Associate Professor
La Follette School of Public Affairs
University of Wisconsin-Madison
Abstract
The U.S. is facing a substance use crisis. The severity of the crisis has increased over time as evidenced by increases in drug overdose mortality, particularly opioid overdose mortality. Between 1999 and 2017, the drug and opioid overdose mortality rate increased 256 and 400 percent, respectively. Beyond the direct effect on mortality, the substance use crisis has myriad spillovers for children and families, and specifically pregnant women and their infants. Substance use during pregnancy can result in adverse maternal and infant outcomes, including neonatal abstinence syndrome (NAS), a condition of newborn withdrawal resulting from in-utero substance exposure. In response to concerns about prenatal substance misuse, some states adopted policies that treat prenatal substance use identified at birth as child abuse or neglect, which can be grounds for the removal of the child from the home or the termination of parental rights. Such punitive policies can negatively affect the provider-patient relationship or the seeking of prenatal care and/or substance use treatment. The American College of Obstetricians and Gynecologists expressed concerns about punitive prenatal substance misuse policies, specifically, recommending that substance use during pregnancy is “best addressed through education, prevention and community-based treatment, not through punitive drug laws or criminal prosecution.” In this paper, we offer preliminary findings on the effect of punitive prenatal substance use policies on prenatal care initiation and utilization using national Pregnancy Risk Assessment & Monitoring System (PRAMS). We also review some of our prior work that has examined the policy effects on foster care admissions for infants, NAS rates, and substance use treatment admissions for pregnant women.
Bio
Dr. Christine Durrance is an economist and Associate Professor in the La Follette School of Public Affairs at the University of Wisconsin-Madison. She is the research co-lead for CORE @ UW-Madison (Collaborative for Reproductive Equity), and a faculty affiliate with the Institute for Research on Poverty, UW Prevention Research Center, Center for Demography & Ecology, Center for Demography of Health and Aging, and the Department of OB/GYN. Her research interests are concentrated in health economics and policy, with particular focus on maternal, infant, and reproductive health; risky behavior (e.g., substance use and violence); the legal and policy environment; and competition in health care markets. Much of her work focuses on vulnerable populations, and utilizes secondary-data and robust econometric methods to identify causal effects with important policy implications. Current research projects are largely focused around substance use and the opioid crisis, maternal and infant health, child welfare, and the intersection of topics.