{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:20:08Z","timestamp":1777940408592,"version":"3.51.4"},"reference-count":99,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>The rising prevalence of opioid use disorder (OUD) among those living in the United States has demanded a collaborative response from health care and policy spheres. Addressing OUD among pregnant women is especially difficult, given the controversies surrounding the medical and ethical balance between meeting maternal versus fetal\/newborn needs. Most medical organizations discourage the criminalization of drug use in pregnancy due to the adverse public health outcomes of such an approach. Despite this recommendation, many states continue to use punitive law to address drug use in pregnancy. In 2014, the Fetal Assault Law in Tennessee (TN) became the first law in the United States to directly allow women to be prosecuted for drug use in pregnancy. Since its expiration in 2016, this law has been re-introduced several times to the TN legislature in support of permanent implementation. This article outlines the impact of the initial Fetal Assault Law on maternal\/newborn health in TN and provides alternative immediate, short-term, and long-term health policy strategies through which health care providers and legislators can better advocate for the well-being of both mothers with OUD and their infants.<\/jats:p>","DOI":"10.1177\/1527154421989994","type":"journal-article","created":{"date-parts":[[2021,2,13]],"date-time":"2021-02-13T06:32:23Z","timestamp":1613197943000},"page":"93-104","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4414-7296","authenticated-orcid":false,"given":"Caroline K.","family":"Darlington","sequence":"first","affiliation":[{"name":"University of Pennsylvania, Philadelphia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peggy A.","family":"Compton","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadie P.","family":"Hutson","sequence":"additional","affiliation":[{"name":"The University of Tennessee, Knoxville, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"bibr1-1527154421989994","unstructured":"American College of Obstetrics and Gynecologists. (2014).\n                      2014 ACOG workforce task sheet: Tennessee\n                      . www.acog.org"},{"key":"bibr2-1527154421989994","unstructured":"American College of Obstetricians and Gynecologists. (2017).\n                      Committee opinion No. 711: Opioid use and opioid use disorder in pregnancy."},{"key":"bibr3-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr4-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1007\/s40429-017-0132-4"},{"key":"bibr5-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00785"},{"issue":"3","key":"bibr6-1527154421989994","first-page":"809","volume":"60","author":"Bach W. A.","year":"2019","journal-title":"William & Mary Law Review"},{"key":"bibr7-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.015"},{"key":"bibr8-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/j.ntt.2010.08.004"},{"key":"bibr9-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000310"},{"key":"bibr10a-1527154421989994","unstructured":"California v. Texas, No. 19-840, cert. granted, 140 S. Ct. 1262 (2020). https:\/\/www.supremecourt.gov\/docket\/docketfiles\/html\/public\/19-840.html"},{"key":"bibr10-1527154421989994","unstructured":"Cavendish S. (2014, April 29). Haslam signs bill criminalizing pregnant drug use into law.\n                      Nashville Scene\n                      . https:\/\/perma.cc\/JW28-FL5E"},{"key":"bibr11-1527154421989994","unstructured":"Centers for Disease Control & Prevention. (2020).\n                      U.S. opioid prescribing rate maps.\n                      https:\/\/cdc.gov\/drugoverdose\/maps\/rxrate-maps.html"},{"key":"bibr12-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2018.1544184"},{"key":"bibr13-1527154421989994","unstructured":"Comprehensive Addiction and Recovery Act of 2016, S. 524, 114th Cong. (2016)."},{"issue":"2","key":"bibr14-1527154421989994","first-page":"305","volume":"25","author":"Davis M.","year":"2018","journal-title":"Georgetown Journal on Poverty Law and Policy"},{"key":"bibr15-1527154421989994","unstructured":"Division of TennCare. (2018). Chapter 1200-13-13. In Bureau of TennCare, Rules of the Tennessee Department of Finance and Administration. https:\/\/publications.tnsosfiles.com\/rules\/1200\/1200-13\/1200-13-13.20180708.pdf"},{"key":"bibr16-1527154421989994","unstructured":"Division of TennCare. (2020).\n                      Neonatal abstinence syndrome among TennCare enrollees\u20142018 data\n                      . www.tn.gov\/tenncare\/information-statistics\/tenncare-neonatal-abstinence-syndrome-nas-data.html"},{"key":"bibr17-1527154421989994","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"issue":"5","key":"bibr18-1527154421989994","first-page":"1299","volume":"104","author":"Duggan E.","year":"2016","journal-title":"California Law Review"},{"key":"bibr19-1527154421989994","author":"Eckholm E.","year":"2014","journal-title":"The New York Times"},{"key":"bibr20-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-0362(01)00166-0"},{"key":"bibr21-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.14078"},{"key":"bibr22-1527154421989994","first-page":"257","volume":"20","author":"Fellner F.","year":"2009","journal-title":"Stanford Law & Policy Review"},{"key":"bibr23-1527154421989994","volume-title":"The relationship between substance use indicators and child welfare caseloads","author":"Ghertner R.","year":"2018"},{"key":"bibr24-1527154421989994","unstructured":"Goldensohn R., Levy R. (2015, February 15). A Tennessee law makes motherhood a crime.