Punishing Pregnant Women for Drug Use Doesn't Actually Reduce Drug Use During Pregnancy
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?Do punitive policies reduce prenatal care utilization?
- ?Would supportive treatment-oriented policies show better outcomes than punitive approaches?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large multi-state population survey with appropriate adjustment, but self-report may be differentially biased by state policy environment.
- Study Age:
- Published in 2026 using 2016-2019 PRAMS data, relevant to the ongoing expansion of punitive prenatal policies across US states.
- Original Title:
- Illicit Drug Use During Pregnancy in States With and Without Punitive Prenatal Substance Use Policies.
- Published In:
- American journal of preventive medicine, 70(3), 108155 (2026)
- Database ID:
- RTHC-08094
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Do punitive drug policies reduce substance use during pregnancy?
No — this study of over 20,000 pregnancies across 19 states found no difference in illicit drug use between states with punitive policies and those without them.
What are punitive prenatal substance use policies?
These are state laws that classify prenatal substance use as child abuse/neglect or require healthcare providers to report it to child protective services, potentially leading to loss of parental rights.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08094APA
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
MLA
Austin, Anna E, et al. "Illicit Drug Use During Pregnancy in States With and Without Punitive Prenatal Substance Use Policies.." American journal of preventive medicine, 2026. https://doi.org/10.1016/j.amepre.2025.108155
RethinkTHC
RethinkTHC Research Database. "Illicit Drug Use During Pregnancy in States With and Without..." RTHC-08094. Retrieved from https://rethinkthc.com/research/austin-2026-illicit-drug-use-during
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.