Prenatal Substance Use Policies And Infant Maltreatment Reports

Abstract

We studied the effect of state punitive and supportive prenatal substance use policies on reports of infant maltreatment to child protection agencies. Punitive policies criminalize prenatal substance use or define it as child maltreatment, whereas supportive policies provide pregnant women with priority access to substance use disorder treatment programs. Using difference-in-differences methods, we found that total infant maltreatment reports increased by 19.0 percent after punitive policy adoption during the years of our study (2004-18). This growth was driven by a 38.4 percent increase in substantiated reports in which the mother was the alleged perpetrator. There were no changes in unsubstantiated reports after the adoption of punitive policies. We observed no changes in infant maltreatment reports after the adoption of supportive policies. Findings suggest that punitive policies lead to large increases in substantiated infant maltreatment reports, which in turn may lead to child welfare system involvement soon after childbirth in states with these policies. Policy makers should design interventions that emphasize support services and improve well-being for mothers and infants.

Exhibit 1:. State adoption of prenatal substance use policies by 2018

Source/Notes: SOURCE Authors’ analysis of prenatal substance use policy data collected by the authors (see online appendix exhibit 1, see note 25 in text). NOTE Map shows states with no prenatal substance use policies, states that ever had a priority treatment prenatal substance use policy only, states that ever had a punitive prenatal substance use policy only, and states that ever had both types of prenatal substance use policies.

Exhibit 3:. Effect of prenatal substance use policies on substantiated infant maltreatment reports where the mother is the perpetrator, per 10,000 infants, by infant demographics, 2014–18

Source/Notes: SOURCE Authors’ analysis of the 2004–18 National Child Abuse and Neglect Data System linked to data on prenatal substance use policies collected by the authors (see online appendix exhibit 1, see note 25 in text). NOTES The unit of observation is a state in a quarter in a year. All difference-in-differences models are estimated with ordinary least squares and control for time-varying state characteristics (see online appendix exhibit 2, see note 25 in text), state fixed effects, and time (quarter-year) fixed effects. Data are weighted by the state population younger than one year. The 95% confidence intervals account for within-state clustering and are reported with vertical lines.

Exhibit 4:. Effect of prenatal substance use policies on substantiated infant maltreatment reports where the mother is the perpetrator, per 10,000 infants, by reporting source, 2014–18

Source/Notes: SOURCE Authors’ analysis of the 2004–18 National Child Abuse and Neglect Data System linked to data on prenatal substance use policies collected by the authors (see online appendix exhibit 1, see note 25 text). NOTES The unit of observation is a state in a quarter in a year. All difference-in-differences models are estimated with ordinary least squares and control for time-varying state characteristics (see online appendix exhibit 2, see note 25 in text), state fixed effects, and time (quarter-year) fixed effects. Data are weighted by the state population younger than one year. The 95% confidence intervals account for within-state clustering and are reported with vertical lines.