Alcohol and pregnancy: do state-level punitive and supportive policies matter?

Investigator: Sarah Roberts, DrPH
Sponsor: NIH National Institute of Alcohol Abuse and Alcoholism

Location(s): United States


State-level policies targeting alcohol use during pregnancy could potentially lead to decreased alcohol use during pregnancy and to decreased negative birth outcomes. However, research to date has not assessed whether they accomplish these public health goals. Understanding the effects of these policies is crucial to our ability to adopt and implement policies that will lead to health improvements.

The primary purpose of this project is to assess effects of state-level policies targeting alcohol use during pregnancy and whether effects vary by race/ethnicity and socioeconomic status (SES). Alcohol is a known teratogen that causes fetal alcohol syndrome and a range of other harms to fetuses. Alcohol use during pregnancy is common, with about 12% of pregnant women reporting any alcohol use and almost 2% of pregnant women reporting binge drinking in the past month. Since 1980, almost all states have enacted one or more policies targeting alcohol use during pregnancy. These policies include punitive policies, i.e. allowing civil commitment of pregnant women for alcohol abuse, defining use during pregnancy as child abuse/neglect, and mandating reporting to Child Protective Services. They have also enacted supportive policies, i.e. requiring warning signs about effects of alcohol use during pregnancy, prohibiting criminal prosecutions for alcohol use during pregnancy, and giving pregnant women priority in entering substance abuse treatment. These policies continue to be enacted at the state-level and some components of them are now beginning to be included in federal legislation. These policies could potentially influence alcohol use during pregnancy as well as birth outcomes such as preterm birth and low birthweight. Punitive policies could also have unintended consequences, such as deterring women from prenatal care. If women are deterred from prenatal care, there will be fewer opportunities to provide other health-promoting interventions, and it is possible that this could negate any health improvements that might otherwise be expected. Previous research has described these policies and examined social and political factors associated with adopting them. However, to date, researchers have not yet comprehensively examined the effects of these policies on alcohol use during pregnancy, prenatal care utilization, and birth outcomes. They also have not examined whether any effects are differential across race/ethnicity and socioeconomic status, an important consideration given that policies that are effective overall do not necessarily reduce racial/ethnic and socioeconomic status disparities. The lack of information about effects of these policies hinders public health and medical decision-making about which policies to support and which to counter. This study will use data from the Behavioral Risk Factor Surveillance System from the 1980s-present, Natality Birth Data from the 1970s-present, NIAAA's Alcohol Policy Information System, and other policy data sources and will conduct a series of generalized least squares fixed and random effects analyses. Findings from this study will be used to inform ongoing policy debates as well as advocacy and professional education efforts by maternal and child health professionals and obstetricians and gynecologists.