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Insights: Prenatal Drug Testing and Reporting: What does the Child Abuse Prevention and Treatment Act (CAPTA) actually require of healthcare providers?

Written by Rebecca Wang, JD, Senior Legal Support Counsel and Lauren Paulk, JD, Senior Research Counsel

Mandatory reporting is not an evidence-based practice. Neither is punishing providers for a failure to report. Still, healthcare provider reports to Child Protective Services of infants have increased substantially over the last decade.¹ This is despite only two states requiring, by law, drug testing of pregnant and birthing parents, and only four states requiring drug testing of newborns in certain circumstances (Minnesota, North Dakota, Louisiana, and Wisconsin).

Child abuse and neglect is real, but the current system is failing. It perpetuates harm against families, primarily focusing on surveillance and family separation instead of support and family preservation. Less than 2 in 10 children who enter the foster system do so due to physical or sexual abuse.² The vast majority of removals are poverty-adjacent, including removals based on substance use without evidence of actual harm, as well as “overcrowded housing, missing school, wearing dirty clothes, going hungry, or being left at home alone.”² Often, these reports are not rooted in neglect, but rather, a lack of access to reliable and affordable community resources.

Currently, providers have to navigate a labyrinthine web of federal, state, institutional, and agency-specific policies to figure out what their reporting obligations are for prenatal substance exposure. A new resource from If/When/How dives into the drug testing and reporting requirements for prenatal substance exposure in all fifty states, and attempts to demystify reporting requirements under the federal Child Abuse Prevention and Treatment Act (CAPTA). This new reporting resource aims to distill the essential information providers need to know when assessing their reporting obligations, including clearly defined legal terms and summaries of relevant information from case law and agency guidance.

Overall, outside of additional reporting requirements your organization may have, providers can help patients maintain their agency and confidentiality while navigating reporting obligations by:

  • Not reporting patients if not legally required
  • Informing patients of what the provider may have to report prior to testing/treating the patient or neonate
  • Obtaining informed and documented consent around parental and neonatal drug testing
  • Carefully considering what information is necessary to document in a medical chart
  • Advocating to ensure that their institutional reporting policies do not conflict with state laws on medical privacy.

RHAP Resources:

Approach to Patients Undergoing Self-managed Medication Abortion

Self-Managed/Self-Sourced Abortion: What Clinicians Need to Know

Non-RHAP Resources:

Prenatal Drug Exposure: CAPTA Reporting Requirements for Medical Professionals

Confronting Pregnancy Criminalization: A Practical Guide for Healthcare Providers, Lawyers, Medical Examiners, Child Welfare Workers, and Policymakers


1. Edwards F, Roberts SCM, Kenny KS, Raz M, Lichtenstein M, Terplan M. Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data. Health Equity. 2023;7(1):653-662. Published 2023 Sep 29. doi:10.1089/heq.2023.013

2. Carmon I. Dorothy Roberts Tried to Warn Us. Intelligencer. Published September 6, 2022.

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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