Abstract
Prenatal substance use, specifically opioid and excessive alcohol use, can cause significant adverse effects for the unborn foetus in both the short-and long-term. Responses by state social systems occur on a spectrum of prevention and early intervention to support mothers. Some but not all states include reporting duties, so that professionals made aware of the situation may alert agencies that can intervene to provide appropriate support. This article will review legal duties to report maternal substance use during pregnancy in the US and Australia. We identify variations in these laws regarding who is required to report, what circumstances must be reported and what indicates child abuse or neglect. Inconsistencies in laws raise questions about the nature of different approaches, and how reforms might be made to improve provision of support. Informed by the medical literature, the contemporary context and federal policy in the US, we make recommendations for reform, and for the appropriate response to such reports.