Opioid use in pregnancy is the latest in a long list of social issues in the United States that is being addressed with punitive policies that disproportionately affect women of color and their families and do not focus on environmental factors contributing to increasing drug use in pregnancy. Evidence is emerging demonstrating that these punitive policies are not achieving their intended goals. Additionally, these policies continue a trend of pitting maternal and fetal interests against each other. Historically, bioethics has divided conversations on biomedical and environmental ethics. However, recent merging of these fields may facilitate the biopolitical translation of emerging epigenetics research of substance use in pregnancy. This paper reviews the ineffectiveness of punitive policies in reducing drug use in pregnancy and related negative health outcomes for both mothers and infants. It demonstrates how these policies perpetuate racial injustice through existing systemic oppressive structures. Leveraging epigenetics to draw a link between the environment and the maternal-fetal dyad can help members of the scientific community advocate for policies that promote equitable and justice-based public health interventions as well as relieve the maternal fetal conflict. / Urban Bioethics