Society for Maternal‐Fetal Medicine (SMFM) et al., Society for Maternal‐Fetal Medicine Position Statement: Decriminalization of Substance Use Disorder in Pregnancy, 1 Pregnancy e70033 (2025).
Quote
“Efforts and policies should focus on preventing family regulation system involvement and tangible ways to support families. Access to treatment (including but not limited to medication for addiction treatment, residential treatment, behavioral therapy, and psychosocial support) and community-based initiatives are needed” (p.3).
“Biologic testing of blood, urine, or other specimens should only be undertaken when doing so will change clinical care or management and as part of evidence-based guidelines” (p.2).
“Substance use screening and testing should not be performed without informed consent (that explains the potential consequences of a positive result as well as the implications of refusal) to uphold patient autonomy and reduce racial disparities” (p.2).
“Universal biologic testing is not recommended, as this approach has the potential for significant harm” (p.2).
Article primary conclusion
The Society for Maternal-Fetal Medicine (SMFM) position statement on the decriminalization of substance use disorder in pregnancy opposes policies and practices that criminalize substance use during pregnancy, including punitive legislation, routine biologic toxicology testing, and mandated reporting to the family regulation system. The statement highlights how punitive laws disproportionately affect Black and Indigenous individuals and families at multiple stages, including screening, testing, reporting, surveillance, and family separation. SMFM recommends evidence-based screening and treatment, informed consent for biologic testing, and policies that prioritize treatment, family support, patient autonomy, and equitable care rather than punishment.
Article context
This statement is notable because it places racial equity at the center of its analysis rather than treating disparities as a secondary concern. SMFM explicitly argues that criminalization, toxicology testing practices, mandated reporting, and family regulation system involvement contribute to racial and ethnic inequities and disproportionately affect Black and Indigenous families. The statement also highlights evidence that child removal is associated with trauma, worse maternal health outcomes, return to substance use, and increased risk of overdose, while children who experience family separation face long-term health and social consequences. In addition to supporting evidence-based treatment, SMFM recommends that biologic testing be performed only when it will affect clinical care and that policies focus on treatment, family support, patient autonomy, and equitable access to services rather than punishment or surveillance. As with other Professional Society StatementDefinition: A professional society statement reflects consensus recommendations developed by experts based on research evidence and clinical experience.Evidence quality: These statements sit lower on the evidence pyramid because they rely on expert interpretation rather than new empirical data.Court use: Courts may consider these statements as guidance on professional standards, but they should not be treated as independent scientific proof.Glossary ›, it synthesizes existing evidence into recommendations rather than generating new empirical data.
Editor's note
This statement reflects the growing incorporation of anti-racist and reproductive justice frameworks into professional guidance on substance use during pregnancy. While earlier statements from ACOG, ASAM, and other organizations increasingly emphasized treatment over punishment, SMFM places racial inequities in testing, reporting, surveillance, and family separation at the center of its analysis. The document suggests that improving outcomes requires not only expanding access to treatment but also examining how healthcare and legal systems contribute to inequitable outcomes for Black and Indigenous families.