Safer Solutions: Increase Adherence to Prenatal Care with This One Weird Trick
Virginia Gov. Abigail Spanberger signed HB 283 into law in April 2026. The bipartisan bill states that it is not child abuse or neglect for a woman to take a prescribed, evidence-based medication for opioid addiction recovery during pregnancy. And while not its stated purpose, the law could have the added benefit of helping more Virginia women get basic prenatal care.
Consistent access to prenatal care is a crucial part of maternal and child health in any pregnancy. It allows for early detection and treatment of a range of medical conditions, reduces the risk of pregnancy complications, and promotes fetal health. It yields “fewer hospital admissions,” “lower pregnancy-associated morbidity and mortality,” and lower preterm delivery risk. It is also associated with lower maternal death rates.
But access to this essential prenatal care is complicated by state laws that punish women for seeking help with addiction. More than 20 states treat the use of medication for opioid use disorder (MOUD) in pregnancy as a crime or a possible sign of child maltreatment. When pregnant women take one of these medications as part of their addiction treatment, the threat of arrest and/or family separation makes going to the doctor seem dangerous. That fear pushes many women who want help with their addiction to stop MOUD treatment—a choice that significantly increases their risk of overdose—or to avoid prenatal care.
Opioid Addiction Treatment During Pregnancy
It is a common societal expectation that women should not use intoxicating substances during pregnancy. For this reason, many people may believe that quitting opioids “cold turkey” upon becoming pregnant is the best option. However, that approach puts both the mother and fetus in grave danger: “Medically supervised withdrawal” in pregnancy is associated with relapse rates in the range of 59 to 90 percent. This approach contributes to unintentional drug overdose—the single leading cause of pregnancy-related death in the period spanning 2018 to 2023.
On the other hand, evidence shows that when pregnant women are treated with MOUD, they can reduce or altogether eliminate their illicit drug use, which reduces their overdose risk by up to 80 percent. MOUD also lowers the risk of preterm birth and low birth weight all while remaining safe for the developing fetus. That is why doctors overwhelmingly recommend MOUD as the best treatment for pregnant women struggling with opioid addiction.
Many women are highly motivated to stop using drugs when they discover they are pregnant, but the “how” of treatment and recovery must carefully consider the safety of the mother and fetus. A Virginia-based health practitioner recently underscored the flaws in the “cold turkey” assumption, telling R Street that addiction does not just “disappear when a person becomes pregnant, just like high blood pressure and diabetes don’t magically resolve when a person becomes pregnant.” That is why treatment for addiction—just as any other health condition—should follow the best available clinical evidence. As with any medication indicated during pregnancy, the provider and patient must work together to determine if the medication’s benefits outweigh its potential risks to the mother and fetus.
State Laws Should Reflect the Benefits of MOUD in Pregnancy
Despite the evidence and physician support behind MOUD use during pregnancy, some states criminalize or punish its use. Some even require healthcare professionals to file child abuse and neglect reports for infants born to mothers who took prescribed MOUD while pregnant. This punitive approach negatively impacts the mother’s recovery journey as well as the health and safety of the fetus. And by positioning healthcare as potentially punitive, such laws might keep expectant mothers from pursuing healthcare altogether—including the prenatal care that helps ensure a healthy pregnancy and delivery.
This is why Virginia’s new law is a meaningful step in the right direction. While a single law cannot unseat deeply held misconceptions about substance use, motherhood, and MOUD, it can remove some of the punitive aspects from the hard work of pursuing recovery. Decreasing the legal risks of using MOUD during pregnancy makes seeking both addiction treatment and prenatal/postnatal care less scary, opening the door to stability and recovery for women during and after pregnancy. Not only does MOUD use during pregnancy improve prenatal care adherence, it can also prompt women to schedule and attend infant well-child appointments after delivery. Together, these actions can support healing, healthy, and whole families.