Governmental Responses to Pregnant Women Who Use Alcohol or Other Drugs

Federal Statutes And Regulations Specifically Addressing Pregnant Women Who Use Drugs or Alcohol

Criminal Statutes
Under the Federal Sentencing Guidelines, two points are added to the offense level for drug offenses "directly involving a protected location or an underage or pregnant individual." 18 U.S.C. Appx § 2D1.2.

Except as authorized by statute, "it shall be unlawful for any person to knowingly or intentionally provide or distribute any controlled substance to a pregnant individual in violation of" Title 21 of the United States Code. 21 U.S.C. § 861(f).

Education and Awareness
The Secretary of Education is authorized to spend funds for the improvement of education which includes "demonstrations that are designed to test whether prenatal and counseling provided to pregnant students may have a positive effect on pregnancy outcomes, with such education and counseling emphasizing the importance of prenatal care, the value of sound diet and nutrition habits, and the harmful effects of smoking, alcohol, and substance abuse on fetal development." 20 U.S.C. § 8001(b)(V).

Under statutes covering Indian Health Care, the Secretary of the Interior must provide instruction in the area of alcohol and substance abuse, including "the causes and effects of fetal alcohol syndrome," to the appropriate employees of the Bureau of Indian Affairs, school personnel, and supervisors of emergency shelters and halfway houses. 25 U.S.C. § 1665d(b).

Applicants for Head Start funding will be evaluated based on, among other things, the applicant's plan "to offer to parents of participating children substance abuse counseling . . . including information on drug-exposed infants and fetal alcohol syndrome." 42 U.S.C. § 9836(d)(4)(D). In order to be designated a Head Start agency, the agency must offer, as part of its enhanced parent involvement, such counseling. 42 U.S.C. § 9837(b)(6).

Education and Awareness-Oversight Committees, Task Forces, Research
The Secretary of Health and Human Services must establish "a comprehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect prevention, intervention, and services delivery program" that includes education and public awareness campaigns, prevention and diagnosis programs, and an applied research program. Congress has also mandated the establishment of a "task force to be known as the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect." 42 U.S.C. § 280f.

The Director of the National Institute on Alcohol Abuse and Alcoholism is authorized to make grants to organizations and individuals for research projects relating to, among other things, "the effects of alcohol use during pregnancy." 42 U.S.C. § 285n(b)(3)(B).

Funding
Congress has established "fetal alcohol syndrome and fetal alcohol effect grants" that the Secretary of the Interior may grant to Indian tribes and tribal organizations to establish programs for training, education, prevention, identification, support, and intervention. 25 U.S.C. § 1665g.

Under legislation establishing Grants for Home Visiting Services for At-Risk Families, the Secretary of Health and Human Services "shall make grants to eligible entities to pay the Federal share of the cost of providing [home visiting services] to families in which a member is . . . a child less than 3 years of age . . . who has been prenatally exposed to maternal substance abuse." 42 U.S.C. § 280c-6(a)(1)(B)(ii).

The Secretary of Health and Human Services is also empowered to make grants for services for children of substance abusers. The grants are to be made to public and nonprofit private entities for the purpose of carrying out programs that, among other things, provide visits and support for substance abusers, "especially pregnant women, who are receiving substance abuse treatment or whose children are receiving services." 42 U.S.C. § 280d(c)(1)(C).

Under the Secretary of Health and Human Services' Fetal Alcohol Syndrome Prevention and Services Program, the Secretary is empowered to make grants to governmental, academic, or non-profit organizations to carry out the program. 42 U.S.C. § 280f-1.

Congress appropriated $27,000,000 to carry out the Fetal Alcohol Syndrome Prevention and Services Program for each fiscal year 1999 through 2003. 42 U.S.C. § 280f-2.

"The Director of the Center for Substance Abuse Treatment shall provide awards of grants, cooperative agreement, or contracts to public and nonprofit private entities for the purpose of providing to pregnant and postpartum women treatment for substance abuse" that complies with the requirements of the statute. 42 U.S.C. § 290bb-1(a).

The Secretary of Health and Human Services, acting through the Director of the Center for Substance Abuse Treatment, "shall make grants to establish projects for the outpatient treatment of substance abuse among pregnant and postpartum women, and in the case of conditions arising in the infants of such women as a result of such abuse by the women, the outpatient treatment of the infants for such conditions." The grants under this statute are to be used to "prevent substance abuse among pregnant and postpartum women." 42 U.S.C. § 290bb-2.

