Medical-State Collaboration: Regulating Substance Using Pregnant Women

This study examines local responses to perinatal substance use in the city of Chicago. I explore the ways that policy makers, medical professionals, and state actors collaborate to regulate substance using pregnant women. The findings of this research contribute to our understanding of the relationship between medicalization and criminalization and documents the emergence of a hybrid form of governance by which medical-state collaborations fundamentally empower and transform each other. Drawing from qualitative interviews (N = 86) with experts, professionals, medical actors, and women who have used substances while pregnant, this study reveals the complementary logics that bring disparate institutions together. The findings reveal that in response to perinatal substance use, medical and carceral logics comingle and pervade medical practices; treatment and diagnostic norms are scaled back while forensic methods used to surveil, monitor, and collect evidence are promoted. This research shows that medical providers play an active role in initiating state interventions in women’s lives for their behavior during pregnancy. This research also documents women’s experiences once they have been referred to child protective services and reveals that on the other side of medical-state handoffs women must contend with precarity within the privatized social service sector. Finally, this dissertation explores how substance using women experience motherhood when maternity status and childrearing are targets for punishment and discipline by multiple experts and institutions.