Historically in the United States, the police have been organized as a publicly accountable, rule of law institution. In theory, this has meant that police engage in partnership with the public to set crime prevention and public safety goals. Since the decline of industrialization in America’s urban centers, however, the police—particularly in racially isolated, structurally disadvantaged communities—have increasingly moved from a model of “liberal consent” or “democratic” policing to one that emphasizes authoritarianism and the imposition of crime control tactics. This increasingly coercive brand of policing has, in many communities, resulted in a loss of legitimacy and cooperation and caused the police to be viewed as something akin to an environmental hazard—i.e., something to be avoided.

Research in community health often shows structural disadvantage to be among the strongest covariates of health behaviors, often as a result of the social isolation that accompanies severe and sustained systemic resource deprivation. Criminology and justice researchers have documented the col-lateral effects of aggressive arrest strategies (e.g., increased crime, decreased trust in police) on disadvantaged communities, perhaps due to the perceived legal marginalization that results from those strategies. This study integrates these research traditions to examine the extent to which aggressive drug enforcement was associated with decreased prenatal care utilization among pregnant women residing in communities across the District of Columbia. The study is grounded primarily in the urban ecological/sociological perspectives that anticipate the social isolation effects of neighborhood disadvantage, and assumes that as distrust for formal institutions increases, use of traditional healthcare resources should decrease. The study combined data from the Department of Health, U.S. Census Bureau, and the Metropolitan Police Department in Washington, D.C. to examine several multilevel hypotheses related to drug enforcement and prenatal health behaviors.