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Pregnant Women and Opioid Use Disorder: Examining the Legal Landscape for Controlling Women’s Reproductive Health

Published online by Cambridge University Press:  30 January 2023

Lynn M. Madden ,
Jenn Oliva ,
Anthony Eller ,
Elizabeth DiDomizio ,
Mat Roosa ,
Lisa Blanchard ,
Natalie Kil ,
Frederick L. Altice  and
Kimberly Johnson
Lynn M. Madden*
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA APT Foundation, Inc., New Haven, CT, USA
Jenn Oliva
Affiliation:
Seton Hall University Law School, Newark, NJ, USA
Anthony Eller
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA
Elizabeth DiDomizio
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA
Mat Roosa
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA
Lisa Blanchard
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA
Natalie Kil
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA
Frederick L. Altice
Affiliation:
AIDS Program, Yale School of Medicine, New Haven, CT, USA APT Foundation, Inc., New Haven, CT, USA Yale School of Public Health, New Haven, CT, USA
Kimberly Johnson
Affiliation:
Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
*
*Corresponding author. Email: LMadden@aptfoundation.org
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Abstract

Women with opioid use disorder (“OUD”) are more likely than other women to experience sexual assault, unintentional pregnancy, transactional sex and coercion regarding reproductive health care choices than women without OUD. Laws described as family friendly may be punitive rather than helpful to women and rarely apply to men. Laws regarding reproductive health and OUD are unevenly enforced and therefore biased against poor, minority women. As part of a larger study oriented toward strengthening systems of care related to the intersection of HIV and OUD, we conducted an analysis of state laws related to pregnant and postpartum women with OUD. Data on disparities in child removals and pregnant women’s use of evidence-based treatment for OUD by income and race were captured for the five states with the most restrictive laws in both categories. Laws that were purportedly designed to improve reproductive health outcomes for women with OUD and/or their children often have the opposite of the expressed intended outcome. There is a relationship between restrictive reproductive choice and coercive OUD treatment policy for women. Restrictive state regulations for pregnant women with OUD persist despite negative outcomes for maternal and child health. Altering coercive and/or criminalizing regulation and redefining ‘family friendly’ may improve outcomes for individuals and families.

Type
Articles
Information
American Journal of Law & Medicine , Volume 48 , Issue 2-3 , July 2022 , pp. 209 - 222
Copyright
© 2023 The Author(s)

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21 Indiana law prohibits a medical provider from releasing information about a pregnant woman’s drug or alcohol test without her consent.

22 Missouri child abuse law considers a parent to be unfit if the woman tests positive for substances within 8 hours after delivery and she has previously been convicted of child abuse or neglect or if she failed to complete a drug treatment program recommended by Child Protective Services.

23 Priority in Missouri here applies to pregnant women who are referred to treatment.

24 The South Carolina Supreme Court held that a viable fetus is a “person” under the state’s criminal child-endangerment statute and that “maternal acts endangering or likely to endanger the life, comfort, or health of a viable fetus” constitute criminal child abuse.

25 Vermont does not require a report to its Department of Children and Families (“DCF”) based on a suspected use alone; there must also be child protection concerns. The State does require HCPs to notify DCF whenever a newborn has experienced prenatal substance exposure but those notifications are de-identified.

26 West Virginia substance use providers that accept Medicaid must give pregnant women priority in accessing services.

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32 Id.

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35 Id.

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