Date of Award

Fall 12-11-2023

Degree Type

Closed Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Erin Ruel

Second Advisor

Wendy Simonds

Third Advisor

Amy Spring


Alabama criminalizes pregnant people for drug use more than any other state in the nation under their “chemical endangerment of a child” statute. However, there have been no empirical studies on the health effects of this law. I addressed this gap by conducting a series of analyses addressing the availability of medication assisted treatment (MAT) since the enactment of the law and the relationship between MAT availability, criminalization of pregnant people, and infant health outcomes between 2006-2020 in Alabama. I found that MAT access increased, but that access to methadone was severely limited by state and local policy. I tested the relationship between MAT availability, criminalization, and infant health outcomes by conducting a series of generalized estimating equation models at the county-level. I found that neither MAT availability nor arrest rates of pregnant people were reliably related to the rate of low birthweight infants or infant mortality. One potential cause for the lack of significant relationships in analyses could be due to the strong skew in county enforcement of the law where only four counties accounted for over 80% of cases in the state. Further research needs to focus on these high enforcement counties. Overall, I had a difficult time studying criminalization and health trends in Alabama due to the lack of public health resources in the state, difficulty in obtaining data from small counties, and poor quality of health-related data, especially pregnancy-associated mortality rates. Currently, there is no way to properly assess the impact of the chemical endangerment law with the available data. Addressing the need for high quality data is important both to inform Alabama policy and other states due to the rise in pregnancy criminalization policies.


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