\n                      Facing South.\n                      https:\/\/perma.cc\/88LP-HHWG"},{"key":"bibr25-1527154421989994","unstructured":"Gonzalez T. (2014, April 25). Haslam receives petition asking for veto of bill criminalizing prenatal drug use.\n                      Tennessean.\n                      https:\/\/perma.cc\/L35U-4YDZ"},{"key":"bibr26-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1215\/03616878-8004886"},{"key":"bibr27-1527154421989994","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6731a1"},{"key":"bibr28-1527154421989994","unstructured":"Hale S., Zelinski A. (2014, May 8). By signing the controversial SB 1391, Gov. Bill Haslam makes Tennessee a battleground over the rights of pregnant women and prosecutorial bounds.\n                      Nashville Scene.\n                      https:\/\/perma.cc\/WC7Z-KCCW"},{"key":"bibr29-1527154421989994","unstructured":"H.B. 1168. (2019). 111th Gen. Assemb. 2019-2020. (T.N. 2019). http:\/\/wapp.capitol.tn.gov\/apps\/BillInfo\/Default.aspx?BillNumber=HB1168&GA=111"},{"key":"bibr30-1527154421989994","unstructured":"H.B. 1295. (2014). 108th Gen. Assemb. 2013-2014. (T.N. 2014). http:\/\/wapp.capitol.tn.gov\/apps\/BillInfo\/Default.aspx?BillNumber=HB1295&GA=108"},{"key":"bibr31-1527154421989994","unstructured":"H.B. 1660. (2016). 109th Gen. Assemb. 2015-2016. (T.N. 2016).http:\/\/wapp.capitol.tn.gov\/apps\/Billinfo\/default.aspx?BillNumber=HB1660&ga=109"},{"key":"bibr32-1527154421989994","unstructured":"House-Criminal Justice Subcommittee. (2016).\n                      Item 1660, Tennessee House of Representative.\n                      www.tnga.granicus.com\/MediaPlayer.php?view_id=341&clip_id=12002"},{"key":"bibr33-1527154421989994","unstructured":"House Session. (2014).\n                      62nd Legislative Day: Item HB 1295, Tennessee House of Representative\n                      . 108th Gen Assemb. www.tnga.granicus.com\/MediaPlayer.php?view_id=269&clip_id=9325"},{"key":"bibr34-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1080\/00981389.2015.1078427"},{"key":"bibr35-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3212"},{"key":"bibr36-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1111\/add.13776"},{"key":"bibr37-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000306"},{"key":"bibr38-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2019.02.005"},{"key":"bibr39-1527154421989994","unstructured":"Joint Task Force to Combat Opioid Trafficking Act of 2018, H.R. 5762, 115th Cong. 2\n                      nd\n                      Sess. 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(2018).\n                      Medicaid behavioral health services: Substance use disorder (SUD) services.\n                      www.kff.org"},{"key":"bibr42-1527154421989994","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6531a2"},{"key":"bibr43-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.20395"},{"key":"bibr44-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001446"},{"key":"bibr45-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000991"},{"key":"bibr46-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e31827feea4"},{"key":"bibr47-1527154421989994","doi-asserted-by":"publisher","DOI":"10.3109\/00952990.2015.1047502"},{"key":"bibr48-1527154421989994","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v7.24815"},{"key":"bibr49-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000000850"},{"key":"bibr50-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2017.6564"},{"key":"bibr51-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2019.01.005"},{"key":"bibr52a-1527154421989994","unstructured":"National Institute for Health Care Management. (2015). Reducing Neonatal Abstinence Syndrome in Tennessee. https:\/\/perma.cc\/C8X2-V35T"},{"key":"bibr52-1527154421989994","unstructured":"National Advocates for Pregnant Women. (2018). M\n                      edical and public health group statements opposing prosecution and punishment of pregnant women\n                      . https:\/\/perma.cc\/LVT3-UFLW"},{"key":"bibr53-1527154421989994","unstructured":"National Institute on Drug Abuse. (2020).\n                      Overdose death rates\n                      . www.drugabuse.gov\/related-topics\/trends-statistics\/overdose-death-rates"},{"key":"bibr54-1527154421989994","unstructured":"Neonatal Abstinence Syndrome. (2019).\n                      Hearings before the Health and Welfare Committee, 111th Tennessee Senate (2019) (Testimony of Dr. Craig Towers\n                      ). https:\/\/perma.cc\/YF2S-N4HF"},{"key":"bibr55-1527154421989994","unstructured":"NORC at the University of Chicago. (2020).