This study assesses the strength of child support enforcement (CSE) in the seven cities included in the Fragile Families study, with a special emphasis on in-hospital paternity establishment. First, using four indicators of the effectiveness of child support enforcement and paternity establishment, I show that Texas has a weak CSE regime compared to the other surveyed states. Second, Texas has a weak in-hospital paternity establishment program compared to a relatively strong regime in California. And third, using a multivariate approach, I show that the critical first step in obtaining increasing paternity establishment--paternity in-take interviews—are positively correlated with increasing the number of staff facilitating acknowledgment. After accounting for hospital practices as well as parents' characteristics, some places still do worse than others. For instance, the analysis suggests that hospitals in Austin, Texas and Newark, New Jersey are significantly worse than hospitals in Oakland, California at approaching unwed parents about voluntary paternity establishment.