Reproductive health consequences of criminal legal involvement for women who use drugs in Taiwan.

BACKGROUND

Criminal legal responses to drug use may carry unintended consequences for women's reproductive health, particularly in systems where punitive and health-oriented approaches coexist. This study explores how criminal legal involvement-both past contact and intervention stages-affects reproductive outcomes for young women who use drugs in Taiwan.

METHODS

We conducted a retrospective cohort study of 4601 women aged 18-29 arrested for Schedule II drug use (predominantly meth/amphetamine) between 2011 and 2015. National police, health insurance, birth registration, and drug intervention datasets were linked to assess three outcomes: time to post-arrest pregnancy, pregnancy loss, and delayed initiation of prenatal care. Time-dependent Cox proportional hazard models and logistic regressions were used to estimate the associations.

RESULTS

Over a three-year follow-up, nearly one-third of young women became pregnant after arrest. Among first post-arrest pregnancies (n = 1367), one-third ended in loss, and 9.2 % of live births lacked timely first-trimester care. Women without prior drug offenses were more likely to conceive soon after arrest (aHR = 1.25, 95 % CI: 1.10-1.43), while pregnancy hazard declined during deferred prosecution (aHR = 0.73, 95 % CI: 0.61-0.88). The incident offense was associated with a 28 % higher risk of pregnancy loss, despite reducing the odds of delayed prenatal care (aOR = 0.48, 95 % CI: 0.28-0.81).

DISCUSSION: These findings reveal how the criminal legal system's involvement shapes reproductive health outcomes among women who use drugs. Early prosecutorial stages represent a pivotal window to integrate reproductive healthcare, reduce maternal risks, and support recovery.