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The Implementation of the Tennessee Fetal Assault Law and Its Association With Out-of-State Births Among Residents of Tennessee

Published:November 25, 2022DOI:https://doi.org/10.1016/j.whi.2022.09.006

      Abstract

      Introduction

      This study analyzed the association between the implementation of the Tennessee Fetal Assault Law (TFAL), which allowed prosecutors to incarcerate people who used substances during pregnancy, and out-of-state births among residents of Tennessee.

      Methods

      The main data source is vital records on singleton births in hospitals to people aged 15–44 years during the period January 2010 to June 2016. We include data from 33 states and the District of Columbia where birth certificate data are comparable over this time period. The statistical significance of the difference in outcomes observed before and after TFAL implementation was tested using a difference-in-differences analysis between Tennessee and the comparison group.

      Results

      After TFAL implementation, the odds of having an out-of-state birth increased by 13% for residents of Tennessee (odds ratio, 1.13; 95% confidence interval, 1.09–1.16) relative to residents of the comparison states. When we adopted different thresholds for travel distances to the birth hospital, the odds of residents of Tennessee having an out-of-state birth more than 75 miles away increased by 17% (odds ratio, 1.17; 95% confidence interval, 1.13–1.21) after TFAL implementation.

      Conclusion

      The results of this study suggest that the implementation of a policy allowing incarceration of people who use substances during pregnancy is associated with an increase in out-of-state births, potentially putting pregnant people and their infants at greater risk.
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      References

