The Impact of State-Level Prenatal Substance Use Policies on Rates of Maternal and Infant Mortality in the United States: A Legal Epidemiology Study

Rates of maternal and infant mortality remain significantly higher in the United States than other similarly developed countries. Prior research has shown that substance use during pregnancy leads to increased rates of maternal and infant mortality, yet no studies have examined the impact of state-level policies regarding substance use during pregnancy on rates of maternal and infant mortality across all 50 states. The current study utilized publicly available data to examine state-level impact of punitive prenatal substance use laws on maternal and infant mortality. Results revealed that mandated testing laws significantly predicted maternal mortality after controlling for race, poverty, neonatal abstinence syndrome, prenatal care, and substance use in pregnant women, with the entire model accounting for 59.6% of the variance in maternal mortality. Child abuse laws significantly predicted rates of infant mortality, when controlling for race, health insurance, neonatal abstinence syndrome, prenatal care, and substance use in pregnant women, with the entire model accounting for 70.8% of variance in infant mortality. In both regression models, lack of prenatal care increased rates of maternal and infant mortality. Results provide support for the position that laws punishing prenatal substance use may lead to higher rates of maternal and infant mortality. Clinical and policy implications are discussed.