The Unintended Consequences of Punitive Drug Laws on Prenatal Care Utilization

Columbia University Mailman School of Public Health finds that state laws criminalizing prenatal drug use are associated with reduced prenatal care engagement and fewer facility-based deliveries, according to a new analysis.

Fear of arrest, mandated reporting, and potential loss of child custody appear to prompt avoidance of prenatal services, reducing engagement with screening and treatment programs. That pattern mirrors prior policy analyses documenting consistent concerns about how criminalization affects access across diverse state contexts.

Avoiding prenatal care raises the risk of unmanaged comorbidities, missed screening and intervention opportunities, and higher maternal and neonatal complication rates. In a cohort spanning more than 124 million births across 83,300 county‑years (1989–2019) covering states such as Alabama, South Carolina, and Tennessee, the study authors report about 4,396 fewer individuals per 100,000 births receiving any prenatal care and about 1,848 fewer facility-based deliveries per 100,000 births in states that criminalized substance use during pregnancy. Declines were seen in overall and first‑trimester care initiation—changes that plausibly mediate elevated perinatal risk—while remaining population-level associations rather than definitive individual causal pathways.

Policy-level responses include decriminalization of prenatal substance use and statutory protections that separate clinical care from criminal reporting. At the health-system level, expanding low-threshold prenatal and substance-use services integrated with harm-reduction strategies, combined with clear confidentiality assurances and dedicated social work or legal navigation, could improve uptake. These policy and system measures aim to restore trust and increase perinatal care engagement, though the relative effectiveness of specific interventions requires targeted evaluation.