Mandatory Treatment for Drug Use During Pregnancy

Chavkin, Wendy

doi:10.1001/jama.1991.03470110102041

Cited by 34 publications

(13 citation statements)

References 25 publications

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“…Moreover, as Chavkin (1991) pointed out, a policy that is punitive toward pregnant women does not clearly serve the goals of either limiting fetal exposure to toxins or improving women's parental functioning. Offspring can be affected by exposure of either parent to drugs prior to conception, through drugs' effects on sperm and ova, meaning that arguably any drug user who plans to procreate should be prosecuted for child neglect.…”

Section: The Effects Of Drug Testing During Pregnancymentioning

confidence: 99%

“…Adversarial policies "assume that the government's role is to protect the fetus from the woman," whereas facilitative policies, rather than punishing women for their behavior, "seek to expand women's choices by, for example, improving access to prenatal care, food, shelter, and treatment" (Johnsen, 1992, p. 571). The Ferguson (2001 policy is adversarial in the sense that women who fail to obtain treatment are liable to criminal prosecution; yet such mandatory treatment for drug use in general is not particularly effective (Chavkin, 1991;Haugaard, 1998). The high likelihood of diminished prenatal care suggests that policies that impose mandatory treatment, under threat of punishment, may not have their intended salutary effect.…”

Section: Alternatives To Punitive Policiesmentioning

confidence: 99%

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Pregnancy, drug testing, and the Fourth Amendment: Legal and behavioral implications.

Bornstein¹

2003

Journal of Family Psychology

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In its efforts to protect the health of unborn children, the government is increasingly attempting to regulate pregnant women's conduct. As with other policies affecting pregnant women's autonomy, these policies have constitutional overtones. In Ferguson v. City of Charleston (2001), the Supreme Court struck down a South Carolina hospital's policy of testing pregnant women for cocaine and turning positive results over to law enforcement for prosecution. This article discusses the basis of the decision and its legal and behavioral implications. Although the decision came down on the side of pregnant women's rights, it left unresolved the issue of whether a similar policy could be constructed that would pass constitutional muster. The article concludes with a consideration of the likely effects of, and alternatives to, such a policy.

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Section: The Effects Of Drug Testing During Pregnancymentioning

confidence: 99%

Section: Alternatives To Punitive Policiesmentioning

confidence: 99%

Pregnancy, drug testing, and the Fourth Amendment: Legal and behavioral implications.

Bornstein¹

2003

Journal of Family Psychology

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“…Outside of pregnancy, the broader use of alcohol screening tests, such as TWEAK (an acronym for Tolerance, Worry about drinking, Eye-opener, Amnesia [blackouts], and Cut down [K/C]) and the Alcohol Use Disorders Identi cation Test (AUDIT), can identify women who are at risk (Bradley, Boyd-Wickizer, Powell, et al 1998). However, medical providers have not been aggressive about incorporating routine chemical screening into prenatal care because they fear it will deter substance abusers from obtaining the care they need (Chavkin 1991). However, because many substance users also smoke cigarettes, identi cation of smokers may be useful in identifying women who use other substances.…”

Section: Interventions During the Postpartum Periodmentioning

confidence: 99%

“…Other programs do not participate in Medicaid. In one study, 87 percent of drug treatment programs surveyed in New York City would not accept pregnant crack users who were covered by Medicaid (Chavkin 1991). Furthermore, a report by the U.S. General Accounting Of ce (1991) concluded that the most important barrier to treatment is the lack of adequate treatment capacity and appropriate services among programs that will treat pregnant women and mothers with young children."…”

Section: Interventions During the Postpartum Periodmentioning

confidence: 99%

“…Chavkin and colleagues recently noted that legal intervention against pregnant substance users is occurring more frequently. Although little evidence exists to test the proposition that prosecution deters maternal substance abuse, there is evidence that it discourages high-risk women from seeking appropriate prenatal care or treatment services (Chavkin 1991).…”

Section: Interventions During the Postpartum Periodmentioning

confidence: 99%

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Maternal Substance Abuse and Infant Health: Policy Options across the Life Course

1999

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Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

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Perinatal substance abuse and human subjects research: Are privacy protections adequate?

Marshall

Menikoff

Paltrow

2003

Ment. Retard. Dev. Disabil. Res. Rev.

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Privacy incursions in the clinical care of substance abusing pregnant women have gained lay and professional attention recently as the result of a high-profile Supreme Court finding in Ferguson vs City of Charleston et al. In March, 2001 the Supreme Court determined that nonconsensual drug screening of pregnant women by clinicians in a public hospital violated the women's Fourth Amendment rights to be secure against unreasonable search and seizure. Coercive or punitive policy approaches to perinatal substance abuse are often based on mistaken assumptions about the nature of addiction and the outcomes of punitive interventions. Much attention has been given to efforts to criminalize pregnancy for drug using women, and civil laws are also coming under increasing scrutiny. Although no state has passed a law criminalizing pregnancy and drug use, an estimated 250 women in more than 30 states have been prosecuted around the country on theories of "fetal abuse." A growing number of states (eighteen to date) have amended their civil child welfare laws to address specifically the subject of a woman's drug use during pregnancy. No one has examined how these laws and social policies could affect research that includes pregnant and parenting women; women (and their families) who stand to lose a great deal should their drug use be brought to the attention of child welfare or criminal justice authorities. We examine the adequacy of current protective mechanisms, such as federal certificates of confidentiality, in protecting research subjects (and investigators) who may be subject to punitive civil or criminal sanctions. We determine that current protective mechanisms may be insufficient to protect research subjects and that investigators and IRB members are often ignorant of the risks imposed by punitive policy approaches to perinatal substance abuse or fall prey to the same mistaken assumptions that inform punitive policies. We conclude that investigators and IRB members have a moral responsibility to understand local, state and national policies and laws governing perinatal substance abuse. Investigators and IRB members should balance the harms of punitive interventions against the protections that may, or may not be afforded to prospective research subjects as well as the prospective benefits, individual and social, of the research. In situations where criminal or punitive policies are in effect, investigators and IRB members should consider whether adequate protections can be achieved. In the context of inadequate protections, potential risks to prospective research subjects and their families may outweigh the individual or social benefits that accrue from the research. Clinical researchers are professionally obligated to work toward amending laws and policies that are not in the best interests of prospective research subjects.

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Mandatory Treatment for Drug Use During Pregnancy

Cited by 34 publications

References 25 publications

Pregnancy, drug testing, and the Fourth Amendment: Legal and behavioral implications.

Pregnancy, drug testing, and the Fourth Amendment: Legal and behavioral implications.

Maternal Substance Abuse and Infant Health: Policy Options across the Life Course

Perinatal substance abuse and human subjects research: Are privacy protections adequate?

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