Addiction, pregnancy, and the fear of losing her children
A pregnant woman with a substance use problem is often carrying two fears at once: what the substance is doing to her body, and what admitting it out loud might cost her — her children. Here is what the data says about that intersection, sourced and dated throughout.
Substance use in pregnancy is not rare, and it is not shrinking.
83%
Rise in neonatal abstinence syndrome — a newborn's withdrawal from a substance used in pregnancy — from 2010 to 2017 (4.0 to 7.3 per 1,000 hospital births). Maternal opioid-related diagnoses at delivery rose roughly 130% over the same years, per a 2022 CDC report citing Hirai et al., JAMA 2021.
9.8%
Of pregnant women report current alcohol use, and 4.5% report binge drinking — higher still in the first trimester — per CDC survey data covering 2015–2018.
3×
Pregnancy-associated overdose deaths among women 35–44 more than tripled between early 2018 and late 2021 (4.9 to 15.8 per 100,000); over 60% happened outside a health care setting, per NIDA/NIH 2023, citing Han et al., JAMA Psychiatry.
Access to treatment has not kept pace with any of this. Only about 1 in 5 pregnant women on Medicaid with a substance use disorder — 19.9% — received treatment in the past year, per a 2020 MACPAC report. And the consequence of the gap reaches past the mother: parental substance use is a factor in roughly 1 in 3 U.S. foster care entries nationally (about 36% — roughly one in three — in FY2017), per Child Trends research citing federal data.
The gap runs sharper here than in most of the country.
66%
Of Texas children removed into foster care in 2015 were removed because of a parent's substance use — nearly double the national rate that year. Texas remained one of five states where over half of entries were linked to parental drug use as of FY2023, per Texans Care for Children (2018), citing Texas DFPS, and Child Trends (2026).
~17%
Drug overdose was the single most common cause of maternal death in Texas from 2012 to 2015, accounting for roughly 17% of maternal deaths, per Texans Care for Children (2018), citing Texas DSHS.
~10
Residential treatment providers statewide, as of 2018, that would let a mother keep her children with her during treatment — in a state of nearly 30 million people, per Texans Care for Children (2018).
The fear of losing her children is not incidental. It is a documented reason women don't ask for help.
A pregnant woman with a substance use problem is navigating a system that, historically, has been built to investigate a positive drug test rather than treat the person behind it. Federal research names the result plainly: fear of losing custody of a child — the one she has, or the one she is carrying — is a documented reason pregnant women avoid substance use treatment altogether, per the 2020 MACPAC report cited above. Silence, in that light, is not denial. It is often a rational response to a real risk.
What the evidence says helps is not more surveillance, but a different structure entirely — one where recovery and custody are not opposed. In studied family-based residential treatment programs, 94–95% of children remained free from abuse or neglect, and 70% were still in their mother's home a year after treatment. Mothers who have their children with them during treatment also tend to stay longer and complete treatment more often than those who do not, per a 2019 Casey Family Programs review. Keeping mother and child together during treatment is not simply kinder — it appears to be part of what makes treatment work.
This is the exact choice Mercy Manor was built to remove.
Mercy Manor takes mothers together with their children up to age 11 — not as an exception, but as part of how the program is designed. Detox has to happen first, at another facility, because Mercy Manor is a home and not a hospital. After that, it is a year: a full year of stable recovery, not the thirty days a fragmented system often offers before sending a woman back to the same pressures she left. A woman should not have to choose between getting well and keeping her children. The evidence above is part of why we built it this way, not just the conviction.
About $6,000 funds a woman's entire year at Mercy Manor. $500 a month covers one woman's care. Either way, the gift is the same thing: a year where a mother does not have to give up her child to get well.
Addiction in pregnancy rarely arrives as an isolated problem. It sits alongside the wider picture of women and addiction in America, and its consequences land hardest on the children affected when a woman is in crisis. See exactly who Mercy Manor can help, and why the program is built around a full year, not a shorter stay.
Help a mother heal without losing her childrenEvery figure on this page, and where it came from
- CDC, MMWR: Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses, citing Hirai et al., JAMA (2022 report; 2010–2017 data)
- CDC, MMWR: Alcohol Use and Binge Drinking Among Pregnant Women (2020 report; 2015–2018 NSDUH data)
- NIH/NIDA, Overdose Deaths Increased for Pregnant and Postpartum Women, 2018–2021, citing Han et al., JAMA Psychiatry (2023)
- MACPAC, Chapter 6: Substance Use Disorder and Maternal and Infant Health (2020)
- Child Trends, Parental Drug Use Is a Leading Cause of Foster Care Entries (2026), citing Casey Family Programs
- Texans Care for Children, Pregnancy, Substance Use Disorder, and Child Welfare in Texas (2018), citing Texas DFPS and Texas DSHS
- Casey Family Programs, Family-Based Substance Use Treatment Programs (2019)
Last reviewed: July 2026. Every figure is dated and linked to its source; we refresh as new data publishes.
Frequently asked questions
How common is substance use during pregnancy?
It is common enough to show up clearly in national health data. About 9.8% of pregnant women report current alcohol use, and 4.5% report binge drinking, with rates higher in the first trimester, per CDC survey data covering 2015–2018. Separately, neonatal abstinence syndrome — a newborn's withdrawal from a substance used in pregnancy — rose 83% from 2010 to 2017, and maternal opioid-related diagnoses at delivery rose roughly 130% over the same years, per a 2022 CDC report citing peer-reviewed research.
Why don't more pregnant women get treatment?
Cost and access are part of it — only about 1 in 5 pregnant women on Medicaid with a substance use disorder received treatment in the past year, per a 2020 MACPAC report. But federal researchers also name a specific, documented reason women avoid coming forward at all: fear of losing custody of the child she already has, or the one she is carrying. A system built to investigate a positive drug test, rather than treat the person who tested positive, teaches women that silence is safer than asking for help.
Is maternal addiction connected to children entering foster care?
Yes, strongly. Parental substance use is a factor in roughly 1 in 3 U.S. foster care entries nationally, per Child Trends research citing federal data. In Texas specifically, 66% of children removed into foster care in 2015 were removed because of a parent's substance use — nearly double the national rate that year — and Texas remained one of five states where over half of entries were linked to parental drug use as of FY2023, per Texans Care for Children and Child Trends.
Does it help outcomes when a mother can keep her children in treatment?
The evidence points that way. In studied family-based residential treatment programs, 94–95% of children remained free from abuse or neglect, and 70% were still in their mother's home a year after treatment, per a 2019 Casey Family Programs review. Mothers who have their children with them during treatment also tend to stay in treatment longer and complete it more often than mothers who do not — removing the choice between recovery and custody, rather than asking her to make it, appears to change the outcome.