Non-Punitive Approach to Substance Use in Pregnancy

Policy Development

Non-Punitive Approach to Substance Use in Pregnancy

State/JurisdictionSettingPopulationTopic AreaNPMs
New MexicoClinicalWomen/Maternal HealthHealth Equity, Mental Health, Substance Use, Birth Outcomes & Breastfeeding, Access to Health Care/InsuranceNA

This policy was developed in New Mexico (NM) in response to the federal CARA amendment to CAPTA that stated all state child welfare agencies are required to ensure every baby born exposed to substances receives a Plan of Care and that the numbers of babies receiving Plans of Care are reported to the Federal Agency. The group was concerned that pregnant women may be receiving discriminatory treatment regarding drug screening and treatment of substance use in pregnancy; therefore, New Mexico decided to go beyond just reporting numbers of care plans but to try to put in place systemic changes and training of hospital staff to provide a non-stigmatizing, equitable response.

Led by the New Mexico Children, Youth and Families Department (CYFD) and the Department of Health (DOH), a task force consisting of healthcare providers, insurance care coordinators, state agency representatives, and other stakeholders has been working since September 2017 to articulate and implement New Mexico’s response to CARA. The task force has been building partnerships with health insurance providers, medical organizations, hospitals, and reproductive justice organizations to facilitate access to support services for expectant mothers, newborns, and their families struggling with addiction. These partnerships were critical in the ultimate success of the legislation.

In January 2019 House Bill 230 was passed after much negotiation around language and many late nights testifying before legislative committees. This bill amended the Children’s Code in New Mexico to require hospitals to create the Plans of Care for newborns with substance exposure and send the plans to CYFD and DOH, and to require managed care organizations to provide care coordinators for this population. The bill also stated that substance use in pregnancy should not, by itself, be considered a reason for a mandatory child abuse report. Of course, reports could still be made if warranted. The law went into effect in July 2019 and over the next eight months staff traveled the state training hospitals and medical providers on the requirements of the law and its intended purpose. Evaluation of the project is ongoing, and we now have data for the first two quarters of 2020, which included 481 Plans of care. As of early 2021, 1,120 Plans of Care have been submitted.

contact information

New Mexico Department of Health
Janis Gonzales MD, MPH