The Secretary of Health and Human Services and the Director of the Center for Substance Abuse Treatment "shall make a demonstration grant for the establishment, within the national capital area, of a model program for providing comprehensive treatment services for substance abuse." In order to receive the grant, an organization must agree, among other things, "to give priority to providing services to individuals who are intravenous drug abusers, to pregnant women, to homeless individuals, and to residents of publicly-assisted housing." 42 U.S.C. § 290gg(b)(4).

"In order to prevent and remedy the neglect and abuse of children, a State may use amounts paid under [the Social Security Act's Block Grants to States for Social Services] to make grants to, or enter into contracts with, entities to provide residential or nonresidential drug and alcohol prevention and treatment programs that offer comprehensive services for pregnant women and mothers, and their children." 42 U.S.C. § 1397f(b)(1).

Under the Congressional nutrition education program, state agencies receiving federal grants for nutrition education "shall ensure that nutrition education and drug abuse education is provided to all pregnant, postpartum, and breastfeeding participants in the program and to parents or caretakers of infant and child participants in the program." 42 U.S.C. § 1786(e)(1).

Legislative Mandates, Findings, Declarations
"It is the intent of the Congress that the Nation meet the following health status objectives with respect to Indians and urban Indians by the year 2000: . . . Reduce the incidence of fetal alcohol syndrome to no more than 2 per 1,000 live births." 25 U.S.C. § 1602(b)(30). By legislation enacted in November 1988, the goal was "one per one thousand live births." 25 U.S.C. § 1680d(3).

As part of the code section regarding adoption reform, Congress found that "an increasing number of infants are born to mothers who did not receive prenatal care, are born addicted to alcohol and other drugs, and exposed to infection with the etiologic agent for the human immunodeficiency virus, are medically fragile, and technology dependent." 42 U.S.C. 5111(a)(3).

Services to Children
Under the Social Security Act's Medicaid program, the requirements of statewideness and comparability, see 42 U.S.C. § 1396a(a)(1); 42 U.S.C. § 1396a(a)(10)(B), may be waived plans of care for children who are drug dependent at birth. 42 U.S.C. § 1396n(e).

No statutes found relating to pregnant women and the use of alcohol or illegal substances.

Alaska passed joint resolutions in both its legislature and its Senate in the Spring of 1997 establishing "Alcohol-Related Birth Defects Awareness Week" during the weeks of both Mother’s Day and Father’s Day. The resolution began by recognizing that "fetal alcohol syndrome and fetal alcohol effects, which are birth defects related to alcohol consumption by pregnant women, can be prevented if pregnant women and women who plan to become pregnant abstain from alcohol consumption." H. Con. Res. 6, 20th Leg., 1st Sess. (Alaska 1997). Similar resolutions were also passed in 1991 and 1994.

The Department of Health and Social Services shall prepare information about "fetal alcohol effects and the fetal health effects of chemical abuse and battering during pregnancy." The Department must make this information available to "public hospitals, clinics, and other health facilities in the state for distribution to their patients." Alaska Stat. § 18.05.037.

The Department of Health and Social Services also must give the information about "fetal alcohol effects and the fetal health effects of chemical abuse and battering during pregnancy" to all marriage licensing officers for issuance along with any marriage license. Alaska Stat. § 25.05.111.

The standard consent form for people undergoing methadone treatment contains a section entitled "Female Patients of Child-Bearing Age" that states that "methadone is transmitted to the unborn child and will cause physical dependence" but that its long-term effects are still unknown, although they may be "significant or serious." Ariz. Comp. Admin. R. & Regs. 9-20-18.

[a] health care professional who is [subject to the statute] and whose routine newborn physical assessment of a newborn infant's health status or whose notification of positive toxicology screens of a newborn infant gives the professional reasonable grounds to believe that the newborn infant may be affected by the presence of alcohol or a substance prohibited by chapter 34 of this title shall immediately report this information, or cause a report to be made, to child protective services in the department of economic security. For the purposes of this subsection "newborn infant" means a newborn infant who is under thirty days of age.

