Child abuse and mandatory reporting policies decrease visits to prenatal care

State child abuse policies and mandated reporting policies reduce visits by pregnant people to prenatal care and postpartum health care, according to a recent study.

Analyzing the United States’ overdose crisis, investigators have observed concerns over substance use during pregnancy. In the 2020 National Survey on Drug Use and Health, 8% of pregnant people reported recent illicit drug use. There has also been a significant increase in opioidand amphetamine affected births in the past few years.

Associations have been made between substance use during pregnancy and adverse outcomes during birth, such as low birth weight, preterm birth, and severe maternal morbidity and mortality. Policies addressing prenatal substance use have arisen in some states, including policies that label substance use during pregnancy as child abuse. Certain policies require that healthcare professionals report instances of prenatal substance use to child welfare agencies.

Child abuse policies have been implemented in 23 states and the District of Columbia, while mandated reporting policies have been implemented in 26 states and the District of Columbia. Leading medical and public health organizations have spoken against child abuse policies, expressing concerns that they will lead less pregnant people to be open to prenatal care and substance use disorder (SUD) treatment in fear of punishment.

Prior studies have indicated reluctance of pregnant people who engage in substance use to seek prenatal and postpartum care out of fear of legal consequences. As early and consistent prenatal care leads to healthy outcomes, investigators stressed the importance of pregnant people visiting care centers, especially in cases of SUD.

Investigators conducted a cross-sectional survey, taking data from the Pregnancy Risk Assessment Monitoring System from 2016 to 2019. This data consisted of a sample of women who delivered a live birth during that year, divided into subgroups based on maternal race and ethnicity and infant birth weight. 

A survey was given to women 2 to 6 months postpartum through mail or telephone, with questions about prenatal substance use and health care visits. Over 4000 women were surveyed across 23 states, and the years in which states had child abuse or mandatory reporting policies were noted.

Prenatal care was recorded based on timing and adequacy, while postpartum care was recorded based on a self-reported receipt by women. Less than 1% of data were missing a receipt for a postpartum healthcare visit.

About 34% of women delivered in states with only a child abuse policy, about 16% in states with a mandatory reporting policy, about 33% in states with both, and about 17% in states with neither. Adequate prenatal care was most seen in states with both policies at 75.1%, then states with neither policy at 75%. States with only child abuse policies saw a 64.1% prenatal care rate, and those with only mandatory reporting policies saw a 66.4% prenatal care rate.

Women on average sought prenatal care about a month later in states with one or more policy compared to states with neither. States with one or more policy implemented saw a decrease in women’s likelihood to receive adequate prenatal care. Postpartum care visits were also less likely in these states. Women in these states were 8.7% to 12.4% less likely to visit postpartum care 4 to 6 weeks after delivery than those in states who had neither policy.

These results indicate that child abuse and mandatory reporting policies decrease the likelihood of women receiving prenatal and postpartum care. This supports statements by leading health and medical organizations that these policies may deter pregnant people from seeking care.

Reference

Austin AE, Naumann RB, Simmons E. Association of state child abuse policies and mandated reporting policies with prenatal and postpartum care among women who engaged in substance use during pregnancy. JAMA Pediatr. 2022. doi:10.1001/jamapediatrics.2022.3396