Reporting requirement type matters: associations between distinct reporting requirements and birth outcomes in the U.S

Background In the context of the maternal overdose crisis and concerns that child welfare reporting is a barrier to care and treatment, current policy discussions in the U.S. focus on alternatives to child welfare reporting requirements. Thus, we examine associations between different state-level reporting requirements and birth outcomes and prenatal care utilization. Methods We use U.S. state-level policy data from the Alcohol Policy Information System and outcome data from vital statistics birth certificate records from 2000–2019 to examine relationships between three reporting requirement types (assessment/treatment, data, and child welfare) related to alcohol and, separately, related to drugs, with birth outcomes and prenatal care utilization. Linear and logistic regression models included individual- and state-level controls, state- and year-fixed effects, state-specific time trends, and clustered standard errors by state. Findings For both alcohol- and drug-related reporting requirements, we did not find associations between reporting requirements and birthweight or low-birthweight, mostly did not find associations with prenatal care, but did find associations with gestation, preterm birth, and low APGAR. We found reporting requirements for assessment/treatment were generally associated with improved birth outcomes, reporting requirements for child welfare were not associated with birth outcomes, and reporting requirements for data were mostly associated with increased adverse birth outcomes. Findings differed by race/ethnicity, with only improvements seen among white, Hispanic, and Other/missing race/ethnicity births and mixed effects among Black and Asian/Pacific Islander births. Conclusions Relationships between reporting requirements and birth outcomes vary across reporting requirement type, with the most benefits associated with reporting requirements for assessment/treatment.