Georgia referred nearly 18,000 cases involving alleged substance use during pregnancy to police or prosecutors over a six-year period, the highest total among 21 states included in a national analysis by The Marshall Project.
That finding is significant. It is also easy to misread.
The data does not establish that Georgia has the highest rate of prenatal drug use in the country. It measures how often child-welfare agencies sent allegations to law enforcement in states where reliable referral data could be verified.
What the six-year analysis found
The Marshall Project compiled state and federal child-welfare data covering federal fiscal years 2018 through 2023, or Oct. 1, 2017, through Sept. 30, 2023. Across 21 states, agencies referred at least 70,778 reports involving alleged substance use during pregnancy to police or prosecutors.
Georgia had the largest raw total, at nearly 18,000 referrals. The analysis estimated that roughly 1 in 42 births in Georgia was connected to such a referral during the six-year period.
Georgia did not have the highest referral frequency. The Marshall Project found the greatest frequency in Oklahoma, where roughly 1 in 24 births resulted in a referral.
Why policy matters
The referral process often begins when a patient or newborn has a positive drug test at a hospital, although the underlying data can also include admissions of drug use or other reasons for concern. Hospitals generally report those concerns to child-welfare authorities, and state policy determines when those allegations are also shared with law enforcement.
The Marshall Project identified Georgia as one of 13 states where child-welfare policy requires pregnancy substance-use allegations to be shared with police or prosecutors, regardless of how the child-welfare review ultimately turns out.
That distinction matters because a referral to law enforcement is not the same thing as a finding of abuse, an arrest or a conviction.
Many referred cases did not end with an abuse finding
Across 15 states where reliable outcome data was available, The Marshall Project found that about 55% of referred cases did not result in a child-welfare finding that abuse or neglect occurred. Even so, law enforcement had already received the reports.
The investigation also highlighted concerns about hospital drug screens, including false positives and results that can be affected by legal medications or other substances. No state requires confirmatory testing in every case before a child-welfare referral is made, according to the reporting.
Race is part of the Georgia story too
A separate Marshall Project analysis of eight states, including Georgia, found that families of Black newborns were more likely than families of White newborns to be referred to law enforcement over alleged prenatal substance exposure. The data does not identify one single cause for the disparity, but prior research cited by the investigation points to differences in testing, reporting and treatment throughout the child-welfare system.
What this number does and does not mean
The safest way to understand Georgia's ranking is this: Georgia had the highest number of police or prosecutor referrals among the 21 states in this verified data set.
It should not be rewritten as "Georgia has the most prenatal drug use." Referral totals can be shaped by state law, hospital screening practices, reporting rules, enforcement systems, population and other factors.
The Georgia question is not only how many allegations were made. It is how state policy moves those allegations from hospitals and child-welfare agencies into the criminal-justice system, sometimes before the underlying facts have been fully reviewed.