Punitive drug laws may deter prenatal care and hospital-based delivery
Columbia University's Mailman School of Public Health
October 29, 2025 — States that explicitly criminalize prenatal drug use may unintentionally discourage pregnant people from seeking essential medical care, according to new research from Columbia University Mailman School of Public Health. The study is the first to empirically test whether fear of legal repercussions leads some people with drug use disorders to give birth outside healthcare settings to avoid hospital drug testing. The findings are published in Social Science & Medicine.
“Comprehensive perinatal care is crucial for healthy pregnancy outcomes, yet people who use drugs are significantly less likely to receive it,” said Emilie Bruzelius, a postdoctoral fellow in Epidemiology at Columbia Mailman School, and first author. “Our findings suggest that criminalizing prenatal drug use may worsen this gap by driving avoidance of healthcare services.”
The researchers examined more than 124 million births across 83,300 county-years and found that explicit prenatal drug criminalization policies were associated with reductions in prenatal care and facility-based deliveries. For example, states adopting such policies saw declines in overall and first-trimester care initiation. In particular, there were on average 4,396 fewer births per 100,000 with any prenatal care in criminalization states relative to non-criminalization states. Additionally, criminalization was associated with 1,848 fewer facility-based deliveries.
Over the past decade, a growing number of states have enacted pregnancy-related substance use laws. Some, including Tennessee, South Carolina, and Alabama -- the focus of this study -- have gone further by directly designating prenatal drug use as a felony or misdemeanor offense.
“These laws were often originally intended to encourage treatment by including provisions to exempt those already in care from prosecution,” according to Silvia Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author. “However, emerging evidence suggests the opposite effect—fewer treatment admissions, less prenatal care, and more births occurring outside healthcare facilities.”
The authors note that healthcare avoidance in response to legal risk mirrors behaviors seen in other contexts—such as among immigrants fearing deportation. They warn that such avoidance carries serious health consequences, particularly for high-risk pregnancies.
“Formal laws do make a difference, and efforts to repeal these types of laws would go a long way to better support maternal and neonatal health,” Bruzelius said. “Future research should pinpoint which policies most discourage care and guide reforms that protect, rather than punish, pregnant people.”
Co-authors include Seth Prins and Lisa Bates, Columbia Mailman School; Karen Underhill, Cornell Law School; and Marian Jarlenski, University of Pittsburgh School of Public Health.
The study was supported by the National Institute on Drug Abuse (T32DA031099, R01DA053745).
The authors report no financial conflicts of interest.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
Journal
Social Science & Medicine
Article Title
Prenatal drug use criminalization and health system avoidance: Evidence from births in Alabama, South Carolina, and Tennessee, 1989–2019
Making menstrual cups more hygienic, easier to use
American Chemical Society
image:
A silicone oil coating and absorbent fibers could complement an existing menstrual cup, making it easier to use.
view moreCredit: Adapted from ACS Applied Materials & Interfaces 2025, DOI: 10.1021/acsami.5c16140
Reusable menstrual cups reduce waste and are more cost-effective than single-use pads and tampons. But some people avoid the cups because they require thorough cleaning and are sometimes messy to empty. To solve these problems, researchers coated a commercially available silicone cup in silicone oil and created a plant-based, absorbent tablet. These design adjustments could make menstrual cups safer and easier to use, according to a study published in ACS Applied Materials & Interfaces.
“This research bridges advanced engineering and women’s health, creating a menstrual product that is not only self-cleaning and sustainable, but also opens doors for future health monitoring,” says Tohid Didar, one of the senior researchers of this study from McMaster University.
Nearly 2 billion people menstruate, and their desire for sustainable, reusable options — menstrual cups, discs and period underwear — is rising. Menstrual cups are designed to hold more fluid than tampons, allowing longer wear than the disposable option, and they can be cleaned and reused for years. But users complain about unexpected spills during removal and the time-consuming process to sterilize the cups in boiling water or other sanitizing solutions — issues that can deter wider adoption of the products. So, Zeinab Hosseinidoust, Didar and colleagues found a cup coating to reduce cleaning time and developed a tablet to absorb liquid inside the device.
The researchers tested bacterial growth on three commercially available menstrual cups made from medical-grade silicone, finding that the cup infused with silicone oil repelled E. coli significantly better than the two other cups. And coating the outside of the infused cup with silicone oil helped keep blood from sticking, too. This result suggests that people only need to wash the coated cup with soap and water; no boiling is required, says Didar.
Then, to create the absorbent tablet, they spun alginate (a polymer from brown algae) into fibers and linked them together with calcium chloride. The white, fluffy fibers clotted human plasma onto them within 16 minutes and neither inhibited nor promoted bacterial growth compared to a control (an empty petri dish without the plant-based fibers). The researchers say that this supports the fibers’ potentially safe usage in consumer products. In experiments, they formed the fibers into 1-gram tablets, and each tablet:
- Soaked 15 milliliters of whole human blood (the capacity of the silicone-infused menstrual cup) over 8 hours.
- Dissolved over four days in a water-based salt solution, breaking down into biocompatible compounds.
To prepare a proof-of-concept for commercialization, they also pressed and cut the fibers into teardrop-shaped tablets that fit inside the menstrual cups. Next, they will test the feasibility of mass-producing these alginate fibers, and the flushability of the liquid-soaked absorbent tablets.
“By making period care more accessible, hygienic and equitable globally, innovations like this have the potential to make a significant impact on women’s everyday health and well-being,” adds Hosseinidoust, a co-lead of the study.
