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- Title
Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy.
- Authors
Austin, Anna E.; Naumann, Rebecca B.; Simmons, Elizabeth
- Abstract
Key Points: Question: Are state child abuse policies and mandated reporting policies for prenatal substance use associated with receipt of prenatal and postpartum care? Findings: In this cross-sectional study of 4155 pregnant women who engaged in substance use during pregnancy, women who delivered in states with a child abuse policy, a mandated reporting policy, or both policies initiated prenatal care later and had a lower likelihood of adequate prenatal care and a postpartum health care visit compared with those who delivered in states with neither policy. Meaning: These results suggest that programmatic and policy strategies that emphasize supportive, nonstigmatizing approaches to substance use during pregnancy are needed. This cross-sectional study uses Pregnancy Risk Assessment Monitoring System survey data to evaluate the association of substance use with prenatal and postpartum care in states with a child abuse policy and/or mandated reporting policy. Importance: Some states have implemented policies that consider substance use during pregnancy as child abuse and require mandated reporting of substance use during pregnancy. Implications of these policies for health care receipt among pregnant people who engage in substance use are unknown. Objective: To examine the association of state child abuse policies and mandated reporting policies with prenatal and postpartum care among women who engaged in substance use during pregnancy. Design, Setting, and Participants: In this cross-sectional study, data from the 2016-2019 Pregnancy Risk Assessment Monitoring System survey were analyzed. The study population included 4155 women from 23 states who reported substance use during pregnancy. Data were analyzed between August and November 2021. Exposures: Delivery in a state with a child abuse policy only (n = 6), a mandated reporting policy only (n = 4), both policies (n = 7), or neither policy (n = 5). One state switched from a mandated reporting policy only to having both policies. Main Outcomes and Measures: Month of gestation at prenatal care initiation (ie, months 1-10, with a higher number of months indicating later initiation), receipt of adequate prenatal care, and receipt of a postpartum health care visit 4 to 6 weeks after delivery. Sample characteristics were calculated using unweighted frequencies and weighted percentages and means. Associations of state policies with the outcomes were examined using generalized linear regression with generalized estimating equations, adjusting for potential confounders and accounting for the complex sampling design of the Pregnancy Risk Assessment Monitoring System survey. Results: The study sample included 4155 women who reported substance use during pregnancy; 33.9% of these women delivered in states with a child abuse policy only, 16.4% in states with a mandated reporting policy only, 32.9% in states with both policies, and 16.8% in states with neither policy. Overall, 14.7% of women were Black, 69.0% were White, and 64.6% were aged 18 to 29 years at delivery. Women who delivered in states with a child abuse policy only, mandated reporting policy only, or both policies initiated prenatal care at a later month of gestation (β = 0.44 [95% CI, 0.10-0.78], 0.32 [95% CI, 0.04-0.59], and 0.40 [95% CI, 0.09-0.72], respectively) and had a lower likelihood of adequate prenatal care (risk ratio, 0.85 [95% CI, 0.79-0.91], 0.94 [95% CI, 0.87-1.01], and 0.95 [95% CI, 0.89-1.03], respectively) and a postpartum health care visit (risk ratio, 0.89 [95% CI, 0.82-0.96], 0.89 [95% CI, 0.80-0.98], and 0.92 [95% CI, 0.83-1.02], respectively) compared with women who delivered in states with neither policy. Conclusions and Relevance: The results indicate that state child abuse policies and mandated reporting policies are associated with reduced receipt of prenatal and postpartum care among women who engage in substance use during pregnancy.
- Subjects
UNITED States; PUBLIC health laws; SUBSTANCE abuse in pregnancy; CONFIDENCE intervals; CHILD abuse; CROSS-sectional method; WOMEN; REGRESSION analysis; GOVERNMENT policy; DESCRIPTIVE statistics; PRENATAL care; POSTNATAL care; WHITE people; DELIVERY (Obstetrics); MEDICAL appointments; AFRICAN Americans
- Publication
JAMA Pediatrics, 2022, Vol 176, Issue 11, p1123
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2022.3396