Physician attitudes concerning legal coercion of pregnant alcohol and drug abusers

OBJECTIVE: We sought to determine the attitudes of obstetricians, pediatricians, and family practice physicians in Michigan concerning involvement of the criminal justice system in preventing drug and alcohol abuse during pregnancy. STUDY DESIGN: Physicians were sent a questionnaire by mail asking for their agreement with statements concerning the involvement of the criminal justice system with respect to substance abuse during pregnancy. RESULTS: Nearly all (95%) agreed that pregnant women have a moral duty to ensure they had healthy babies; 59% agreed that they should also have a legal responsibility to do so. Most physicians (77%) agreed that screening for acquired immunodeficiency syndrome during pregnancy should be mandatory. Almost as high a percentage (61% to 75% depending on subspecialty) were also in favor of mandatory screening for alcohol abuse; agreement for screening for illicit drugs was much lower (43% to 55% depending on subspecialty). Despite their consensus (61%) that fear of prosecution would deter pregnant abusers from seeking prenatal care, most were in agreement that existing laws regarding child abuse and neglect need to be redefined to include alcohol (54%) and drug abuse (61%) during pregnancy; 52% were in favor of enacting a statute that includes drug or alcohol use during pregnancy as "child abuse" for purposes of removing that child from maternal custody. Physicians were highly in favor of compulsory treatment for illicit drug use and alcohol abuse for women already in the criminal justice system (82%-83%), neutral with respect to court-ordered contraception for alcohol- (50%) and drug-abusing women (47%), and opposed to criminal prosecution for either alcohol abuse (18%-31% depending on subspecialty) or illicit drug use (23%-34%) during pregnancy. CONCLUSIONS: Other than criminal prosecution, physicians are not opposed to involvement of the legal justice system in preventing alcohol and drug abuse during pregnancy.