Abstract
BACKGROUND: State policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients' care seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes. OBJECTIVES: This study sought to characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws. METHODS: We conducted a systematic content analysis of statutes in all U.S. states that mentioned reporting by health care providers of substance use by pregnant women or infants exposed to substances in utero; inter-rater reliability was high. We calculated the number of states, and proportion of U.S. births occurring in states, with processes for mandatory reporting of perinatal substance use to authorities, and substance use disorder treatment provision for individuals who are reported. RESULTS: Twenty states (corresponding with 31% of births) had laws requiring health care providers to report perinatal substance use to child protective authorities, and four states (18% of births) had laws requiring reporting only when a health care provider believed the substance use was associated with child maltreatment. About one-half of states (13) with any reporting law had a provision promoting substance use disorder treatment in the perinatal period. CONCLUSIONS: Findings inform the ongoing debate about how health policies may be used to reduce the population burden of perinatal substance use.