The deputy director of the division of behavioral health has the authority and funding to establish educational, counseling, and research activities to prevent alcohol and substance addiction and to give priority to pregnant women seeking drug treatment. Ariz. Rev. Stat. Ann. § 36-141.

A "Child Protective Services expedited substance abuse treatment fund" was established to "provide expedited substance abuse treatment to parents or guardians with a primary goal of facilitating family preservation or reunification, including, if necessary, services that maintain the family unit in a substance abuse treatment setting." Ariz. Rev. Stat. Ann. § 8-812(A), (C).

Any "individual who was exposed to an illegal drug in utero" can "bring an action in circuit court for damages caused by use of an illegal drug by an individual" against the persons enumerated in the statute. Ark. Code Ann. § 16-124-104.

The legislature has created a Family Treatment and Rehabilitation Program for Addicted Women and Their Children. The program is designed to

(1) Develop a statewide program of treatment, rehabilitation, prevention, intervention, and relevant research for families affected by maternal addiction by coordinating existing health services, human services, and education and employment resources; (2) Develop resources for local treatment and rehabilitation programs for families affected by maternal addiction by providing policy research, technical assistance, and evaluation of program outcomes; (3) Identify gaps in service delivery to families affected by maternal addicted and propose solutions; (4) Enter in contracts for the delivery of services under the program; (5) Solicit, accept, retain and administer gifts, grants or donations of money, services or property for the administration of the program; and (6) Provide centralized billing for providers who agree to provide a comprehensive array of specialized coordinated services under or through the program.

In 1998, a program was established "for special training and services to facilitate the adoption of children who are HIV positive or who have a condition or symptoms resulting from substance abuse by the mother and who are dependent children of the court or who have an adoption case plan and reside with a preadoptive or adoptive caregiver. . . . [P]readoptive parents trained by health care professionals may provide specialized in-home health care to children placed by the county pursuant to certain procedures." Cal. Welf. & Inst. Code § 16135; see also Id. § 16135.10 (establishing training and supportive services); Id. § 16135.13 (establishing special training curriculum for the adoptive parents).

California’s penal code makes the sale or furnishing of controlled substances to pregnant women, among others, a "circumstance in aggravation of the crime" which could trigger an augmented sentence. Cal. Penal Code § 1170.82.

The California Legislature found in 1990 that alcohol and drug treatment was not being accessed by "women, ethnic minorities, and other disenfranchised segments of the population" in proportion to the problems experienced by those communities and attributed this problem to, among other things, "lack of educational materials appropriate to the community . . . [l]anguage differences . . .[and l]ack of representation by affected groups employed by public and private service providers and policymakers." Cal. Health & Safety Code § 11781.

The State Department of Alcohol and Drug Programs must develop a brochure on care and treatment of infants exposed to drugs, and the brochure must include the following: "(1) The signs and symptoms of an infant who has been exposed to drugs[;] (2) The health problems of infants who have been exposed to drugs[;] (3) The special feeding needs of infants who have been exposed to drugs[; and] (4) The special care needs of infants who have been exposed to drugs. . ." Cal. Health & Safety Code § 11868.5.

California’s Business and Professional Code encourages the Division of Licensing for Medical Professionals to include within its requirements for continuing education two courses related to fetal exposure to alcohol and controlled substances: "a course in the early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women," Cal. Bus. & Prof. Code § 2191(f), and "a course in the special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants," id. § 2191(g).

California’s Education Code provides for the development of a school plan to assist school personnel in dealing with children who may have been "prenatally substance exposed." Cal. Educ. Code § 52853.

As part of the legislative findings that accompany California Business and Professions Code section 23320.6 (providing for the establishment of the Wine Safety Fund), the legislature noted that "[a]n industry-funded program already provides warnings advising pregnant women not to drink, utilizing point-of-sale and point-of-display notices that convey a uniform clear and reasonable warning message . . . ." 1993 Cal. Stats. 1025 § 1(e).

"Instruction on the effects of alcohol, narcotics, restricted dangerous drugs . . . and other dangerous substances upon prenatal development as determined by science shall be included in the curriculum of all secondary schools." Cal. Educ. Code § 51203.

Proposition 10, passed by the voters in 1998, created the California Children and Families Commission. One of the Commission's duties is to adopt guidelines to improve early childhood development, including "parent education and support services" that encompass, among others, the subject of "avoidance of tobacco, drugs, and alcohol during pregnancy." Cal. Health & Safety. Code § 130125.