Human blood sample collection was approved by the McMaster University Research Ethics Board.
The authors acknowledge funding from the Canada Research Chairs Program, and the Natural Sciences and Engineering Research Council of Canada through the Discovery Grant and the Ontario Early Researcher Award.
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The American Chemical Society (ACS) is a nonprofit organization founded in 1876 and chartered by the U.S. Congress. ACS is committed to improving all lives through the transforming power of chemistry. Its mission is to advance scientific knowledge, empower a global community and champion scientific integrity, and its vision is a world built on science. The Society is a global leader in promoting excellence in science education and providing access to chemistry-related information and research through its multiple research solutions, peer-reviewed journals, scientific conferences, e-books and weekly news periodical Chemical & Engineering News. ACS journals are among the most cited, most trusted and most read within the scientific literature; however, ACS itself does not conduct chemical research. As a leader in scientific information solutions, its CAS division partners with global innovators to accelerate breakthroughs by curating, connecting and analyzing the world’s scientific knowledge. ACS’ main offices are in Washington, D.C., and Columbus, Ohio.
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Journal
ACS Applied Materials & Interfaces
Article Publication Date
10-Oct-2025
Researchers discuss gaps, obstacles and solutions for contraception
Boston University School of Medicine
(Boston)—Contraception and family planning are vital aspects of sexual and reproductive health and rights. Despite major advances in modern contraception over the past 60 years, many gaps remain and the rate of unplanned pregnancies and abortions remains high. These issues have given rise to a new era in contraception research with great opportunities and many challenges.
In the second in a series of five papers in Lancet about innovations in sexual and reproductive health, researchers led by Deborah Anderson PhD, professor of medicine at Boston University Chobanian & Avedisian School of Medicine, address global trends and current contraception use, as well as barriers to use. They also focus on underserved populations such as adolescent girls and young women, men, and transgender and gender non-binary populations, and include action items intended to improve contraception choices.
“Despite major advances in contraceptive technologies over more than half a century, substantial unmet needs remain. In recent years approximately 50% of pregnancies worldwide have been unintended, leading to a high rate of abortion. Providing improved contraception choices will enhance the health, economic status and well-being of women and their families and is an important step towards social justice,” says Anderson.
UN survey data from 2024 revealed that 57% of reproductive-age women worldwide reported wanting to avoid pregnancy at the time they were questioned, highlighting a desire to postpone, space out or stop childbearing. Of these women, an estimated 77% reported having used a modern method of contraception to prevent pregnancy and approximately 15% did not use any contraception.
The researchers point out there are substantial differences in modern contraceptive use across the world, ranging from 40% to 83% in Africa, for example, depending on the region, and 77% to 89% in the high-income countries of Europe. Although men share responsibility for 100% of unintended pregnancies, they comprise less than one quarter of the population using contraception. Only 2% of men worldwide opt for a vasectomy and approximately 20% of couples use male condoms as their primary contraception method.
While contraceptives with hormonal mechanisms of action (pills, rings, implants, injections and hormonal intrauterine devices) are highly effective, the researchers point out that they are associated with serious side-effects and health risks making them a barrier for certain women. Other barriers for contraceptive use include infrequent sex, religious beliefs and individual or social opposition.
Anderson believes underserved populations need immediate attention when it comes to contraception. She points out that adolescent pregnancies are a universal challenge and occur in all countries, but are more likely to occur in marginalized families and communities.
“Adolescent girls and young women have unique needs and experience more barriers to accessing available reproductive health services than adults because of restrictive laws and policies, lack of education, financial hardship, stigma or lack of family or community support,” says Anderson.
Men can face cultural pressure to prove their fertility, and no new male contraception methodologies have entered the market in over 100 years. Some transgender and gender non-binary individuals might engage in sexual activity that has the potential for pregnancy, particularly in individuals who have not undergone gender-affirming genital surgeries.
According to Anderson, gains in modern contraceptive use have stagnated over the past 25 years. Among the action items she and her colleagues recommend are:
- Current contraception gaps should be addressed by intensifying modern basic and clinical research including social and behavioral science. Intensification of financial support from government philanthropic and industrial entities is needed to produce novel contraceptives that address some of the current gaps within the next decade.
- Needs of underserved populations should be addressed to achieve equity and
population-level impact.
- Novel products and intensified messaging are needed to increase male contraception. Two new reversible male contraceptives are currently in clinical trials: NET/T, a hormonal method, and YCT-529, a testicular enzyme inhibitor. Both methods reversibly inhibit spermatogenesis to decrease the number of sperm in semen. Another promising drug, TDI-10229, reversibly inhibits sperm motility.
- Technological advancements are necessary but understanding user preferences
will be key to guaranteeing adoption and success.
- Providers are key actors and must be trained and supported by health systems to
inform, educate, and counsel users to achieve their sexual and reproductive goals
through informed choice.
- The best way to improve family planning and promote the health of women and their families is to offer better contraception education and more options to those who wish to avoid unplanned pregnancy.
The presentation of this paper along with the other Lancet papers of this series will take place at The Lancet Innovations in Sexual & Reproductive Health Series Launch on Oct. 31, 2025, at Fenway Health.
Journal
The Lancet
Method of Research
Commentary/editorial
Subject of Research
People
Article Title
Biomedical innovations in contraception: gaps, obstacles, and solutions for sexual and reproductive health
Article Publication Date
31-Oct-2025
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