The impact of state-level prenatal substance use policies on infant foster care entry in the United States

Abstract

BackgroundThe United States is facing a substance use crisis. One consequence, resulting from overdose deaths, arrests, parental and prenatal substance use, is increased reliance on the foster care system. In response to concerns about prenatal substance use, some states adopted policies that treat prenatal substance use identified at birth as child abuse or neglect. ObjectiveTo investigate the effects of state-level policies treating prenatal substance use as child abuse or neglect on admissions to the foster care system for children less than 1 year. Participants and SettingWe use data on foster care entries for children less than 1 year from the Adoption and Foster Care Analysis and Reporting System from 2000 to 2016. MethodWe employ a difference-in-difference approach to estimate the effect of state-level policies treating prenatal substance use realized at birth as child abuse or neglect on the rate of foster care entry for children less than 1 year. ResultsWe find these policies increase the rate of entry into the foster care system for children under the age of 1 year by approximately 9.5 percent (p < 0.10). Falsification tests support no change in other age groups or unrelated reasons for removal. ConclusionsImplementing punitive policies, without accounting for the complex nature of prenatal substance use, may fail to improve the lives of infants and families. Policymakers should focus on supportive interventions that modify maternal behavior and outcomes.