The Department of Health must submit a report to the state Legislature detailing:

(a) An accounting of the incidence of high-risk pregnant or parenting adolescents who are abusing alcohol or drugs, or a combination of alcohol and drugs[;] (b) An accounting of the health outcomes of infants of high-risk pregnant and parenting adolescents including: infant morbidity, mortality, rehospitalization, low birth weight, premature birth, developmental delay, and other related areas[;] (c) An accounting of school enrollment among high-risk pregnant and parenting adolescents[;] (d) An assessment of the effectiveness of the counseling services in reducing the incidence of high-risk pregnant and parenting adolescents who are abusing alcohol or drugs, or a combination of alcohol and drugs[;] (e) The effectiveness of the component of other health programs aimed at reducing substance use among pregnant and parenting adolescents[; and] (f) The need for an availability of substance abuse treatment programs in the program areas that are appropriate, acceptable, and accessible to teenagers.

As part of Proposition 10, approved by the voters in 1998, the California Children and Families Trust Fund was created with six percent of the funds to be deposited in a Mass Media Communications Account for use on "communications to the general public utilizing television, radio, newspapers, and other mass media on subjects . . . including . . . the prevention of tobacco, alcohol, and drug use by pregnant women . . . ." Cal. Health & Safety Code § 130105.

The legislature mandated that by July 1, 1991, the Health and Welfare Agency "develop and disseminate a model needs assessment protocol for pregnant and postpartum substance abusing women in conjunction with the appropriate professional organizations in the areas of hospital administration, substance abuse prevention and treatment, social services, public health, and appropriate state agencies." Cal. Health & Safety Code § 123600. The protocol would be used by local hospitals and agencies in the assessment of the needs of substance exposed infants with the purpose of identifying needed services for the mother, child, and family, determining the level of risk to the newborn, and gathering data for information and planning purposes. Id. § 123605.

The State Department of Health Services must report to the legislature and the governor by March 15 of every year the number of newborn babies with Fetal Alcohol Syndrome, the number of babies born with drug dependencies, and "[w]hether the mother smoked, consumed alcoholic beverages, or used controlled substances without a prescription, during pregnancy." Cal. Welf. & Inst. Code § 14148.91(b).

"[A] positive toxicology screen at the time of the delivery of an infant is not in and of itself a sufficient basis for reporting child abuse or neglect. However, any indication of maternal substance abuse shall lead to an assessment of the needs of the mother and child pursuant to Section 123605 of the Health and Safety Code. If other factors are present that indicate risk to a child, then a report shall be made. However, a report based on risk to a child which relates solely to the inability of the parent to provide the child with regular care due to the parent' s substance abuse shall be made only to county welfare departments and not to law enforcement agencies." Cal. Penal Code § 11165.13.

that there is a strong statistical relationship between early entry into prenatal care and healthy birth outcomes. An investment in early intervention is highly cost-effective and prevents untold suffering. . . . It is the intent of the Legislature that the goals of the program established pursuant to this article, in combination with other programs for pregnant women and children shall be: (1) To improve access to and quality of prenatal care by making existing programs serving poor women more accessible through outreach, coordination, and removal of barriers to care [and] (2) To combine efforts with other programs to measurably reduce the number of women who smoke, use drugs, or engage in other unhealthy practices during pregnancy. . . . In order to achieve these goals, it is the intent of the Legislature to improve and coordinate existing programs for pregnant women and infants and to remove barriers to care with an intense focus on women who are at high risk of delivering a low or high birth weight baby or a baby which will suffer from major health problems or disabilities.

The legislation establishes a "focus on those target populations that are comprised of pregnant high risk women or potentially pregnant teenagers, pregnant women and women of childbearing age who are likely to become pregnant who smoke, consume alcoholic beverages, or use controlled substances, and Black, Hispanic, Native American, and Asian-Pacific Island women who are pregnant or of childbearing age, and uninsured women of childbearing age." Cal. Welf. & Inst. Code § 14148.9(d).

As part of the statutory requirement that each schoolsite council develop a school plan, the legislature found that "[t]here has been a rapid and alarming increase in the number of infants born in California who are affected by alcohol and other drugs during their mother's pregnancy. The Department of Alcohol and Drug Programs conservatively estimates that 70,000 of these infants are born in the state each year. Many children who have been exposed prenatally to drugs are now entering California's public school classrooms." 1991 Cal. Stats 251, § 1(b) (accompanying Cal. Educ. Code § 52853).

