Mandated supporting, not reporting: Reimagining maternal health care for women who use drugs

This study examines how carceral logics shape maternal healthcare for pregnant women who use drugs. Through qualitative interviews with 21 women and 14 providers in Florida, we explore how punitive surveillance, via mandatory reporting and child welfare investigations, disrupts prenatal care and exacerbates stigma. We find that actual and anticipated involvement of child welfare services (CWS) inadvertently operates as an extension of poverty governance. Participants described deep fear of CWS, particularly newborn removal, as a central reason for avoiding prenatal care. Many reported dehumanizing clinical encounters shaped by stigma. To overcome structural barriers, women identified the need for trauma-informed, nonjudgmental care models, including expanded access to medication for opioid use disorder (MOUD), harm reduction services, peer service navigation, and parenting support. Providers echoed these calls and critiqued abstinence-oriented mandates. Instead, "mandated supporting", a relational, harm reduction-based approach, emerged as an alternative to punitive reporting. The study demonstrates how punitive state policies, while well-intended, exacerbate trauma, disrupt recovery, and intensify health inequities. Findings underscore how reproductive justice frameworks can inform more compassionate and effective responses to maternal substance use.