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A new state-level investigation from Wisconsin, combined with a growing body of national data, reveals just how badly the addiction treatment system is failing this population, and what would need to change to protect women and their babies.
The National Scope of the Crisis
Among all maternal deaths in the United States from 2018 through 2023, unintentional drug overdose was the single leading cause, accounting for 1,152 deaths at a rate of 5.2 per 100,000 live births.
Between 2018 and 2021 alone, pregnancy-associated deaths caused by drug overdoses surged 76 percent nationally. In some states, substance use has become the leading cause of maternal death overall.
State maternal mortality review committees paint an even starker picture: the most recent CDC report covering 38 state committees found substance use contributed to more than one in five pregnancy-related deaths.
More than 60 percent of pregnancy-associated overdose deaths occurred at home or in other non-healthcare settings, often in counties where emergency and obstetric care were available nearby. The deaths are not primarily happening because treatment doesn’t exist. They are happening because too many women never reach it.
Wisconsin as a Window Into a Nationwide Problem
A data investigation by the Milwaukee Journal Sentinel illustrates how this national crisis plays out at the state level. From 2016 through 2024, 134 Wisconsin women died from overdose during pregnancy or within one year of giving birth, according to data from the state’s Maternal Mortality Review Board, roughly one in three pregnancy-associated deaths in that period.
In 2018, overdose accounted for more than half of all pregnancy-associated deaths in Wisconsin. From 2019 through 2023, it remained the cause of about one in three each year.
Wisconsin’s experience is not unusual. Women are at the highest risk for substance use disorder during their reproductive years, and substance use during pregnancy is prevalent across the country.
The most frequently used substances among pregnant women are tobacco, alcohol, and marijuana, followed by cocaine and opioids, the latter carrying the highest overdose risk.
Stigma Shuts Women Out of Care
Substance use disorder is one of the most stigmatized and undertreated chronic medical conditions, and this is compounded during the perinatal period.
Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. The Journal Sentinel investigation documents what this looks like in practice.
Women with substance use disorder during pregnancy describe providers who avoided eye contact, dismissed reports of pain as drug-seeking behavior, or simply never asked. For many, a single judgmental encounter was enough to end engagement with prenatal care entirely.
Punitive policies toward substance use in pregnancy have been shown to decrease prenatal care utilization, do not improve birth outcomes, and disproportionately impact Black, Indigenous and other families of color.
The Medical College of Wisconsin’s MOTHERS Program, a multidisciplinary model offering high-risk obstetrics, psychiatry, addiction medicine, social work and pediatric care, was built explicitly to counter that dynamic.
Staff use non-stigmatizing language, conduct screenings with direct eye contact and treat substance use disorder as the medical condition it is. The program enrolled more than 60 patients in its first 13 months.
Fear of Losing Children Keeps Women Silent
One of the most significant barriers to addiction treatment nationally is fear, specifically, the fear that seeking help will trigger child welfare involvement and separation from children.
These barriers arise from fragmented systems including healthcare, health insurance, child welfare, childcare and the criminal justice system. Women navigating all of these simultaneously, while pregnant or postpartum, face a near-impossible path to care.
In Wisconsin, CPS agencies investigated 1,465 allegations of unborn child abuse between 2020 and 2024 under a 1998 state law that was found unconstitutional in 2017 but remains on the books.
That legal environment, present in varying forms across the country, sends a clear message to women who are struggling: disclosing drug use is dangerous.
Clinicians working in perinatal addiction care note that the majority of pregnancy-associated overdose deaths occur in the latter months of the year following delivery, a window when women who have lost custody face acute grief and isolation, and often lose access to care along with their coverage.
The Coverage Gap That Makes Everything Worse
Among individuals with opioid use disorder who recently gave birth, the risk of overdose is highest between seven and twelve months postpartum.
Yet until recently, Medicaid, which covers the majority of births affected by opioid use disorder, terminated coverage just 60 days after delivery in many states.
From 2021 to 2025, 48 states and Washington, D.C. adopted the option to extend postpartum Medicaid coverage from 60 days to 12 months, a change made permanent under the Consolidated Appropriations Act of 2022.
Wisconsin was among the last holdouts, finally passing the extension in early 2026 with a 95-1 Assembly vote. Arkansas remains the only state that has not adopted the extension.
An estimated 47 percent of maternal deaths occur between one week and one year postpartum, including deaths from substance use disorder and mental health conditions, precisely the window the 60-day cutoff left uncovered.
For Dr. Lizzie Hovis, a perinatal psychiatrist at the Medical College of Wisconsin, the extension is essential but long overdue. Medicaid covers approximately 70 percent of pregnancies affected by opioid use disorder.
Cutting off addiction medications, mental health care, and case management at 60 days, during the highest-risk stretch of the postpartum period, has for years left women in a medically indefensible gap.
Housing and Basic Needs Are Part of the Treatment Picture
Clinicians and women with lived experience interviewed for the Journal Sentinel investigation were consistent on one point: addiction treatment alone is not sufficient for pregnant and postpartum women.
Stable housing and recovery-oriented living arrangements are key to promoting substance use recovery and minimizing treatment engagement barriers.
Transportation to appointments, food assistance, child care and access to employment all shape whether a woman can follow through with care, regardless of how good the treatment program is.
Providers working in this space describe connecting patients to strollers, food benefits, and housing referrals as part of clinical care, not an afterthought.
Programs that offer residential addiction treatment specifically for women and families, allowing mothers to remain with their children during recovery, are considered a model worth expanding.
What This Means for Treatment Seekers
If you are pregnant, postpartum, or supporting someone who is, and substance use disorder is a factor, the most important step is finding addiction treatment from providers trained specifically in perinatal care.
Look for programs that offer medication-assisted treatment (MAT) for opioid use disorder, integrated mental health care, and family-inclusive or residential options.
If you are on Medicaid, confirm your state’s current postpartum coverage window, most states now offer 12 months of continuous coverage, which can fund addiction medications, counseling, and case management through the highest-risk period after birth.
Finding Addiction Treatment for Pregnant and Postpartum Women
Pregnancy and the postpartum period are among the highest-stakes windows for addressing substance use disorder — and also among the most underserved.
When comparing rehab centers, prioritize facilities with specific experience treating perinatal populations, co-occurring mental health conditions, and the trauma that often underlies addiction in women.
Rehab.com’s listing includes thousands of verified rehab centers nationwide, including programs designed specifically for women, mothers, and families. Call [phone] to speak with a treatment advisor about options near you.
