Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy

Abstract

r Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation. Methods:We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture statelevel perspectives on policy implementation.Findings: Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners.Conclusions: Many states have enacted laws that may disincentivize treatmentseeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance.

Racial Disparities in Newborn Drug Testing After Implementation of Question-Based Screening for Prenatal Substance Use

“…[1][2][3][4][5] Illicit substance use in pregnancy can have negative health consequences for the birthing parent-newborn dyad and requires mandated reporting to child protective services in 37 states and Washington, DC. 6 Black birthing people are more likely to be screened for substance use, to experience barriers in accessing support and treatment programs, to be penalized by reporting to health authorities and child protective services for prenatal substance exposure, and to be investigated by child protective services. [7][8][9][10][11] Regardless of the outcome, child protective services investigation alone is associated with future adverse outcomes.…”

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

“…1 Thirty-seven states and the District of Columbia require clinicians to report suspected prenatal drug use to the state. 2 The American College of Obstetricians and Gynecologists opposes criminalization of substance use during pregnancy and the use of biologic testing of newborns as a proxy for child abuse or neglect. 3 Clinicians were found to report Black parents to Child Protective Services (CPS) for prenatal substance use at higher rates than their White counterparts.…”

“…The US Child Abuse and Prevention Treatment Act (CAPTA) requires that all states have policies to identify newborns exposed to substances . Thirty-seven states and the District of Columbia require clinicians to report suspected prenatal drug use to the state . The American College of Obstetricians and Gynecologists opposes criminalization of substance use during pregnancy and the use of biologic testing of newborns as a proxy for child abuse or neglect .…”

Self-fulfilling Prophecy: Does Structural and Interpersonal Bias Against Pregnant and Postpartum People With Substance Use Disorders Undermine Parenting Identity?

“…Stigma is a near universal experience for people with substance use conditions, among whom pregnant people represent a particularly marginalized and often criminalized group 1 . State and federal policies frequently equate prenatal substance exposure with child abuse or neglect and mandate child protection reporting even when the only substance involved is prescribed medication for opioid use disorder (MOUD) 2 . Unequal application of policies targets racialized and low-income groups, resulting in high rates of child removals, foster care placement, and the lifelong impacts of adverse childhood events for their children 3 .…”

“…1 State and federal policies frequently equate prenatal substance exposure with child abuse or neglect and mandate child protection reporting even when the only substance involved is prescribed medication for opioid use disorder (MOUD). 2 Unequal application of policies targets racialized and low-income groups, resulting in high rates of child removals, foster care placement, and the lifelong impacts of adverse childhood events for their children. 3 Structural barriers including provider reluctance to provide lifesaving medications during pregnancy, limited treatment access in rural and low-income communities, and loss of supports for noncustodial parents place postpartum people at particular risk of substance-related morbidity and mortality.…”