Policymaking requires standards – criteria against which policymakers test the anticipated outcomes of alternative treatments. According to Collins (2005), five criteria should be applied during treatment evaluation: relevance, progress, efficiency, effectiveness, and impact. These standards help in understanding if the intervention contributes to the health needs of the target population, what the projected results are, and if the treatment is cost-effective and objectively practical. Also, it is possible to evaluate what impact the activity has on socioeconomic progress and general health. All mentioned criteria can be applied to voluntary sterilization programs, intrauterine contraceptive devices (ICD), and criminal prosecution as to policies for drug-addict pregnant women and their unborn babies.
Female sterilization is an irreversible contraceptive procedure that includes blocking the oviduct. In terms of relevance, such a policy can help women avoid possible traumas to their health and the health of their unborn children. However, female sterilization has immediate and long-term complications with hemorrhage, infections, bowel, bladder, and blood vessel injuries, among others (Thanoon et al., 2022). Besides, the procedure does not contribute to drug rehabilitation. Thus, the policy poorly attains its objectives, the results may be unjustified in relation to resource expenditure, and the actual outcomes may be worse than expected and negatively impact women’s health. Female sterilization meets only one of Collins’ criteria, relevance, and is of current interest to patients who voluntarily request the procedure.
Pregnant women addicted to drugs or alcohol can investigate alternatives to voluntary sterilization, such as intrauterine contraceptive devices. ICD is a small, T-shaped contraceptive device inserted into the womb to prevent conception. Contraceptive implantation is an effective and safe alternative treatment with a high continuation rate, low ejection rate, and little risk of complications (Sudha & Singh, 2017; Vilvapriya & Veeraragavan, 2017). It is relevant for the health needs of women with substance use disorders as the procedure helps avoid unwanted pregnancies and potential psychological and physical traumas to women and unborn babies. The actual outcomes are predictable and reversible, yet they do not contribute to drug rehabilitation. The treatment alternative is cost-effective and attains the main objective – improving the life quality of drug-addicted women. The ICD implantation does not adversely affect patients’ health and still allows them to have children later. Thus, this policy fulfills all five criteria and is one of the safest and most effective interventions for pregnant women with substance use disorders.
Finally, mothers-to-be may be prosecuted for putting their unborn children in danger due to substance abuse. Even though women are more likely to participate in drug treatment through penalties than men, such measures do not guarantee positive outcomes. Therefore, the results are unpredictable and cannot be correlated with potential resource expenditures. Besides, such an alternative as rehabilitation through psychotherapy or group counseling is proven to be more successful in treating drug addiction in pregnant women than criminal penalties (Faherty et al., 2019). Therefore, this policy poorly attains treatment objectives and may either have zero impact on women’s overall health or provoke further substance abuse episodes. Thus, criminal prosecution does not meet Collins’ evaluation criteria and cannot be considered an actual treatment alternative for drug-addicted women.
Collins’ standards enable policymakers to evaluate treatment alternatives regarding their relevance, progress, efficiency, effectiveness, and impact. Three policies – voluntary sterilization, intrauterine contraceptive devices, and criminal prosecution – have been analyzed based on these criteria. As a result, only ICD implementation meets all standards and can be considered an effective and safe treatment alternative for women with substance abuse disorders.
References
Collins, T. (2005). Health policy analysis: A simple tool for policy makers. Public Health, 119(3), 192-196. Web.
Faherty, L. J., Kranz, A. M., Russell-Fritch, J., Patrick, S. W., Cantor, J., & Stein, B. D. (2019). Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome. JAMA Network Open, 2(11), e1914078. Web.
Mallicoat, S. L. (2019). Women, gender, and crime: Core concepts. SAGE Publications.
Sudha, R., & Singh, N. (2017). A prospective study to evaluate safety, efficacy and expulsion rate of post-partum insertion of intrauterine contraceptive device in a tertiary care centre. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(3), 814-819. Web.
Thanoon, O., Gharabeih, A., & Mahmood, T. A. (2022). Female sterilization. In J. Bitzer & T. A. Mahmood (Eds.), Handbook of contraception and sexual reproductive healthcare (pp. 81-88). Cambridge University Press.
Vilvapriya, S., & Veeraragavan, K. (2017). Long term clinical outcome of intra caesarean intrauterine contraceptive device insertion. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(5), 1894-1900. Web.