From Taxes to Treatment: Policy Approaches to Substance Use and Maternal and Child Health

Session Submission Type: Panel

Abstract

This session examines how state-level decisions shape substance use, treatment access, and downstream maternal and child health outcomes. The four papers leverage natural experiments related to alcohol taxation and availability, Medicaid coverage, and access to substance use disorder (SUD) treatment facilities to generate evidence about strategies for addressing substance use before and during pregnancy.  

The first two papers focus on alcohol policy as a population-based lever influencing prenatal exposure and early-life outcomes. Using variation in state alcohol excise taxes over time, the first paper shows that increases in alcohol taxes are associated with reductions in third-trimester drinking, highlighting the potential of non-stigmatizing, broad-based fiscal policies to improve fetal health. Complementing this evidence, the second paper examines Washington State’s liquor privatization policy, documenting that expanded alcohol availability affected birth outcomes and teen fertility. Together, these papers underscore that how states regulate alcohol markets—through prices or access—has measurable consequences for children, even when policies do not explicitly target pregnant individuals.  

The latter two papers turn to substance use disorder and treatment access, emphasizing the role of Medicaid policy and provider supply. The third paper evaluates the recent expansion of postpartum Medicaid coverage to 12 months, and shows that Medicaid expansion increases medication treatment for opioid use disorder among postpartum parents. The fourth paper exploits variation in the timing of facility openings in Kentucky to show that greater local access to SUD treatment improves maternal and infant outcomes. These papers together highlight how state decisions about insurance coverage duration and treatment infrastructure can mitigate substance-related harms during a critical window around childbirth.

Collectively, the session illustrates how different approaches to addressing alcohol and substance use impact prenatal behavior and fertility decisions. The findings offer actionable insights for policymakers seeking to design effective policies and systems that improve maternal and child wellbeing.

Policy Area

• Health Policy

Chair

• Joseph Benitez, University of Kentucky

Discussants

• Christine Piette Durrance, University of Wisconsin-Madison

• Danielle Atkins, Florida State University

Organizer

• Beth Munnich, University of Louisville

Individual Presentations

• Do alcohol tax changes reduce pre-pregnancy and pregnancy alcohol consumption? Evidence from the PRAMS - Presenting Author: Sarah Hamersma, Syracuse University

• Pour Decisions: The Effects of Alcohol Privatization on Child Health and Safety - Presenting Author: David M Hall, University of Oregon

• Medicaid Coverage and Postpartum Opioid Use Disorder Treatment - Presenting Author: Sumedha Gupta, Indiana University

• The Impact of Access to Substance Use Disorder Treatment Facilities on Maternal and Infant Health - Presenting Author: Beth Munnich, University of Louisville