Drug Use during Pregnancy Policies in the United States from 1970-2016

As U.S. states legalize marijuana and as considerable governmental attention is paid to the "opioid crisis", state policies pertaining to drug use during pregnancy are increasingly important. Although recent research has examined state policies on alcohol use during pregnancy, little is known about the scope of state policies targeting drug use during pregnancy, how they have evolved, and how they compare to alcohol use during pregnancy policies.

Our 46-year (1970-2016) original dataset of statutes and regulations in U.S. states covers the entirety of state-level legislating in this policy domain. Data were obtained through original legal research and from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System. Policies were analyzed individually as well as by classification as punitive toward or supportive of women.

The number of states with drug use during pregnancy policies has increased from one in 1974 to 43 in 2016. Policies started as punitive. By the mid-to-late 1980s, supportive policies emerged, and mixed policy environments dominated in the 2000s. Overall, drug/pregnancy policy environments have become less supportive over time. Comparisons of drug laws to alcohol laws shows that states started in opposite directions at the start of the era, with drug use during pregnancy policy beginning as punitive and alcohol policy beginning as supportive. But, by 2016, the results were the same: whether via punitive-only or mixed policy environments, punitive policies were more prevalent than supportive drug use during pregnancy policy environments across states. Moreover, there is a great deal of overlap between drug use during pregnancy policies and alcohol/pregnancy policies.

This study breaks new ground and lays the foundation for a wealth of future research. Among those studies should be those that explore the effects of these policies on drug and alcohol use by pregnant women and on birth outcomes.