        • Amnesty International
        Criminalizing pregnancy: Policing pregnant women who use drugs in the USA.
        Author, London2017
        • Angelotta C.
        • Weiss C.J.
        • Angelotta J.W.
        • Friedman R.A.
        A moral or medical problem? The relationship between legal penalties and treatment practices for opioid use disorders in pregnant women.
        Women's Health Issues. 2016; 26: 595-601
        • Batra K.
        • Cruz P.
        • Cross C.L.
        • Bhandari N.
        • Abdulla F.
        • Pharr J.R.
        • Buttner M.P.
        Incidence of neonatal abstinence syndrome epidemic and associated predictors in Nevada: A statewide audit, 2016–2018.
        International Journal of Environmental Research and Public Health. 2021; 18: 232
        • Bronstein J.M.
        • Morrisey M.A.
        Determinants of rural travel distance for obstetrics care.
        Medical Care. 1990; 28: 853-866
        • Bronstein J.M.
        • Morrisey M.A.
        Bypassing rural hospitals for obstetrics care.
        Journal of Health Politics, Policy and Law. 1991; 16: 87-118
        • Darlington C.K.
        • Compton P.A.
        • Hutson S.P.
        Revisiting the fetal assault law in Tennessee: implications and the way forward.
        Policy, Politics, & Nursing Practice. 2021; 22: 93-104
        • Debiec K.E.
        • Paul K.J.
        • Mitchell C.M.
        • Hitti J.E.
        Inadequate prenatal care and risk of preterm delivery among adolescents: A retrospective study over 10 years.
        American Journal of Obstetrics and Gynecology. 2010; 203: 122.e1-122.e6
        • Devlin L.A.
        • Young L.W.
        • Kraft W.K.
        • Wachman E.M.
        • Czynski A.
        • Merhar S.L.
        • Davis J.M.
        Neonatal opioid withdrawal syndrome: a review of the science and a look toward the use of buprenorphine for affected infants.
        Journal of Perinatology. 2021; 42: 1-7
        • El-Mohandes A.
        • Herman A.A.
        • El-Khorazaty M.N.
        • Katta P.S.
        • White D.
        • Grylack L.
        Prenatal care reduces the impact of illicit drug use on perinatal outcomes.
        Journal of Perinatology. 2003; 23: 354-360
        • Epstein R.A.
        • Bobo W.V.
        • Martin P.R.
        • Morrow J.A.
        • Wang W.
        • Chandrasekhar R.
        • Cooper W.O.
        Increasing pregnancy-related use of prescribed opioid analgesics.
        Annals of Epidemiology. 2013; 23: 498-503
        • Faherty L.J.
        • Kranz A.M.
        • Russell-Fritch J.
        • Patrick S.W.
        • Cantor J.
        • Stein B.D.
        Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome.
        JAMA Network Open. 2019; 2: e1914078
        • Faherty L.J.
        • Kranz A.M.
        • Russell-Fritch J.
        • Patrick S.W.
        • Cantor J.
        • Stein B.D.
        State policies related to substance use in pregnancy.
        Rand Corporation, Santa Monica, CA2020
        • Gressler L.E.
        • Savyasachi S.
        • Shaya F.T.
        Opioid use disorder with prevalence and treatment among pregnant women with commercial insurance in the United States.
        JAMA Network Open. 2019; 2: e190338
        • Griffin B.A.
        • Schuler M.S.
        • Stuart E.A.
        • Patrick S.
        • McNeer E.
        • Smart R.
        • Pacula R.L.
        Variation in performance of commonly used statistical methods for estimating effectiveness of state-level opioid policies on opioid-related mortality (No. w27029).
        National Bureau of Economic Research, Cambridge, MA2020
        • Grzybowski S.
        • Stoll K.
        • Kornelsen J.
        Distance matters: A population based study examining access to maternity services for rural women.
        BMC Health Services Research. 2011; 11: 1-8
        • Guttmacher Institute
        Substance use during pregnancy.
        (Available:)
        • Heaman M.I.
        • Newburn-Cook C.V.
        • Green C.G.
        • Elliott L.J.
        • Helewa M.E.
        Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices.
        BMC Pregnancy and Childbirth. 2008; 8: 1-8
        • Hedegaard H.
        • Miniño A.M.
        • Warner M.
        Products - DATA Briefs - Number 394 – Drug overdose deaths in the United States, 1999–2019. Centers for Disease Control and Prevention.
        (Available:)
        www.cdc.gov/nchs/products/databriefs/db394.htm
        Date: 2020
        Date accessed: September 16, 2021
        • Hirai A.H.
        • Ko J.Y.
        • Owens P.L.
        • Stocks C.
        • Patrick S.W.
        Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017.
        JAMA. 2021; 325: 146-155
        • Hudak M.L.
        • Tan R.C.
        Neonatal drug withdrawal.
        Pediatrics. 2012; 129: e540-e560
        • Hwang S.S.
        • Diop H.
        • Liu C.L.
        • Yu Q.
        • Babakhanlou-Chase H.
        • Cui X.
        • Kotelchuck M.
        Maternal substance use disorders and infant outcomes in the first year of life among Massachusetts singletons, 2003-2010.
        Journal of Pediatrics. 2017; 191: 69-75
        • Jessup M.A.
        • Humphreys J.C.
        • Brindis C.D.
        • Lee K.A.
        Extrinsic barriers to substance abuse treatment among pregnant drug dependent women.
        Journal of Drug Issues. 2003; 33: 285-304
        • Ko J.Y.
        • Patrick S.W.
        • Tong V.T.
        • Patel R.
        • Lind J.N.
        • Barfield W.D.
        Incidence of neonatal abstinence syndrome—28 states, 1999–2013.
        Morbidity and Mortality Weekly Report. 2016; 65: 799-802
        • Kozhimannil K.B.
        • Dowd W.N.
        • Ali M.M.
        • Novak P.
        • Chen J.
        Substance use disorder treatment admissions and state-level prenatal substance use policies: Evidence from a national treatment database.
        Addictive Behaviors. 2019; 90: 272-277
        • Kozhimannil K.B.
        • Hung P.
        • Henning-Smith C.
        • Casey M.M.
        • Prasad S.
        Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States.
