1 Herlev University Hospital and University of Copenhagen, Copenhagen, Denmark
Since 1982 Swedish law has allowed involuntary detention and treatment of all alcohol and drug abusers, including pregnant women, for up to six months without consent. However, detention cannot be carried out with a reference to the fetus. In the period 2000 to 2009, 150 pregnant alcohol and drug abusers were detained: 5% only abused alcohol, 39% used alcohol to various extents. The 150 women gave birth to 94 live born children (2 twins), 40 had an induced abortion, 4 a spontaneous abortion, 1 was stillborn and for 12 the outcome was unknown. 24 children were removed from the mother after birth.
Since 1996 it has been possible in Norway to detain pregnant alcohol and drug abusers in an institution during the entire pregnancy. However, involuntary treatment is not allowed. The aim is to limit the possible damage to the fetus, to help the pregnant woman out of her abuse, and to enable her to take care of her baby. Formal evaluations of the Norwegian measures to prevent abuse of alcohol and illegal drugs are few but point to huge differences in the use of detention, both between counties and among staff. Less than a third of detentions seem to involve alcohol. Short term obstetric outcomes are comparable between voluntarily treated and involuntarily detained abusers.
Since 2007, the counties in Denmark have had the option of offering voluntary contracts to pregnant alcohol abusers, including involuntary detention. Without a voluntary signature from the pregnant alcohol abuser, detention is not allowed. As in Norway, the aim is to protect the fetus. However, the voluntariness is threefold: A) Each county must decide if it wants to offer voluntary treatment contracts. B) In every case, the county must decide whether a voluntary treatment contract should be offered to a specific pregnant woman. C) The pregnant woman must decide to voluntarily sign a contract of possible involuntary detention. So far, no pregnant woman has voluntarily signed a contract of involuntary detention.
In Greenland, early detection of alcohol and drug abuse has been a focus area since 2007. The strategy is based on confidence and voluntariness.