As part of the findings accompanying Proposition 10, the people of California found that "[c]igarette smoking and other tobacco use by pregnant women and new parents represent a significant threat to the healthy development of infants and young children." The findings listed as a purpose of Proposition 10 the development of community-based services that "include education and skills training . . . in avoidance of tobacco, drugs, and alcohol during pregnancy." Proposition 10 also had a purpose of educating "the public, using mass media, on the dangers caused by smoking and other tobacco use by pregnant women . . . ." Prop. 10, § 2(i), (m)(1), (m)(3).

Legislative Mandates, Findings, Declarations— Oversight Committees, Task Forces, Research

In 1990, California passed the Alcohol and Drug Affected Mothers and Infants Act, which established the Office of Perinatal Substance Abuse. Cal. Health & Safety Code § 11757.53. The Act was passed due to a legislative finding that there had been a "rapid and alarming increase in the number of infants born in California . . . affected by alcohol or other drugs during their mother’s pregnancy." Id. § 11757.51(1). The legislature estimated that "there were 30,000 of these infants born in the state during the 1988-89 fiscal year." Id. § 11757.51(1). It estimated that "the average cost for an infant requiring admission into a neonatal intensive care unit is nineteen thousand dollars ($19,000) and that those costs sometimes reach as high as one million dollars ($1,000,000)." Id. § 11757.51(5). It also reported that the state had spent nearly $104 million dollars during fiscal year 1986-87 to provide neonatal intensive care to these infants. Id. § 11757.51(5).

Recognizing that there was a need for "comprehensive prevention and treatment services for both mothers and infants," the California legislature created an Interagency Task Force to "develop a coordinated state strategy for addressing the treatment needs of pregnant women, postpartum women, and their children for alcohol or drug abuse," Cal. Health & Safety Code § 11757.55(c), and provided for training to professionals providing services to women of childbearing age and their children to improve their ability to identify those needing alcohol and drug treatment services and to provide referrals to those in need. Id. § 11757.57(a) & (b).

Any "individual who was exposed to an illegal controlled substance in utero" can "bring an action for damages caused by an individual's use of an illegal controlled substance" against the persons enumerated in the statute. Cal Health & Safety Code § 11705.

The state legislature provided funding to expand its pilot project, "Services for Alcohol and Drug Abusing Pregnant and Parenting Women and Their Infants" to various counties, and provided that such funding was to be used to provide "(A) Low-risk and high-risk prenatal care[;] (B) Pediatric followup care, including preventive infant health care[;] (C) Developmental follow-up care[;] (D) Nutrition counseling[;] (E) Methadone[;] (F) Testing and counseling relating to AIDS[;] (G) Monthly visits with a physician and surgeon who specializes in treating persons with chemical dependencies." Cal. Health & Safety Code § 11757.59(b)(1).

The legislature also allowed for the provision of "nonmedical services" including the following:

"(A) Case management[;] (B) Individual or group counseling sessions, which occur at least once a week[;] (C) Family counseling, including, but not limited to, counseling services for partners and children of the women[;] (D) Health education services, including perinatal chemical dependency classes, addressing topics that include, but are not limited to, the effects of drugs on infants, AIDS, addiction in the family, child development, nutrition, self esteem, and responsible decision making[;] (E) Parenting classes[;] (F) Adequate child care for participating women[;] (G) Encouragement of active participation and support by spouses, domestic partners, family members, and friends[;] (H) Opportunities for a women-only treatment environment[;] (I) Transportation to outpatient treatment programs[;] (J) Followup services, which may include, but not be limited to, assistance with transition into housing in a drug-free environment[;] (K) Child development services[;] (L) Educational and vocational services for women[;] (M) Weekly urine testing[;] (N) Special recruitment, training, and support services for foster care parents of substance exposed infants[;] (O) Outreach which reflects the cultural and ethnic diversity of the population served.

Counties that receive funding under the Act are required to establish "Perinatal coordinating councils" which are to evaluate the extent of the perinatal alcohol and drug abuse problem in the county, coordinate countywide efforts to provide services to affected women and infants, and promote community understanding of the issues surrounding perinatal alcohol and drug abuse. Cal. Health & Safety Code § 11757.61.

