custody) and supportive policies (which attempt to address the issue of alcohol use during pregnancy through education and treatment).

The study, from Advancing New Standards in Reproductive Health (ANSIRH), a reproductive health research group based at the University of California San Francisco, found that states with punitive policies tend to also have a history of restrictive reproductive rights laws, as opposed to states that have supportive policies.

“People who want to reduce harms due to the consumption of alcohol by pregnant women should be concerned that policymaking in this area appears to be more about restricting women’s reproductive autonomy than addressing the issue itself,” said the study’s lead author, Sarah Roberts, Dr.P.H., associate professor of obstetrics, gynecology, and reproductive sciences at ANSIRH.

During this first phase of the project, Roberts said, they were really focusing on determining whether policymaking around alcohol use during pregnancy was more similar to policymaking related to reproductive rights, or to more general public-health-oriented policies. Their findings of a strong connection to state-level policy around reproductive rights, which raises questions as to whether these punitive policies are beneficial to public health at all, or if they’re really about restricting the autonomy of pregnant women.

“It doesn’t seem to be at all related to policymaking related to reducing health harms from alcohol use in general,” Roberts said. “It raises some concerns that policymaking in this area isn’t coming from a process that we generally like to see in terms of public health policies where they’re actually looking at the data about the outcome and designing policies based on everything we know about affecting that outcome.”

The study shows that there has been an increase in state-level policies around alcohol use during pregnancy since 1970, and that they’ve become increasingly punitive since then. Between 2003 and 2012, the number of states that consider alcohol use during pregnancy child abuse and/or neglect has increased by 40 percent, but the number of states that give pregnant women priority access to substance abuse treatment hasn’t increased—meaning women are more likely to be punished for drinking, but not any more likely to get help if they try to stop.

Roberts says they’ll need more time to analyze the date before they can say definitively whether punitive policies are effective in preventing alcohol abuse during pregnancy (or whether they’re more or less effective than supportive policies), but that’s something they’re working toward determining. But, she says, her past research has indicated that similar punitive policies regarding drug use during pregnancy cause women to avoid necessary prenatal care out of fear. “That’s one of the outcomes that we’re investigating here,” Roberts said.

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