Concerns Mount over Punitive Approaches to Substance Abuse Among Pregnant Women

state’s highest court, the South Carolina Supreme Court in late 1997 upheld the criminal conviction of a woman charged with child abuse for using crack cocaine during her pregnancy. Finding that a viable fetus is a “child” under the state’s child abuse law, the court ruled that “maternal acts endangering or likely to endanger the life, comfort, or health of a viable fetus” could constitute child abuse. The South Carolina decision—which the United States Supreme Court recently declined to review—has unleashed a full-scale debate that had been simmering in the states for several years, as policymakers grapple with the agonizing issue of prenatal substance abuse.