California requires all counties participating in the "Comprehensive Perinatal Outreach Program" to maintain systems that provide "early outreach, pregnancy screening, patient advocacy, targeted case management, health education, and referral to drug and alcohol treatment and perinatal care services to pregnant women." Counties must also provide patient advocacy and education. Cal. Health & Safety Code § 104564.

Under the Pregnant and Parenting Women's Alternative Sentencing Program Act of 1994, the California Department of Corrections was required to use funding to construct or renovate facilities designed to "reduce drug use and recidivism." In awarding funding to certain counties, the Department was to ensure that participating drug programs meet "standards for perinatal services." Selected agencies were to receive funding based on "[a] demonstrated ability to provide comprehensive services to pregnant women or women with children who are substance abusers[.]" Proposals for funding were to include "a plan for the required 12-month residential program, plus a 12-month outpatient transitional services program to be completed by participating women and children." Cal. Penal Code § 1174.2.

"[C]omprehensive coordinated substance abuse prevention, intervention, and counseling program[s]" must include programs that attempt to "reduce the incidence of high-risk pregnant or parenting adolescents." The programs must be in "coordination and collaboration with existing perinatal substance abuse programs." Cal. Health & Safety Code § 124190.

Under the Medi-Cal Benefits Program, the State Department of Health Services is to "assess the feasibility of applying to the federal Health Care Financing Administration for a Medicaid State Plan amendment to provide targeted case management to pregnant substance-abusing women and women who have given birth to a drug-exposed or alcohol-exposed infant." Cal. Welf. & Inst. Code § 14132.21.

The Medi-Cal Benefits Program also includes, "[t]o the extent that federal financial participation becomes available, residential care for alcohol and drug exposed pregnant women and women in the postpartum perinatal period . . . ." Cal. Welf. & Inst. Code § 14132.36. The program also provides for "day care habilitative services" and "outpatient drug free services" for alcohol and drug exposed pregnant women, even if those services for other patients is eliminated. Id. § 14132.90.

The Department of Alcohol and Drug Programs has promulgated special regulations for drug treatment counselors who discover that a patient is pregnant. Cal. Code Regs. tit. 9, § 10360.

The Department of Corrections has created a special program called the Family Foundations Program (FFP). FFP is a "12-month residential substance abuse treatment program for pregnant and/or parenting female inmates who have been determined by the court to benefit from participation, recommended by the court for placement, and are accepted by the Department to participate. Female inmates in the program will be placed in a Family Foundations facility in the community as an alternative to serving their prison term in a State prison institution." Cal. Code Regs. tit. 15, § 3074.3.

[t]he health care practitioner for each pregnant woman who is enrolled for services pursuant to section 26-4-508 or section 26-2-118 shall be encouraged to identify as soon as possible after such woman is determined to be pregnant whether such woman is at risk of a poor birth outcome due to substance abuse during the prenatal period and in need of special assistance in order to reduce such risk. If the health care practitioner makes such a determination regarding any pregnant woman, the health care practitioner shall be encouraged to refer such woman to any entity approved and certified by the department of health for the performance of a needs assessment. Any pregnant woman who is eligible for services pursuant to [the above sections] may refer herself for such needs assessment.

(1) The general assembly hereby finds and declares that the health and well-being of the women of Colorado is at risk; that such women are at risk of poor birth outcomes or physical and other disabilities due to substance abuse, which is the abuse of alcohol and drugs, during the prenatal period; that early identification of such high-risk pregnant women and substance abuse treatment greatly reduce the occurrence of poor birth outcomes; and that the citizens of Colorado will greatly benefit from a program to reduce poor birth outcomes and subsequent problems resulting from such poor birth outcomes in cases involving high-risk pregnant women through the cost savings envisioned by the prevention and early treatment of such problems. (2) In recognition of such problems, there is hereby created a treatment program for high-risk pregnant women.

Colorado has elected to receive federal financial participation for a list of "optional services under the medical assistance program," including "alcohol and drug counseling and treatment, including outpatient and residential care but not including room and board while receiving residential care" for "any pregnant woman who is enrolled for services pursuant to section 26-4-508 or who would be eligible for aid to families with dependent children . . . ." Colo. Rev. Stat. § 26-4-302.

