Over the past 40 years, policies that focus on alcohol use during pregnancy have proliferated throughout America. These policies have become increasingly punitive, a new study finds, despite the fact that there's no evidence that punishing pregnant women reduces harm.
The study, titled Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women's Reproductive Rights?, was conducted by the reproductive health research group Advancing New Standards in Reproductive Health (ANSIRH). It examines US state policies regarding pregnancy and alcohol consumption from 1970 through 2003. Researchers categorized these policies as either supportive or punitive. Three types of policies were deemed supportive: mandatory warning signs on the dangers of drinking while pregnant, the prohibition of women's medical test results from being used as evidence in criminal prosecutions, and mandating priority access for pregnant women and/or women with children to treatment facilities. Punitive policies, conversely, are those that mandate reporting pregnant women who drink to child protective services, those that involve civil commitment of pregnant women who drink, and those that define alcohol use during pregnancy as child abuse and neglect.
Researchers then looked at the relationship between the types of alcohol and pregnancy–related policies in a state, each state's reproductive rights policies, and the state's efficacy in reducing harms from alcohol use overall (beyond pregnancy). What they found was that states with the toughest pregnancy drinking laws are not the same states that are the most effective at reducing the harms of alcohol use. Instead, the states with the most punitive pregnancy drinking policies are those in which reproductive health access is the most policed. Namely, Oklahoma, South Dakota, and Wisconsin, which have instated all three punitive pregnancy and drinking policies.
"This finding suggests that a primary goal of pursuing such policies appears to be restricting women's reproductive rights rather than improving public health," the study states.
According to the study's findings, there has been a drastic increase of alcohol and pregnancy–related policies introduced in the last 40 years. In 1970, not a single such policy existed in the United States. By 2013, only eight states remained free of any pregnancy and drinking–related policies.
As these policies have become more common, they've also become far harsher towards women. Dr. Sarah Roberts, one of the study's four authors and an associate professor at the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco was quite shocked by this fact. "I think the most surprising finding was the fact that policies really are becoming more punitive over time," she tells Broadly. In the 1980s, she explains, states generally had policies that were either punitive or supportive. By the 1990s, the trend moved towards mixed environments: those with both types of policies in place. In recent years, however, even more supportive policy environments have added punitive policies. By 2013, half of states had adopted both types of policy.
Punitive policies are bad for pregnant women, the study warns: It discourages them from seeking vital healthcare due to a fear of being reported to authorities. "This trend is worrying because research related to drug use during pregnancy suggests punitive policies lead women to avoid and delay entering prenatal care and substance abuse treatment," it reads.
This research is part of a larger project at ANSIRH that aims to survey whether these policies are associated with low birth rates, pre-term birth, and prenatal care use. Dr. Roberts says the project will be completed within a year and a half. She and her colleagues at ANSIRH are hopeful that their findings will lead to more effective policies in the future to reduce the harms of drinking while pregnant.