Doctoral Dissertation Research Improvement: Medical System-State Collaborations

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The study examines how government mandates affect medical responses to substance-using pregnant women. Federal and state mandates increasingly encourage medical providers to initiate punitive state responses when they suspect perinatal substance use by pregnant women. This challenges the professional role of medical personnel as providers of care to their patients. This study uses a variety of qualitative methods to investigate the actions of the different actors in this process, state actors, medical professionals, and pregnant women. Findings of this research have the potential to influence government policy-making concerning substance-using pregnant women as well as the responses of medical experts and maternal health advocates. This study employs a multi-level analysis to assess macro, micro, and intermediate level factors that mutually shape interventions on pregnant women. To assess macro-level processes, a systems-level analysis informed by interviews with stakeholders such as medical experts and child welfare advocates looks at how policy domains (including drug policy, child welfare policy, and maternal-fetal health policy) shape medical agendas and encourage medico-legal collaborations. At an intermediate level, a year-long ethnographic study of a Labor and Delivery unit uncovers how day-to-day medical practices are carried out and to what extent the state is invited into or intervenes upon these processes. At the micro level, semi-structured interviews with medical professionals and women directly affected by medically-initiated state sanctions show how medical-state collaborations affect care outcomes and patient well-being. A key consideration throughout is the role that social class and race play in shaping institutional responses.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.