In 1991, Colorado amended a statute relating to grants made by its Health Department to include grants made to public programs providing "services to pregnant women who are alcohol and drug dependent through demonstration and evaluation projects." Colo. Rev. Stat. § 25-1-203(2)(g).

[a]ny entity which qualifies to provide services pursuant to section 26-4-302 (1) (s), in regards to the treatment program for high-risk pregnant women, shall make available, in addition to alcohol and drug counseling and treatment: Risk assessment services; care coordination; nutrition assessment; psychosocial counseling; intensive health education, including but not limited to parenting education and education on risk factors and appropriate health behaviors; home visits; transportation services; and other services deemed necessary by the division of alcohol and drug abuse of the department of human services, the department of public health and environment, and the department of health care policy and financing.

Among the responsibilities of Colorado’s Children’s Trust Fund Board is a duty to "expend moneys of the trust for the establishment, promotion, and maintenance of prevention programs, including pilot programs, for programs to prevent and reduce the occurrence of prenatal drug exposure . . . ." Colo. Rev. Stat. § 19-3.5-105(1)(f).

The Department of Public Health and Addiction Services promulgated a regulation requiring all local WIC agencies to "provide information on the dangers of drug, alcohol and tobacco use during pregnancy to each pregnant participant, and appropriate referrals shall be made." Conn. Agencies Regs. § 19a-59c-4(k)(3)(E).

The Department of Mental Health and Addiction Services must also establish a committee on substance-abusing pregnant women and their children to oversee treatment programs and their development. Conn. Gen. Stat. § 17a-711.

In 1991, the legislature provided for a three year demonstration program through the Department of Public Health and the Office of Health Care Access and the Department of Social Services to provide indigent uninsured pregnant women improved access to health care, including "substance abuse counseling, and other ancillary services which may include substance abuse treatment . . . ." Conn. Gen. Stat. § 19a-7e.

The State Department of Mental Health and Addiction Services is required to develop comprehensive programs to provide treatment, education, medical care, vocational services, and housing to pregnant women who use drugs and their children, to the extent that private and public funds are available. The Department is required to submit an annual report to a legislative committee on the development of programs and statistical and demographic information about women seeking treatment and treatment availability. Conn. Gen. Stat. § 17a-710.

Professionals who treat, advise, or counsel pregnant women must post and give written and oral warnings about the effects of alcohol, cocaine, marijuana, heroin or other narcotics consumed during pregnancy on the fetus. Del. Code Ann. tit. 16, § 190 (1998); Del. Code Ann. tit. 24, § 1770.

The District of Columbia Code requires any business selling alcoholic beverages to post a sign in a conspicuous place that reads: "Warning: Drinking alcoholic beverages during pregnancy can cause birth defects." D.C. Code Ann. § 25-147.

Although district residents are generally eligible for substance abuse treatment regardless of their ability to pay, "[a]ny minor, pregnant woman, or the parent, guardian, or other person who has legal custody of a minor . . . shall have priority for admission to the treatment facility over any single adult who does not have a minor child." D.C. Code Ann. § 32-1602(b).

Among the definitions of "harm" to a child’s health and welfare is when a "parent, legal custodian, or caregiver responsible for the child's welfare . . . Exposes a child to a controlled substance or alcohol. Exposure to a controlled substance or alcohol is established by: 1. Use by the mother of a controlled substance or alcohol during pregnancy when the child, at birth, is demonstrably adversely affected by such usage; or 2. Continued chronic and severe use of a controlled substance or alcohol by a parent when the child is demonstrably adversely affected by such usage." Fla. Stat. Ann. § 39.01(30)(g).

A guardian advocate must be appointed for one year for any child named in a petition who " (a) . . . is or was a drug dependent newborn . . .; [and] (b) The parent or parents of the child have voluntarily relinquished temporary custody of the child to a relative or other responsible adult"; . . . (2) The appointment of a guardian advocate does not remove from the parents the right to consent to medical treatment for their child." Fla. Stat. Ann. § 39.828(1)(a) & (b), (2).

The State Department of Health is authorized to use state and federal funds to conduct health outreach campaigns which recognize that alcohol consumption and substance abuse during pregnancy is "detrimental to public health." Fla. Stat. Ann. § 20.43(7)(b).

