In the early 1970s, the law didn’t care if pregnant women drank alcohol. Bars didn’t have to erect warning signs in their bathrooms. Doctors didn’t have to report women to Child Protective Services if they suspected alcohol use. State authorities didn’t commit women against their will to treatment programs if they drank in their third trimester.
By 2013, nearly every state in the U.S. had put laws on the books addressing alcohol and pregnancy. Some laws, like those allowing the prosecution of pregnant women for child abuse if they drank, were punitive. Others, like those providing education on alcohol risks and giving pregnant women and new mothers priority placement in substance-abuse treatment programs, were supportive. Many states have a mix of supportive and punitive policies, though punitive policies have become more common over time. According to a new report published in Alcohol and Alcoholism, states with a greater number of punitive pregnancy and alcohol laws are more likely to have greater restrictions on women’s reproductive rights.
The study comes from researchers at the Pacific Institute for Research and Evaluation, San Jose State University, and Advancing New Standards in Reproductive Health at the University of California, San Francisco. Authors cite previous research that showed that between 1980 and 2003, after accounting for political and socioeconomic differences, a higher proportion of women serving in a state’s legislative body was the one predictor of whether a state would pass a supportive law on pregnancy and alcohol. After completing their analysis of reproductive-rights restrictions and alcohol-use laws, the authors concluded that neither a state’s number of punitive laws nor its number of supportive laws are associated with a greater efficacy of its alcohol policies as measured by policy experts’ estimates.
“Punitive alcohol and pregnancy policies are associated with policies that restrict women’s reproductive autonomy rather than general alcohol policy environments that effectively reduce harms due to alcohol use among the general population,” the authors write. “This finding suggests that a primary goal of pursuing such policies appears to be restricting women’s reproductive rights rather than improving public health.”
In recent years, more and more women’s health advocates have taken cues from hundreds of studies indicating that light drinking later in pregnancy is probably okay. Last year, the New York City Commission on Human Rights issued new guidelines that prohibited bars and restaurants from refusing to serve alcohol to pregnant women. At the same time, the Centers for Disease Control and Prevention is recommending that all women of reproductive age abstain from alcohol unless they’re on birth control, as if they were nothing but fetal incubators–in-training.
Of course, an occasional drink is not the same as alcohol abuse. But the new study in Alcohol and Alcoholism notes that the most common punitive U.S. pregnancy-alcohol policy requires or encourages medical practitioners to report a pregnant woman or new mother’s suspected alcohol use to Child Protective Services. Such laws exist in 21 states. They often don’t take effect until babies are born and tested, the report says, putting the emphasis on punishment rather than harm prevention or reduction. Babies would benefit from policies that make it easier for pregnant women to find subsidized spots in alcohol treatment programs. They don’t benefit from policies that leave them in state custody or put their mothers in jail. Research has shown that the threat of being jailed for illegal drug use keeps many pregnant women from seeking treatment for substance-abuse issues. If the same holds true for women who need treatment for alcohol addiction, punitive policies would pose an even greater threat to fetal and infant health.
Another report released this week, this one from the Center for Reproductive Rights and Ibis Reproductive Health, claims that states with the highest number of restrictions on abortion rights are more likely to have comparatively few policies that support women’s and children’s health. They also generally score worse on indicators like maternal mortality and child health. The authors included Medicaid expansion, required screening protocols for domestic abuse, prohibitions on shackling pregnant prisoners, mandatory sex education, and smoking bans in restaurants on their list of 24 policies that have been shown to improve the wellbeing of women and children. States with 12 or more supportive policies in place had a median of four abortion restrictions, researchers found, while states with 11 or fewer supportive policies had a median of 12 abortion restrictions on the books.
The results suggest that state legislatures that prioritize passage of abortion restrictions are not doing so out of an abundance of concern for women’s health, as anti-abortion advocates have recently argued in legislative debates and before the Supreme Court. It should be noted that legislators that support reproductive rights also usually support policies like paid family leave, increased Medicaid income limits, and increased family-planning funding, all of which the study names as policies that support women’s and children’s health. But the fact that these policies usually align with one of the two parties in the American political system doesn’t negate this analysis. Instead, it should be seen as another addition to the already gigantic pile of evidence that one party consistently conspires to force women into unwanted births, then makes it as hard as possible for them to raise healthy children.
Texas is one of the biggest and best-known offenders of the bunch, with an ever-increasing roster of abortion restrictions and a maternal mortality rate that almost doubled between 2010 and 2014 to become the highest rate in the developed world. Just this week, as they mull even more rollbacks of reproductive rights, members of the state’s House of Representatives passed four bills that would give financial incentives to managed care organizations with good track records on postpartum health and help a special task force established in 2013 continue to study maternal mortality. Hopefully, that task force will informlegislators that the start of the maternal-mortality spike coincided with a two-thirds cut to the state’s family-planning budget, closing more than 80 women’s health clinics in the state. But if history prevails, neither data nor pleas to legislators’ humanity won’t be enough to change their minds.