When It Comes to Pregnant Women and Substance Use Treatment, Not All State Policies Work the Same Way
States have taken very different approaches to substance use during pregnancy, from laws that treat it as a criminal or child welfare matter to policies that prioritize pregnant women for treatment access. New research from , faculty in the Department of Health, Behavior, and Society at the , examines which of these approaches actually help women finish the treatment they start. Using national data on nearly 38,500 pregnant women admitted to publicly funded substance use treatment programs between 2020 and 2022, the study found that only about 3 in 10 completed their treatment episode, and the state policy environment made a measurable difference in who did.
Two categories of policy were linked to higher odds of completion: laws treating prenatal substance use as a criminal or child welfare matter, and policies that give pregnant women priority access to treatment or protect them from discrimination in care. Additionally, states that require healthcare providers to report suspected prenatal substance use, or to test for it, were associated with notably lower odds that a woman finished treatment. The criminal justice finding comes with a caveat worth sitting with: prior research shows that punitive laws, on their own, tend to keep fewer pregnant women from ever entering treatment in the first place, even as they may pressure those already in a program to stick with it out of fear of legal consequences. Given that admission has to happen before completion is even possible, that tradeoff complicates any simple reading of "criminal justice policies work."
The clearest takeaway may be about provider reporting mandates. When pregnant women worry that being honest with a doctor could trigger a report to authorities, they may be less likely to stay in care, and the patient-provider relationship that treatment depends on can break down. The findings point toward a policy approach that leans into trust and access rather than surveillance and punishment: prioritizing pregnant women for treatment slots, expanding wraparound services like case management and mental health support, and rethinking reporting requirements so they support treatment linkage rather than deter women from seeking help in the first place.