Abstract

Drug use by pregnant women is a source of legal and ethical controversy about the nature of a woman's obligations to her fetus, the state's role in controlling pregnant women's behavior, and the obligations of health professionals toward drug-involved women, their fetuses, and their newborns. Unresolved policy issues include whether or under what conditions pregnant women or their newborns should be drug tested, how information about drug-involvement should be used, and whether or under what conditions the legal system should be engaged. ;Because more than 99% of women deliver in hospitals, health providers are uniquely situated to play a key role in implementing policies for drug-involved pregnant women and their newborns. Unfortunately, little is known about hospital policies and physician practices related to prenatal drug use. ;This study aims to fill this gap. After developing key legal and ethical issues, this report describes a survey of 1,321 health professionals in 269 hospitals designed toward two purposes. First, the survey documents the policies and practices for identifying and intervening in cases of drug-involved pregnant women. Secondly, the survey explores the attitudes of health professionals toward a range of medical and legal options for controlling such drug use. ;Results indicate hospitals tend not to have a clear measure of drug use among their patients or a strategy for addressing it. Fewer than 30% of hospitals had anonymously tested pregnant women or their newborns for drugs. More common was to drug test pregnant women or their newborns based on risk factors. Only 30% reported written policies for drug testing. Also uncommon was obtaining consent to drug test; only 26% reported obtaining consent to test pregnant women. Even fewer, 8.5%, reported obtaining parental consent to test newborns. ;Written intervention policies were more common. Although engagement of the legal system was reported to be rare, provider attitudes were remarkably favorable toward it. Approximately 40% consistently approved the use of criminal sanctions for drug-involved pregnant women. Forty-four percent approved mandating Norplant for continued drug use. Criminal sanctions, however, are matched with high percentages in strong opposition. ;Virtually all respondents indicated a desire for hospitals policies and practice guidelines