Oklahoma is at the precipice of a major shift in the way we understand and respond to substance use during pregnancy. History and research have made it clear that making maternal substance use a crime does not protect children or families, a conclusion we also heard time and again from the many Oklahoma-based experts who spoke with us for this report.

Though often well-intended, punitive policies have been proven ineffective and are, at their core, rooted in an outdated understanding of addiction and the challenges of those impacted by it. Women, who have historically been responsible for childrearing and caregiving, are especially vulnerable to harsh judgement and even condemnation when their health affects their ability to support and nurture their families. ¹⁸⁰Stringer, Kate L., and Elise H. Baker. “Stigma as a Barrier to Substance Abuse Treatment Among Those With Unmet Need: An Analysis of Parenthood and Marital Status.” Journal of Family Issues 39 (2018): 3–27.

Familial separation and incarceration are expensive, harmful to both mother and infant, and less effective than preventive and supportive approaches. When the consequences of substance use disclosure could be separation from their infant and/or other children or, worse, incarceration, it is not difficult to understand why these policies instill fear and mistrust in medical and social service providers.

This report confirms that the conclusions reached by researchers across the country hold true in Oklahoma. We spoke directly with Oklahomans who have experienced or regularly work with those navigating substance use during pregnancy, and we analyzed their words. This population is in desperate need of compassionate care, not incarceration. By and large, they want to be good parents. But many are facing an uphill battle of circumstance and mental health challenges, made that much more daunting by fear that reaching out for help could shatter the very future upon which their motivations for recovery rest.

In pairing our qualitative findings with policy recommendations, we hope this research will not only supply evidence in support of a conclusion. With the help of a massive body of existing research and input from experts across the state, we outlined the problems with how substance use during pregnancy is understood and addressed in Oklahoma. We uncovered how, through evolving scientific and popular understandings of addiction and motherhood, we arrived in this confused medico-legal landscape. We identified the policies driving areas of that landscape that are no longer effectively serving families, and we presented a blueprint for evidence-informed changes to them.

It is our intention that this work serve as a call to action for medical and mental health treatment providers, social workers, law enforcement, policymakers, and everyday Oklahomans. It is time to carve out safe, reliable, and effective paths to recovery for pregnant women struggling with substance abuse.