States with punitive prenatal substance use policies (child abuse charges, mandatory reporting) showed no reduction in illicit drug use during pregnancy compared to states without such policies.
Policymakers, OB-GYNs, public health officials, pregnant individuals in states with punitive policies, and reproductive rights advocates
What the researchers found
Multivariable analysis found no difference in illicit drug use during pregnancy between states with punitive policies and those without (RR=1.02, 95% CI=0.93-1.11), suggesting these policies fail to achieve their stated goal.
Why it matters
Punitive policies that criminalize prenatal substance use are spreading across the US — this evidence suggests they don't work and may only deter women from seeking prenatal care.
The numbers in context
20,356 participants across 19 states; risk ratio=1.02 (95% CI: 0.93-1.11); policies examined include child abuse classification and mandatory healthcare professional reporting.
How the study worked
Cross-sectional analysis of 2016-2019 PRAMS survey data from 19 states (N=20,356), comparing self-reported illicit drug use during pregnancy between states with and without punitive prenatal substance use policies.
What this study cannot tell us
Self-reported data may undercount use, especially in punitive states where women fear consequences; 19 states may not represent all US contexts; cross-sectional design limits causal inference.
How to read the evidence
Large multi-state population survey with appropriate adjustment, but self-report may be differentially biased by state policy environment.
When this study was published
Published in 2026 using 2016-2019 PRAMS data, relevant to the ongoing expansion of punitive prenatal policies across US states.
The bigger picture
This adds to mounting evidence that criminalizing health behaviors during pregnancy backfires — it doesn't reduce use but may push women underground, away from the prenatal care that could actually help.
Questions still open
- Do punitive policies reduce prenatal care utilization? Would supportive treatment-oriented policies show better outcomes than punitive approaches?
Common questions
Do punitive drug policies reduce substance use during pregnancy?
What are punitive prenatal substance use policies?
Read the original research
Illicit Drug Use During Pregnancy in States With and Without Punitive Prenatal Substance Use Policies.
American journal of preventive medicine, 70(3), 108155
Citation
Austin, Anna E; Hergenrother, Laura C; Shanahan, Meghan E. (2026). Illicit Drug Use During Pregnancy in States With and Without Punitive Prenatal Substance Use Policies.. American journal of preventive medicine, 70(3), 108155. https://doi.org/10.1016/j.amepre.2025.108155
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