Imagine you’re pregnant and excited for your new baby—tracking kicks, setting up the crib, picking out names. Then comes sudden, unexpected pain. You lose your pregnancy at home, terrified and bleeding, and you do what you’ve always taught your kids to do in an emergency: you call for help.

The paramedics arrive—and with them, police. The questions come before the care: How far along were you? How long did you wait before calling 911? Did you get regular prenatal care? Were you excited to be pregnant? Have you taken any drugs? Instead of prioritizing your physical and emotional well-being, you’re suddenly facing criminal charges, worried about losing your kids, and trying to find a lawyer you can afford.

Cases like these are not unique. They have been happening across the country in the first two years since Roe v. Wade fell. Pregnancy Justice and our research partners have documented more than 400 prosecutions across 16 states for pregnancy, miscarriage, and abortion—as police and prosecutors, often alerted by hospitals and healthcare workers when someone seeks care, treat medical emergencies as crimes. This is pregnancy criminalization: when someone is charged with a crime because of their behavior during pregnancy, or because of a pregnancy loss, such as miscarriage or stillbirth. These charges are typically not for abortion-specific crimes; in fact, at least for now, most states cannot charge the pregnant person with an abortion-related crime. Instead, prosecutors misuse and misapply various statutes to charge pregnant people with anything from “child” abuse, neglect, or endangerment, to murder, manslaughter, or abuse of a corpse.

Pregnancy criminalization in the United States started long before the Supreme Court’s 2022 decision to overturn Roe, but the guardrails that once existed to protect women from being criminalized for pregnancy loss or abortion are now off. Today, it is a dangerous framework driving these prosecutions, one that aims to treat fertilized eggs, embryos, and fetuses as “persons” with rights, and recasts behavior during pregnancy as a potential crime. In practice, this kind of criminalization falls hardest on low-income, Black, brown, Indigenous, and rural communities—those most at risk of over-policing and a lack of affordable health care or legal counsel.

In many cases, the “evidence” used to prosecute a pregnant person is a positive urine toxicology test or drug screen—often ordered and shared with child welfare authorities and the police without a patient’s knowledge or informed consent. Some positive drug tests are later shown to be false; others are a result of prescribed medications; still others reflect substance use or substance use disorder (SUD). And yet this positive test is often enough to charge a pregnant patient with a felony for allegedly putting their pregnancy at “risk” of potential harm, often resulting in the removal of their other children from their care. It’s why leading medical organizations, including the American College of Obstetricians and Gynecologists, the American Medical Association and the American Academy of Pediatrics, recommend against the use of drug testing to punish or criminalize people who use drugs during pregnancy.

The application of child abuse or neglect statutes to embryos and fetuses is a slippery and dangerous slope. The practice quickly expands: Any pregnancy loss is treated with suspicion. As this punitive net widens, the actual systems that support the health and well-being of patients and their infants—prenatal care, mental health care, and treatment for SUD—are being stripped away. We are witnessing the gutting of Medicaid, which is worsening maternity care deserts, and the defunding of proven treatment for SUD, which was already insufficient to meet capacity, even as overdose deaths rise among pregnant and postpartum people. If policymakers and legislators were truly interested in improving outcomes for pregnant people and their babies, they would invest in care, not punishment.

But by participating in nonconsensual drug testing and reporting of those results to government agencies and legal entities, hospitals and clinicians are inviting law enforcement into exam rooms, initiating and facilitating the criminalization and incarceration of pregnant people. Each decision amounts to centering the institution’s needs at the expense of the patients, who are then blamed for not getting pregnancy “right.”

It can be overwhelming to navigate the complicated health care system as a pregnant person, whether giving birth or seeking care for pregnancy loss; the system was designed that way. One powerful way to interrupt this cycle of punishment is by staying alert and informed. We can all help our community members, neighbors, loved ones, and family members by going with them to visits and listening, taking notes, and asking questions with their safety in mind. In the midst of so much political chaos, our most important tool is information about our rights and how to protect those rights. For example, a person can exercise their Fifth Amendment right by refusing to talk to the police without legal representation present. It’s essential not to let unconstitutional threats and actions distract us from demanding that our freedoms be protected.

Here’s the good news: People seeking care and those who want to support them don’t have to do it alone. Clinicians and hospitals have agency too, and organizers around the country are working hard to ensure they know this. Health systems can refuse to allow law enforcement into the exam room, by prohibiting non-required and nonconsensual reporting and by ordering tests to support care rather than to build criminal cases. These strategies work. In New York City, a policy shift like this cut toxicology-only reports to child welfare by 80 percent with no negative impact on infant health outcomes. We can collectively advocate for more cities and states to follow their lead and protect families.

Prosecutors also should state plainly that no one should be criminalized for pregnancy loss, abortion, or substance use and they will refuse to prosecute those who are. Medical education should teach medical trainees about providing patients with health care that is responsive to their needs and supportive of their goals, not making assumptions about what’s “best” for a patient and increasing their risk of criminalization. If people are facing threats of criminalization for their pregnancy outcomes, they can reach out to organizations like Pregnancy Justice to get the legal support they need.

Our goal should be simple: safeguard the health of the pregnant and postpartum person. That commitment improves outcomes for newborns, for patients after pregnancy loss, and for families. But it is going to take all of us. Our personal advocacy for our loved ones, our laws, policies, and medical guidelines must support one premise: No one should be criminalized for being pregnant, however that pregnancy ends.