This report examines how policy in Canada deals with the issue of substance use during pregnancy and suggests alternative ways of addressing this problem that may prove less polarizing and punitive toward women. One focus of this project has been to analyse the Supreme Court of Canada case of Ms. G. (October 31, 1997), in which a judge ordered mandatory drug treatment for a young, low-income Aboriginal woman who was addicted to sniffing solvents; both the Majority and Minority judgments and the media coverage of the case were examined through a discourse analysis. Another important component of the project has been to uncover the experiences of substance use, pregnant women and the practitioners who work most closely with them, and to hear their ideas about approaches that make a positive difference. A final and important component has been an in-depth case study, carried out in one Aboriginal community to determine approaches that have a chance for success in that community. The project has also aimed to address the challenge of integrating diversity into policy research, development and analysis. Our project resulted in a number of important directions for policy and practice, and our report concludes by providing a set of recommendations grounded in the experiences of the people directly affected by the issues, which,we submit, will help ensure the proposed directions’ relevance and ultimate success.