The Effects of State Alcohol and Pregnancy Policies on Women’s Health and Healthy Pregnancies

Bibliographic Data

ID6409848
AuthorsSue Thomas (0000-0002-6628-3328, Pacific Institute For Research and Evaluation), Carol Cannon (Pacific Institute For Research and Evaluation), Jillian French, Jillian Claire French (University of Washington)
Year2015
Volume36
Issue1
Pages68-94
Publication date2015-01-02
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueWomen & Politics (JOURNAL)
Journal identifiersISSN: 0195-7732 • E-ISSN: 1540-9473
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/1554477x.2015.985153
OpenAlexW1996998827
LanguageEN
Citations received3
References cited25

US states have enacted a wide range of laws to address health challenges associated with alcohol use during pregnancy. Some have taken punitive approaches that restrain women’s behavior, and some have taken supportive approaches aimed at improving women’s health and supporting healthy pregnancies. In this article we report on a study of implementation of supportive and punitive policies when both types of policies operate simultaneously in the same jurisdiction. Effects of mixed use laws on multiple stakeholder groups, especially pregnant and postpartum women, are studied. We conclude by identifying how our findings can be extended for future comparative state research.KEYWORDS: alcoholpregnancyreproductive healthwomen’s health policy Notes1. Among the diagnoses subsumed within FASD are: Fetal Alcohol Syndrome (FAS), the most severe form, characterized by facial defects, growth deficiencies, and central nervous system dysfunctions; Partial FAS (pFAS): most of the growth deficiencies and facial dysmorphologies of FAS; Alcohol Related Neurodevelopmental Disorders (ARND): central nervous system damage; and Alcohol-Related Birth Defects (ARBD): abnormalities of the skeleton and certain organ systems (Centers for Disease Control Citation2012).2. However, the use of tobacco during pregnancy results in higher risk and preterm births and low birth weight babies. Some of the effects of tobacco can be lifelong (see Hackshaw, Rodeck, and Bonface Citation2011).3. Relatedly, the Newsletter of Assistance with Alcohol & Sobriety Uniting Latinas (Citation2006) in Santa Fe Springs, California, reports that imprisoning a mother and taking away children is seven times more costly than long-term residential treatment.4. US Indian tribes have their own set of laws pertaining to alcohol use during pregnancy (SAMHSA Citation2004).5. Many such laws also address use of illegal drugs by pregnant women.6. Some feminist analysis goes further. Concern has been raised that FASD has taken on the status of a moral panic that overemphasizes women’s nonabusive drinking and may reverberate against women in intrusive ways, such as banning tobacco, caffeine, foods, or extreme sports—or requiring beneficial supplements (Armstrong and Abel Citation2000). Concern has also been voiced about the medical and public health trend toward preconception care, a framework to provide childbearing age women with comprehensive medical attention. Critics question whether women’s bodies will be regulated throughout their reproductive years (Williams Citation2011).7. Note that in this study, like many in this field, the number of women studied is small. Because few treatment centers have large numbers of women at any one time, the literature features samples of this sort.8. Data come from the Alcohol Policy Information System (APIS) at http://www.alcoholpolicy.niaaa.nih.gov/.9. These data were as of January 1, 2003.10. Forty states had a higher proportion of supportive provisions than punitive; 10 states had the reverse pattern. And 33 states had supportive provisions only; 2 states had punitive only provisions.11. Fifteen states were mixed: Arizona, California, Florida, Illinois, Minnesota, Nevada, North Dakota, Oklahoma, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, and Wisconsin.12. This type of mandatory reporting requirements law is distinguished from the laws of other jurisdictions that permit reporting but do not require it.13. The interviews were done among state-level policymakers over the phone; all others were in person. All contact with pregnant and postpartum women was in person, with the exception of one individual who was interviewed over the telephone.14. Policymaking is undertaken in the California legislature. In state government, several departments have responsibility for alcohol use during pregnancy and FASD such as the Department of Alcohol and Drug Programs (DADP) within which is the Office of Women’s and Perinatal Services. The DADP also oversees a State Interagency Task (SIT) Force on Children and Youth, and the SIT FASD Work Group is composed of department representatives. At the county level, social services, child welfare/child protective services, the courts, law enforcement, treatment centers, and hospitals are engaged in these efforts. The private sector, with which counties often contract to provide medical and social services, is also responsible for implementation. Nongovernmental entities play a role, such as the statewide California FASD Task Force, an independent, public-private partnership of parents and professionals. Finally, grassroots and professional advocacy organizations, including those in the women’s, medical, and substance abuse communities, and those representing FASD children and affected families, are involved.15. A rural county was included because prior research suggests that the urban or rural nature of a region has a greater impact than other demographic variables on responses taken in response to maternal substance abuse during pregnancy (Ondersma, Malcoe, and