Nursing Group Says Punishment of Substance-Using Pregnant Women Must End

A punitive approach to addressing substance use in pregnant and parenting women is shown by scientific evidence to be “ineffective and potentially harmful,” states a policy brief from the American Academy of Nursing. The newly published report advocates a comprehensive public health response to the challenges facing these women, driven by federal and state commitments of increased funding and integrated care.

The policy brief also offers a glimmer of hope for advocates of removing punitive responses to maternal substance use, citing the emergence of treatment-oriented efforts such as the Mommies Program in Texas and the Maternal Opiate Medical Support initiative in Ohio. Still, it points out that 24 states and the District of Columbia have laws stating that substance use during pregnancy constitutes child abuse under child welfare statutes. Three states enforce civil commitment in order to deter drug use, according to the report.

Moreover, “Law enforcement, probation officers and courts have been known to order women to discontinue medication approved by the Food and Drug Administration for treatment, potentially placing them at risk for relapse and/or overdose death,” the policy brief states.

The document is published in the March/April issue of the academy's journal Nursing Outlook.

Turn the tide

The brief, “Pregnant and Parenting Women with a Substance Use Disorder: Actions and Policy for Enduring Therapeutic Practice,” states that according to Amnesty International data and other research, more than 1,000 women in the United States have been prosecuted for substance use during pregnancy since the 1970s. Most of these prosecutions have occurred since 2005.

While opioid use in pregnancy has increased substantially in many states, and with that an increase in cases of neonatal abstinence syndrome (NAS), the report states that “early therapeutic intervention can lead to lifelong benefits for these women and their children. Access to quality healthcare plays a vital role in long-term health and social outcomes, birth spacing, prevention of preterm delivery, and low birth weight.”

The report calls for an end to criminal prosecution and punitive civil actions based solely on a pregnant or parenting woman's substance use or substance use disorder, saying these approaches discourage women from disclosing substance use and pose barriers to essential health and social services. It recommends instead several actions at the federal and state level to support a public health approach.

At the federal level, the academy states, more funding under the Substance Abuse and Mental Health Services Administration's (SAMHSA's) State Targeted Response to the Opioid Crisis program is needed for treatment services for pregnant and parenting women. In addition, SAMHSA should advance more training to ensure culturally competent treatment and recovery strategies in communities.

States, according to the policy brief, should increase funding for accessible substance use treatment, recovery support and general health services for this population, and should pass legislation to improve integrated care that is gender- and trauma-responsive.

The report also highlights the critical role nurses can play in serving as patient advocates. Among the areas where the academy states nurses can have influence are in leading efforts to use an objective protocol for clinical assessment of women of childbearing age, as well as to use a standardized assessment for NAS.

“Whereas law enforcement authorities have historically used a single drug test as grounds for prosecution of pregnant and parenting women with a [substance use disorder], comprehensive assessments are essential to ensure the validity and integrity of clinical findings and must be upheld and protected,” the report states.