Clients and families utilizing birth centers in the state are to be provided information on the effects of smoking and substance abuse. Fla. Stat. Ann. § 383.311(2)(d).

The Marriage Preparation and Preservation Act, ch. 98-403, 1998 Fla. Sess. Law Serv. Ch. 98-403, § 173 repealed a 1997 law that provided that "[t]he parent of a newborn infant may not be subject to criminal investigation solely on the basis of the positive drug toxicology of a newborn infant." Fla. Stat. Ann. § 415.503(g).

The Florida Legislature released a finding that indicated that services were needed to meet the increasing number of infants at risk due to parent risk factors, such as substance abuse, and other high-risk conditions. Fla. Stat. Ann. § 391.301. The finding also stated that it was "the intent of the Legislature to establish developmental evaluation and intervention services . . . in order that families with high-risk or disabled infants may gain the services and skills they need to support their infants." Id. § 391.301(2).

A child is found to be in need of early childhood assistance and handicap prevention services if he or she is a "drug exposed child," defined as: "any child from birth to 5 years of age for whom there is documented evidence that the mother used illicit drugs or was a substance abuser, or both, during pregnancy and the child exhibits: (a) Abnormal growth; (b) Abnormal neurological patterns; (c) Abnormal behavior problems; or (d) Abnormal cognitive development." Fla. Stat. Ann. § 411.202(6). A "high-risk child" or "at-risk child" is defined as a "preschool child [whose] parent or guardian who is developmentally disabled, severely emotionally disturbed, drug or alcohol dependent, or incarcerated and who requires assistance in meeting the child's developmental needs [or] the child is drug exposed." Id. § 411.202(9)(g) & (i).

Florida created a Children's Early Investment Program for "at risk" children. One of the stated goals of the program is to "reduce the numbers of cocaine babies born in [the] state." The program was to be developed in high-risk areas around the state. Fla. Stat. Ann. § 411.232.

The legislature has created a "prekindergarten early intervention program" whose target population is children who come from low-income families. Also included in the target population are three- and four-year olds "who may not be economically disadvantaged but who are . . . prenatally exposed to alcohol or harmful drugs . . . ." Fla. Stat. Ann. § 230.2305 (2)(a)1.

Florida regulations for the Department of Health establish an elaborate system for reporting and treating physically drug dependent newborns and women who may give birth to them. The system includes giving out information about the adverse effects of prenatal exposure to alcohol and drugs, reporting pregnant drug users to the appropriate agencies, providing treatment to those women, and investigating the circumstances surrounding the pregnancy. The regulations require a reporting of abuse under the state's abuse registry. Fla. Admin. Code Ann. r. 64F-4.001 - .010.

The "Targeted Outreach for Pregnant Women Act of 1998" established a 2-year pilot program in five of the state’s counties with the highest rates of HIV infection and the largest proportion of substance-exposed newborns of "targeted outreach program[s] for high-risk pregnant women who may not seek proper prenatal care, who suffer from substance abuse problems, or who are infected with human immunodeficiency virus (HIV), and to provide these women with links to much needed services and information." Fla. Stat. Ann. §381.0045.

Each county's health department's primary care program cannot deny access to "[f]inancially eligible women at risk for adverse pregnancy outcomes due to any potential medical complication." Those include "alcohol abuse, drug abuse, or delay in obtaining prenatal care. The inability of the primary care program to provide funding for hospitalization or other acute services shall not preclude an eligible patient from obtaining prenatal services." Fla. Stat. Ann. § 154.011(4).

Georgia statute requires that any retailer of alcoholic beverages for consumption on the premises must post a warning that reads: "Warning: Drinking alcoholic beverages during pregnancy can cause birth defects." Ga. Code Ann. § 3-1-5.

Any "person injured by an individual drug abuser may bring an action . . . for damages against a person who participated in illegal marketing of the controlled substance used by the individual abuser." Plaintiffs under the statute can include a "child whose mother was an individual abuser while the child was in utero." Ga. Code Ann. § 51-1-46.

The Georgia legislature created a priority admissions policy at programs licensed and funded by the Department of Health which provides for "immediate access to services for [drug dependent pregnant females] applying for admission, which access shall be contingent only upon the availability of space." Ga. Code Ann. § 26-5-20 (1998).

Governmental Responses to Pregnant Women Who Use Alcohol or Other Drugs - Year 2000 Overview. Part 1