BIRMINGHAM, Ala. — Alabama has become the epicenter of a growing national battle over the criminalization of pregnancy, using laws meant to protect children from meth labs and abuse to arrest and imprison hundreds of women for their behavior while pregnant.
The issue is back in the spotlight after a Lee County judge vacated the conviction of Brooke Shoemaker, an Alabama woman who was serving an 18-year sentence after a stillbirth that prosecutors blamed on methamphetamine use. Lee County Circuit Judge Jeffrey Tickal ordered a new trial on Dec. 22, writing that new medical evidence about a genetic abnormality and severe infection “lend toward the innocence of the offense,” while state prosecutors moved to appeal.
Shoemaker was convicted in 2020 of chemical endangerment of a child resulting in death, a felony rooted in a 2006 statute originally aimed at keeping children away from toxic fumes in home meth labs. In the years since, Alabama appellate courts have interpreted “child” in that law to include fetuses, opening the door to charging pregnant women whose pregnancies end in miscarriage, stillbirth or births following alleged drug use.
Advocacy groups and researchers say no state has used those powers more aggressively than Alabama. In a fact sheet released this year, Pregnancy Justice reported that Alabama accounted for 104 of at least 210 pregnancy-related prosecutions nationwide in the first year after the U.S. Supreme Court’s Dobbs decision overturned Roe v. Wade, nearly half of all known cases. The group says it has now documented 192 such prosecutions in Alabama in the first two years after Dobbs, most involving allegations of drug use during pregnancy rather than violence or harm to a newborn.
Those prosecutions build on a pattern that began well before the fall of Roe. A 2015 investigation by ProPublica and AL.com found at least 479 Alabama women were prosecuted for drug use while pregnant between 2006 and 2015, more than under any other single state law, prompting warnings from human rights groups that the statute was being used to punish addiction rather than protect children.
The pace has continued in the post-Dobbs era, as prosecutors in a dozen states bring criminal charges tied to pregnancy outcomes but the Gulf South — and Alabama in particular — supply most of the cases. A recent national review of pregnancy-related prosecutions found that in roughly two-thirds of cases, alleged substance use during pregnancy was the only claim, and that Alabama prosecutors have often pressed ahead even when children were born healthy or when medical evidence of harm was thin.
State officials have defended the aggressive approach as a way to protect children and deter drug use. Attorney General Steve Marshall previously supported using chemical endangerment charges against pregnant women while serving as a local district attorney, and some district attorneys have touted convictions as “justice” for fetuses or infants in public statements.
Medical and civil rights organizations counter that criminalization undermines both maternal and fetal health. Groups such as the American College of Obstetricians and Gynecologists and the ACLU of Alabama have argued that fear of arrest discourages pregnant people struggling with addiction from seeking prenatal care or being honest with their doctors, increasing the risk of poor outcomes for both parent and child.
In Shoemaker’s case, the state medical examiner found methamphetamine in the fetus’ bloodstream but listed the cause of death as “undetermined,” a conclusion defense lawyers later challenged with an expert who said infection and a genetic condition caused the loss. Pregnancy Justice’s legal director welcomed the new-trial order as a rare instance of a court taking emerging science seriously in a field where, she said, authorities often assume harm without proving it.
For advocates and legal scholars, Alabama’s record has become a test of how far “fetal personhood” theories can reach in criminal law. Researchers note that courts and lawmakers in a handful of states, including Alabama, have recognized fetuses or even embryos as legal persons in certain contexts, encouraging prosecutors to stretch child abuse and neglect statutes into the realm of pregnancy itself.
Pregnancy Justice and other groups say those legal theories fall hardest on poor women and women in rural counties, especially those with limited access to treatment for substance use disorder. In many Alabama cases, they say, women are arrested after hospital staff report a positive drug test at delivery or after a pregnancy loss, with criminal charges filed even when no long-term injury to a child is documented.
As Shoemaker awaits a new trial and the state presses its appeal, the larger debate over Alabama’s pregnancy prosecutions shows no sign of easing. Supporters of the current approach insist that harsh penalties are necessary to protect the unborn, while critics argue that a state already known for overcrowded, violent prisons is using its most punitive tools against some of its most vulnerable residents: pregnant women who need health care and support, not handcuffs.