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What factors influence providers to report alcohol and drug use during pregnancy to health authorities, police, or CPS?

One effect of the Dobbs decision is nearly certain: more people will be surveilled, reported, and criminalized for activities during pregnancy. Research has found that harms related to alcohol and/or drug (AOD) use during pregnancy are not limited to use, but from policies and health care practices adopted in response, including reporting to Child Protective Services (CPS). A recent study from ANSIRH aims to learn more about provider decision-making around prenatal substance use reporting.

Key Findings

Most physicians saw reporting to Child Protective Services (CPS) as someone else’s job, primarily social workers.
A few physicians saw CPS reporting as connecting people to services.
Many physicians were aware of negative consequences of CPS reporting.
Physicians were more worried about potential harms to babies if CPS reports were not made.
Interpersonal, organizational, and policy factors constrain reporting decisions.

Study Design

The research team conducted 37 interviews with hospital-based obstetricians/gynecologists, family medicine physicians, and emergency department physicians, focused on experiences with reporting pregnant/birthing people with AOD to government authorities.


Social, structural, and policy changes are needed, considering that many of the factors that influence physician decision-making in reporting pregnant/birthing people who use AOD to CPS are outside the control of individual physicians. While a few participants associated reporting with connecting people to resources and services, many participants expressed awareness of negative consequences associated with reporting. Moreover, participants were much more concerned about potential harms to the baby associated with not reporting.

Participants shared the following:

"Because of the institutional policy, we have to report everybody with an illicit substance use.”

“If we report these patients they won’t come in when they’re using these substances and they won’t seek care…”

“The big thing that kept crossing my mind as I thought about not reporting was just what if something were to happen to the baby.”

The article, Health care provider decision-making around prenatal substance use reporting, is available in Drug and Alcohol Dependence.