        JAMA. 2018; 319: 1239-1247
        • Krans E.E.
        • Cochran G.
        • Bogen D.L.
        Caring for opioid dependent pregnant women: Prenatal and postpartum care considerations.
        Clinical Obstetrics and Gynecology. 2015; 58: 370
        • Lind J.N.
        • Petersen E.E.
        • Lederer P.A.
        • Phillips-Bell G.S.
        • Perrine C.G.
        • Li R.
        • Anjohrin S.
        Infant and maternal characteristics in neonatal abstinence syndrome—Selected hospitals in Florida, 2010–2011.
        MMWR. Morbidity and Mortality Weekly Report. 2015; 64: 213
        • Logan B.A.
        • Brown M.S.
        • Hayes M.J.
        Neonatal abstinence syndrome: Treatment and pediatric outcomes.
        Clinical Obstetrics and Gynecology. 2013; 56: 186
        • Maguire D.J.
        • Taylor S.
        • Armstrong K.
        • Shaffer-Hudkins E.
        • Germain A.M.
        • Brooks S.S.
        • Clark L.
        Long-term outcomes of infants with neonatal abstinence syndrome.
        Neonatal Network. 2016; 35: 277-286
        • Martin J.A.
        • Hamilton B.E.
        • Ventura S.J.
        • Osterman M.J.K.
        • Wilson E.C.
        • Mathews T.J.
        Births: Final data for 2010.
        National Vital Statistics Reports. 2012; 61: 1-72
        • Osterman M.J.K.
        • Martin J.A.
        Timing and adequacy of prenatal care in the United States, 2016.
        National Vital Statistics Reports. 2018; 67: 1-14
        • Patrick M.E.
        • Schulenberg J.E.
        • O’Malley P.M.
        High school substance use as a predictor of college attendance, completion, and dropout: A national multicohort longitudinal study.
        Youth & Society. 2016; 48: 425-447
        • Patrick S.W.
        • Schiff D.M.
        A public health response to opioid use in pregnancy.
        Pediatrics. 2017; 139
        • Poland M.L.
        • Dombrowski M.P.
        • Ager J.W.
        • Sokol R.J.
        Punishing pregnant drug users: Enhancing the flight from care.
        Drug and Alcohol Dependence. 1993; 31: 199-203
        • Rayburn W.F.
        • Richards M.E.
        • Elwell E.C.
        Drive times to hospitals with perinatal care in the United States.
        Obstetrics & Gynecology. 2012; 119: 611-616
        • Reddy U.M.
        • Davis J.M.
        • Ren Z.
        • Greene M.F.
        Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: Executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation.
        Obstetrics and Gynecology. 2017; 130: 10
        • Roberts S.C.
        • Pies C.
        Complex calculations: How drug use during pregnancy becomes a barrier to prenatal care.
        Maternal and Child Health Journal. 2011; 15: 333-341
        • Robusto C.C.
        The cosine-haversine formula.
        American Mathematical Monthly. 1957; 64: 38-40
        • Stone R.
        Pregnant women and substance use: fear, stigma, and barriers to care.
        Health & Justice. 2015; 3: 1-15
        • Strahan A.E.
        • Guy G.P.
        • Bohm M.
        • Frey M.
        • Ko J.Y.
        Neonatal abstinence syndrome incidence and health care costs in the United States, 2016.
        JAMA Pediatrics. 2020; 174: 200-202
        • Terplan M.
        • McNamara E.J.
        • Chisolm M.S.
        Pregnant and non-pregnant women with substance use disorders: the gap between treatment need and receipt.
        Journal of Addictive Diseases. 2012; 31: 342-349
        • Thomas S.
        • Treffers R.
        • Berglas N.F.
        • Drabble L.
        • Roberts S.C.
        Drug use during pregnancy policies in the United States from 1970 to 2016.
        Contemporary Drug Problems. 2018; 45: 441-459
        • Whiteman V.E.
        • Salemi J.L.
        • Mogos M.F.
        • Cain M.A.
        • Aliyu M.H.
        • Salihu H.M.
        Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States.
        Journal of Pregnancy. 2014; 2014: 906723
        • Winkelman T.N.
        • Villapiano N.
        • Kozhimannil K.B.
        • Davis M.M.
        • Patrick S.W.
        Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014.
        Pediatrics. 2018; 141: e20173520
        • Yeoh S.L.
        • Eastwood J.
        • Wright I.M.
        • Morton R.
        • Melhuish E.
        • Ward M.
        • Oei J.L.
        Cognitive and motor outcomes of children with prenatal opioid exposure: A systematic review and meta-analysis.
        JAMA Network Open. 2019; 2: e197025
        • U.S. Bureau of Labor Statistics
        Education pays. U.S. Bureau of Labor Statistics.
        (Available:)
        www.bls.gov/emp/chart-unemployment-earnings-education.htm
        Date: 2021
        Date accessed: June 16, 2022

      Biography

      Sung W. Choi, PhD, is an assistant professor of Health Administration in the School of Public Affairs at the Pennsylvania State University in Harrisburg, PA. His research interests include substance abuse and racial/ethnic disparities in health and health care.

      Biography

      Edeanya Agbese, MPH, is a research project manager in the Center for Applied Studies in Health Economics at the Pennsylvania State University in Hershey, PA. Her research interests include mental health and substance abuse.

      Biography

      Austin C. Cohrs, MPH, is a research project manager in the Center for Applied Studies in Health Economics at the Pennsylvania State University in Hershey, PA. His research interests include mental health and behavioral health.

      Biography

      Christal Ramos, PhD, is a senior research associate in the Urban Institute's Health Policy Center, where her research interests include payment and delivery system reforms, health information technology, and opioid use disorder and treatment, particularly in Medicaid.

      Biography

      Douglas L. Leslie, PhD, is a professor and vice chair for education in the department of Public Health at the Pennsylvania State University in Hershey, PA. He has extensive research expertise in health services research, health economics, and pharmacoeconomics.