\n                      Drug overdose deaths in the United States\n                      [Interactive Map]. https:\/\/opioidmisusetool.norc.org\/"},{"key":"bibr56-1527154421989994","volume-title":"Neonatal abstinence syndrome surveillance annual report 2019","author":"Nyakeriga A. M.","year":"2019"},{"key":"bibr57-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03144.x"},{"key":"bibr58-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000491"},{"key":"bibr59-1527154421989994","volume":"40","author":"Patrick S. W.","year":"2018","journal-title":"Substance Abuse"},{"key":"bibr60-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3299"},{"key":"bibr61-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.20851"},{"key":"bibr62-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-4070"},{"key":"bibr63-1527154421989994","unstructured":"Pew Research Center. (2014).\n                      Views about abortion by state\n                      . www.pewforum.org\/religious-landscape-study\/compare\/views-about-abortion\/by\/state\/"},{"key":"bibr64-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(93)90001-7"},{"key":"bibr65-1527154421989994","unstructured":"Public Chapter No. 686 (2018, April 9). https:\/\/publications.tnsosfiles.com\/acts\/110\/pub\/pc0686.pdf"},{"key":"bibr66-1527154421989994","unstructured":"Public Chapter No. 761. (2020, June 30). https:\/\/publications.tnsosfiles.com\/acts\/111\/pub\/pc0761.pdf"},{"key":"bibr67-1527154421989994","unstructured":"Public Chapter No. 820. (2014, April 9). https:\/\/publications.tnsosfiles.com\/acts\/108\/pub\/pc0820.pdf"},{"key":"bibr68-1527154421989994","unstructured":"Public Chapter No. 1006. (2012, May 10). https:\/\/publications.tnsosfiles.com\/acts\/107\/pub\/pc1006.pdf"},{"key":"bibr69-1527154421989994","unstructured":"Public Chapter No. 1061. (2018, May 21). https:\/\/publications.tnsosfiles.com\/acts\/110\/pub\/pc1061.pdf"},{"key":"bibr70-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002054"},{"key":"bibr71-1527154421989994","doi-asserted-by":"crossref","unstructured":"Safe Harbor Act of 2013. Tenn. Code Ann. \u00a7 Section 33-10-104(f) (2013).","DOI":"10.1089\/gen.33.17.02"},{"key":"bibr72-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0000000000000589"},{"key":"bibr73-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2017.10.011"},{"key":"bibr74-1527154421989994","unstructured":"S.B. 1391. (2014). 108th Gen. Assemb. 2013-2014. (T.N. 2014). http:\/\/wapp.capitol.tn.gov\/apps\/Billinfo\/default.aspx?BillNumber=SB1391&ga=108"},{"key":"bibr75-1527154421989994","unstructured":"S.B. 1629. (2016). 109th Gen. Assemb. 2015-2016. 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Item SB 0659, Tennessee Senate (April 2, 2019). 111th Gen Assemb. www.tnga.granicus.com\/MediaPlayer.php?view_id=414&clip_id=17050&meta_id=399130"},{"key":"bibr81-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1177\/1527154419864540"},{"key":"bibr82-1527154421989994","volume-title":"Case study: Tennessee\u2019s perinatal episode of care payment strategy promotes improved birth outcomes","author":"Smith D.","year":"2017"},{"issue":"2","key":"bibr83-1527154421989994","volume":"31","author":"Soderberg V. R.","year":"2016","journal-title":"Berkeley Journal of Gender, Law & Justice"},{"key":"bibr84-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002403"},{"key":"bibr85-1527154421989994","unstructured":"Springer D. (2014). Drug-addicted mothers need access to treatment.\n                      The Chattanoogan\n                      . https:\/\/perma.cc\/Y4WR-NW8F"},{"key":"bibr86-1527154421989994","unstructured":"Substance Abuse and Mental Health Services Administration. (2018).\n                      Clinical guidance for treating pregnant and parenting women with opioid use disorder and their infants\n                      (HHS Publication No (SMA) 18-5054)."},{"key":"bibr87-1527154421989994","unstructured":"The Sycamore Institute. (2018).\n                      The opioid epidemic in Tennessee: 2018 update on new policy actions\n                      . https:\/\/perma.cc\/BFW4-2UH9"},{"key":"bibr88-1527154421989994","unstructured":"Tenn. Code Ann. \u00a7 Section 39-17-402. (2019)."},{"key":"bibr89-1527154421989994","unstructured":"Tennessee State Government. (n.d.)\n                      TN together: A comprehensive plan to end the opioid crisis in Tennessee.\n                      https:\/\/perma.cc\/4L97-VGNU"},{"key":"bibr90-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002562"},{"key":"bibr91-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511552069.012"},{"key":"bibr92-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1177\/0091450918790790"},{"key":"bibr93-1527154421989994","unstructured":"TN Together. (n.d.).\n                      TN together media campaign.\n                      https:\/\/perma.cc\/KY6N-YGFV"},{"key":"bibr94-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1689001"},{"key":"bibr95-1527154421989994","doi-asserted-by":"publisher","DOI":"10.1080\/1554477X.2015.985155"},{"issue":"5","key":"bibr96-1527154421989994","first-page":"125","volume":"64","author":"Warren M. 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