Prenatal Substance Exposure and Reporting of Child Maltreatment, by Race and Ethnicity


In the United States, black infants are reported to child protective services (CPS) at significantly higher rates than other infants. Little is known, however, about the role of prenatal substance exposure on decisions to report. The current study explored whether clinicians were more likely to report black and Hispanic substance-exposed infants compared to white infants. By linking birth, hospital discharge, and CPS records for all black, Hispanic, and white infants born in 2006 in California, we examined racial differences in maltreatment reports among infants with diagnosed substance exposure. Diagnostic codes from hospital records were used to document substance exposure. CPS records provided information on maltreatment reports made during the first 28 days of life (i.e., the neonatal period). The prevalence of infant exposure was calculated by race/ethnicity, substance type, and sociodemographic covariates. Racial differences in maltreatment reporting among substance-exposed infants were estimated using multivariable regression models.

Overview of Findings

Overall, 1.6% of infants born in this cohort had diagnosed substance exposure (7,428 of 474,071). Exposure varied significantly between racial/ethnic groups (p < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most frequently observed substances were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for sociodemographic and pregnancy factors, we found that substance exposed black and Hispanic infants were reported to CPS at significantly lower or statistically comparable rates to substance exposed white infants.

Although we were unable to address potential racial/ethnic bias in screening for substances at birth, there was no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure. Black and Hispanic newborns with prenatal substance exposure were no more likely than white infants to be reported for maltreatment. Findings held across specific substance types and suggest racial/ethnic reporting disparities are minimized in the presence of prenatal substance exposure.


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