Linking illicit substance misuse during pregnancy and child abuse: what is the quality of the evidence?

• Published in: Child & family social work 2014-05, Vol.19 (2), p.136-148
• Main Authors: De Bortoli, Lillian, Coles, Jan, Dolan, Mairead
• Format: Article
• Language: English
• Subjects: Australia; Child Abuse; Child abuse & neglect; Child protection; Child Safety; Child welfare; Child Welfare Services; Decision making; Drug abuse; Drug Use; Empirical research; Ethnicity; Evidence; Evidence Based Practice; Family; Intervention; Legislation; Literature Reviews; Pregnancy; Risk Assessment; Social security; Social support; Substance Abuse; substance misuse during pregnancy; U.S.A
• ISSN: 1356-7500; 1365-2206
• DOI: 10.1111/cfs.12002

In most Australian states, legislation makes provision for professionals to report their concerns about the future welfare of an unborn child to appropriate authorities. The legislation establishes guidance for the implementation of family supports to minimize future child protection involvement. Given the legislation and the potential benefits, empirical research linking substance misuse during pregnancy and child protection involvement is relatively limited. We review 21 original studies linking substance misuse during pregnancy with child protection outcomes and the potential generalizability of results to the Australian context. The majority of studies reviewed were conducted in the USA and were mostly retrospective. Other differences between studies include sample sizes, comparison groups, study setting, participants’ ethnicity and pattern of drug use. In the postnatal literature, it is well established that child abuse is associated with a complex array of factors including partner, as well as broader family factors and yet, the studies reviewed focus upon maternal substance abuse without including the wider context. Given the available evidence‐based literature, it is difficult to come to definitive conclusions that can assist clinicians involved in frontline decision‐making for early intervention. Well‐designed research, accessible by antenatal health‐care professionals, is needed to adopt an evidence‐based approach to risk assessment in the prenatal context.