Simpson Citation2001).16. Although we have tracked numbers within each professional county per type of professional, those data are not presented because we assured participants of confidentiality and reporting data by county runs the risk of compromising on the promise.17. Each contact was fully informed of the purpose of the study and the voluntary nature of recruitment. A representative from each location asked women if they would participate in the study. This was facilitated by a short informational handout about the study. The handout contained a contact information section that women filled out if they wanted to participate. Comporting with standard procedures in research of this kind, a modest incentive of a $40 gift card was provided.18. Three interview protocols were used, depending on whether those interviewed were at the state level, the county level, or were pregnant and postpartum women.19. See Young et al. (Citation2008) for similar observations.20. Rather than reversing, however, the situation has gotten worse. California’s budgetary shortfalls have resulted in large cuts to social services (see http://www.ebudget.ca.gov/).21. Although these are an exception, approximately one dozen family drug treatment courts in California provide more comprehensive services to those in the system. The professional staff members and women in our study who were exposed to those services praised them. Research also suggests that such courts are effective (see Edwards and Ray Citation2005; Lester, Andreozzi, and Appiah Citation2004; Milliken and Rippel Citation2004).22. In two counties, there were examples of treatment options that provided a large array (but not a comprehensive list) of services and were seen by the women to be high quality. These were not widely replicated, however.23. See Chriqui et al. (Citation2008) who found that outpatient drug treatment programs in states with comprehensive service requirements were more likely to deliver them than programs in states without mandates.24. Data collected by the state are consistent with these observations. Although California has the highest rate of women in treatment of any state, only part of the need is being met. Many fewer publicly funded residential and outpatient slots are available than are necessary, and few treatment facilities provide specialist services. Although some pregnant women obtain private treatment, data are unavailable to determine the scope of these efforts, even though it has been established that private pay women have higher rates of alcohol use than public pay women (Boles et al. Citation2006).25. The economic downturn prompted the governor to cut back state government. The former Department of Alcohol and Drug Programs in now subsumed within the California Department of Health Care Services.26. Our data indicate that some medical professionals lack the training to handle cases involving addiction and pregnancy. One woman described going to the doctor after becoming pregnant while on methamphetamines and being told that she just needed to stop. However, specialists recommend that prenatal care for substance abusing patients should be carefully managed (see Day and George Citation2005).27. Loss of custody and treatment for addiction is complicated by the federal Adoption and Safe Families Act of 1997, which accelerated the process of placing a child in permanent adoption. To comply, California added legislation mandating that the time for family reunification could be limited to six months. As a judge we interviewed noted, “[i]t’s unconscionable to ask people to get clean within six months, especially when they have to wait 4 months for treatment.” (See Cal. Welf. & Inst. Code § 361.5; D’Andrade and Berrick Citation2006; Edwards Citation2008).28. This is a conclusion consistent with prior research (see Drabble Citation2007; Grella Citation2007; Jessup and Brindis Citation2005; Roberts and Pies Citation2011).29. For discussion of popular conceptions of drinking during pregnancy, see “Alcohol During Pregnancy: More Dangerous Than We Can Know” (2011).30. There is no law in California that mandates universal screening and no federal requirement for prenatal screening for substance abuse.31. Indeed, conclusions from recent research in one California county echoes this concern in its findings that rather than risk being identified and being reported to Child Protective Services, women avoided or emotionally disengaged from prenatal care (Roberts and Nuru-Jeter Citation2010).32. For similar findings see Brindis et al. (Citation1997), Werner (Citation2005), California FASD Task Force (Citation2006), Chasnoff et al. (Citation2008), Grella (Citation2003), Drabble (Citation2007), Lester et al. (Citation2004), and Young et al. (Citation2008).33. This argument is supported by a 2011 law review piece by Lynn Paltrow, Executive Director of National Advocates for Pregnant Women: “But far more than Roe and abortion is at stake. The health, dignity and human rights of all pregnant women are threatened by anti-abortion and fetal rights laws. Such laws create the basis not only for outlawing abortion but also for forcing women to have unnecessary Caesarean sections, for banning vaginal births after Caesarean sections and for treating pregnant women with drug, alcohol and other health problems as child abusers before they have even given birth” (Paltrow Citation2011

Developmental psychology · Disease · Environmental health · Political science · Pregnancy · Psychiatry · Punitive damages · Sobriety · Homelessness and Social Issues · Law · Medicine · Prenatal Substance Exposure Effects · Psychology · Substance Abuse Treatment and Outcomes

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