Pregnant Women With Health Problems Need Care, Not Incarceration

Throwing pregnant women in jail or involuntarily committing them to mental health facilities for alcohol and drug abuse problems is ineffective and counterproductive, according to a new committee opinion released today by The American College of Obstetricians and Gynecologists (The College). Physicians should instead work with state legislators to retract punitive mandatory reporting laws and replace them with evidence-based strategies outside the legal system to help pregnant women with addictions.

Currently, fifteen states consider substance abuse during pregnancy to be child abuse under civil child-abuse statutes, and three states consider it grounds for involuntary commitment to a mental health or substance abuse treatment facility. States vary widely in what they consider drug abuse during pregnancy. Some states consider alcohol use by pregnant women to be child neglect.

“Although states with mandatory reporting requirements and criminalization statutes may have been well intentioned, these laws have not reduced the incidence of alcohol and drug abuse among pregnant women,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women.

“Unfortunately, the effect of these laws is that many pregnant women who need help avoid prenatal care altogether and may have worse outcomes as a result.”

According to The College, pregnant women who seek health care often risk being jailed or involuntarily committed, losing custody of their children, or losing their housing if they are found to be using drugs. “Addiction is a biological and behavioral disorder that needs medical and behavioral treatment in order to improve outcomes for both mothers and their children,” said Dr. Phipps

Studies have shown that getting prenatal care significantly reduces the negative effects of substance abuse during pregnancy, including decreased risks of low birth weight and premature birth. What is needed, according to The College, is the development of safe, affordable, and effective comprehensive alcohol and drug treatment services for all women, especially pregnant women, and their families.

Committee Opinion #473, “Substance Abuse Reporting in Pregnancy,” is published in the January 2011 issue of Obstetrics & Gynecology.

American Congress of Obstetricians and Gynecologists

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