Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy

Abstract

ImportanceSome states have implemented policies that consider substance use during pregnancy as child abuse and require mandated reporting of substance use during pregnancy. Implications of these policies for health care receipt among pregnant people who engage in substance use are unknown.ObjectiveTo examine the association of state child abuse policies and mandated reporting policies with prenatal and postpartum care among women who engaged in substance use during pregnancy.Design, Setting, and ParticipantsIn this cross-sectional study, data from the 2016-2019 Pregnancy Risk Assessment Monitoring System survey were analyzed. The study population included 4155 women from 23 states who reported substance use during pregnancy. Data were analyzed between August and November 2021.ExposuresDelivery in a state with a child abuse policy only (n = 6), a mandated reporting policy only (n = 4), both policies (n = 7), or neither policy (n = 5). One state switched from a mandated reporting policy only to having both policies.Main Outcomes and MeasuresMonth of gestation at prenatal care initiation (ie, months 1-10, with a higher number of months indicating later initiation), receipt of adequate prenatal care, and receipt of a postpartum health care visit 4 to 6 weeks after delivery. Sample characteristics were calculated using unweighted frequencies and weighted percentages and means. Associations of state policies with the outcomes were examined using generalized linear regression with generalized estimating equations, adjusting for potential confounders and accounting for the complex sampling design of the Pregnancy Risk Assessment Monitoring System survey.ResultsThe study sample included 4155 women who reported substance use during pregnancy; 33.9% of these women delivered in states with a child abuse policy only, 16.4% in states with a mandated reporting policy only, 32.9% in states with both policies, and 16.8% in states with neither policy. Overall, 14.7% of women were Black, 69.0% were White, and 64.6% were aged 18 to 29 years at delivery. Women who delivered in states with a child abuse policy only, mandated reporting policy only, or both policies initiated prenatal care at a later month of gestation (β = 0.44 [95% CI, 0.10-0.78], 0.32 [95% CI, 0.04-0.59], and 0.40 [95% CI, 0.09-0.72], respectively) and had a lower likelihood of adequate prenatal care (risk ratio, 0.85 [95% CI, 0.79-0.91], 0.94 [95% CI, 0.87-1.01], and 0.95 [95% CI, 0.89-1.03], respectively) and a postpartum health care visit (risk ratio, 0.89 [95% CI, 0.82-0.96], 0.89 [95% CI, 0.80-0.98], and 0.92 [95% CI, 0.83-1.02], respectively) compared with women who delivered in states with neither policy.Conclusions and RelevanceThe results indicate that state child abuse policies and mandated reporting policies are associated with reduced receipt of prenatal and postpartum care among women who engage in substance use during pregnancy.

Mandated Reporting of Perinatal Substance Use

“…2 A recent meta-analysis showed that approximately 3% of infected children are hospitalized. 3 Other studies demonstrated that prior to and after the emergence of variants of concern, children with COVID-19 had similar or higher risk of hospitalization, need for life-sustaining therapy, and death as those infected with influenza. 4,5 Children also are at risk of developing multisystem inflammatory syndrome in children (MIS-C), a rare but severe postinfectious complication, often after asymptomatic or mild infection.…”

“…In fact, Austin et al 3 find that pregnant women who reported substance use and deliver in states with a child abuse and/or mandated reporting policy are less likely to receive timely prenatal care, adequate prenatal care, and postpartum care compared with women in states that have neither policy. 3 Care delays may have marked implications for access to substance use disorder treatment and services for pregnant patients and implications for neonatal abstinence syndrome, low birth weight, prematurity, and other neonatal birth outcomes.…”

Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization

“…This difference has been found in both selective and universal screening programs despite similar prevalence of drug use between the 2 groups . While CPS reports can facilitate referral to substance treatment programs and social services, they can also lead to emotional, social, and legal repercussions, including termination of parental rights …”

“…[5][6][7] While CPS reports can facilitate referral to substance treatment programs and social services, they can also lead to emotional, social, and legal repercussions, including termination of parental rights. [7][8][9] Prior cross-sectional studies found that clinicians are more likely to ask Black people about substance use in pregnancy and test Black newborns for substance exposure. [10][11][12][13] A study of urine toxicology testing for hospitalized pregnant people demonstrated more frequent testing for Black and Hispanic people for reasons other than history of substance use.…”

Expansion and commentary on a two generation approach to prenatal opioid exposure – a commentary on Conradt et al. (2023)

“…These simultaneous effects can lead to discriminatory interactions, shared inculcation of pre‐conceived stereotypes, and poor health outcomes, advancing the argument that health‐related stigma should be considered a social determinant of health. Above and beyond health‐related stigma that may be activated in response to substance use in isolation, people who are pregnant may be subject to additional social mores, societal expectations around the expectations of the “good mother” and punitive policies that have been shown to result in avoidance of prenatal care, worse perinatal outcomes, and increased risk of family separation at delivery (Austin, Naumann, & Simmons, 2022; Stone, 2015).…”