This paper briefly examines the actions by states that criminalize substance use during pregnancy through a critical lens that grants attention to the reasons for and implications of punishing pregnant women for specific actions taken during pregnancy. It first embarks on a case study into a particular Alabama law that has warranted the arrests of hundreds of women since its implementation in 2006. Then, using qualitative research, this paper investigates broader state intervention into the lives of pregnant, substance using women via criminal prosecution and the termination of parental rights. Results indicate that current punitive policies have often developed without appropriate consideration of the negative outcomes of criminalization. This includes the effects on the health, well-being, and reproductive autonomy of women. Lastly, I argue that the most effective way to approach the issue at hand will be from a perspective that accounts for women’s own voices and social locations, including wholesome public health approaches that emphasize harm reduction, treatment, and a dedication to reproductive freedom.