Racial Disparities in Newborn Drug Testing and Prenatal Care

Black pregnant women are drug tested more often than white ones are…one and one-half times more, to be precise. (Axios)

Black babies are referred to Child Protective Services (CPS) more often than white ones are…two times more, to be precise. (NCBI)

Yet, all the testing and referrals aren’t helping.

Black mothers experience a greater percentage of pregnancy-related deaths than white ones do…three times more, to be precise. (KFF)

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And, Black neonates die at a higher percentage than white ones do…two times more, to be precise. (KFF)

There’s something wrong with our system.

Michigan Medicine’s Department of Family Medicine and Antiracism and Health Equity Program determined that “Newborns born to white parents were 24% less likely to receive a drug test than those in Black families […], but were more likely to have a drug test positive for opioids” and “Positive newborn drug tests for THC increased across all racial and ethnic groups after its legalization […], up from 50% to 69%. About two in five newborn drug tests were positive only for THC, with Black newborns more likely to have a positive test than white newborns.” (IHPI)

States have been required, through the United States Child Abuse and Prevention Treatment Act (CAPTA), to establish policies to identify newborns who’ve been affected by parental substance use disorders or prenatal substance exposure (PSE), but the resulting policies are a mish-mash of good, bad, and indifferent, oftentimes leading to more structural racism or missing the PSE completely.

Umbilical cord tissue provides a wealth of information with a long look-back period…longer than any other drug test (MomBaby), which goes far in determining if there’s been prenatal substance use, but why does it matter?

MomBaby.org, a collaborative from the University of North Carolina School of Medicine for Maternal and Infant Health, indicates that “20% of pregnant women use illicit drugs during pregnancy. Polysubstance use is a common phenomenon during pregnancy.” (MomBaby)

MomBaby says that testing should occur when any of the following occurs with the mother:

Mothers prescribed opiates during their pregnancy
History of drug abuse within the last 12-18 months
Prenatal care starting after 16 weeks or fewer than a total of four prenatal visits
History of child abuse, neglect, or court-ordered placement of other children outside the home
History of domestic violence
History of hepatitis, human immunodeficiency virus, syphilis, or prostitution
Unexplained placental abruption
Acute maternal alcohol intoxication observed around the time of delivery

And that testing should occur when any of the following happens with the infant:

Unexplained intrauterine growth restriction
Infants with evidence of drug withdrawal such as hypertonia, irritability, or tremulousness

However, there’s an overarching question regarding these standards: how would you possibly know? We know that simply asking someone if she’s used substances is a poor way to get an accurate answer. (Using)

What would a pregnant woman on the verge of delivering a baby say if she were asked if she has a history of drug abuse within the last 12-18 months? How about if she’s asked about her history of child abuse, neglect, or court-ordered placements of children outside the home? History of domestic abuse or prostitution?

I’m no doctor, but it feels as though those questions may not be answered honestly, ESPECIALLY when one suspects the outcome of a “yes.” And once a neonate is showing evidence of withdrawal, a test is too late because the sample to be tested is no longer available.

We have the tools to do better, but they need to be implemented across the nation, not in tiny pockets. Some states are developing good policies, and some states are reinventing the wheel. Meanwhile, mothers and babies are dying.

We have got to do better.

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