Doctors drug test black and poor families at higher rates, risking family separation

This article was published by TalkPoverty.org and written by Elizabeth Brico.

Ericka Brewington’s youngest child, a boy, was born on August 27, 2017, and it should have been a day of joy for her and her family. But instead of receiving the rest and celebration all new parents deserve, she was separated from her newborn infant. It was not due to an act of abuse or neglect on her part — it was the result of a drug test performed on her infant without her knowledge.

“I was given a stack of papers, and I remember on a couple pieces of paper the words were blurry, this is how much copying was going on. They just said, ‘it’s a normal consent form; if something happens to you and the baby, if the baby’s heart stops beating or yours, do you want us to save you?’ Of course I do, so I signed the form, a bunch of forms.”

Brewington said she was later told those papers included the consent forms that gave her providers permission to drug test her and her child. She said she never saw such consent plainly stated, even when she checked for it after the fact.

Drug testing pregnant and postnatal people and their infants without the patient’s informed consent is a common practice in the United States — but only among certain demographics. Several studies have found that Black women in particular are subjected to prenatal drug testing at higher rates than women in other racial and ethnic demographics, but do not have higher rates of positives. A study published in the February 2004 issue of Child Abuse & Neglect also found several other factors unrelated to drug use that led to higher testing rates, including single motherhood, tobacco use, a history of preterm labor, and a history of child services involvement, among others.

“I provided care in Black and brown communities, so [drug testing pregnant and postnatal patients] was routine, and it wasn’t until I got out and saw the difference in the way care was provided in communities that…were wealthier that it became clear that this is not routine, this is not what everybody does,” said Jamila Perritt, an OB-GYN in Washington, D.C., and the president and CEO of Physicians for Reproductive Health. Perritt also recounted that when she was pregnant, she was not drug tested despite being one of the more commonly-tested demographics (Perritt is a Black woman), which she attributed to her status as a physician.

Now activists are fighting back, saying the practice is rooted in racism and classism, and that it denies patients crucial agency over their care.

“Is our consent truly informed? It can’t be in those reams of paper that people are signing,” said Perritt. “What does it mean if we as physicians say informed consent is one of our core values? …Who would think you’re signing a form that could result in such severe consequences? The truth is that it is a violation of trust to not take the time to name that [drug testing consent is included] and its consequences.”

As Brewington’s case demonstrates, those consequences can be devastating. After her newborn son tested positive for opiates and cocaine, which Brewington admits to using once during the last term of her pregnancy, New York child services placed him into foster care. Although her two older children were out of the state at the time on a vacation with their father, child services ordered her to bring them back and placed them into foster care as well. They are home with their mother now, but Brewington is still fighting to regain custody of her son, who was awarded to his father.

“The medical profession, health profession, that is still one of the top three referrants [to child services],” said Jeyanthi Rajaraman, a parental defense attorney at Legal Services of New Jersey. Rajaraman added: “I’ve asked [at hospitals] when do you drug test and when do you not, and the information that comes out is that ‘if mom shows up and we’ve never seen her and she didn’t do a hospital tour and says she’s had no prenatal care and she’s by herself.’ What I really think they are also saying is Black and poor or no medical insurance because that is the majority of our clients who face and experience drug testing.”

Because child removal data is self-reported by the agencies, which do not track how many removals occur due to hospital drug tests, it is difficult to gauge how often these tests lead to severe consequences on a national level. One report by Movement for Family Power estimates that in 2017, in the Bronx borough of New York City alone, 60 babies under one month of age were removed because of maternal substance use. The United States child services system acknowledges that Black and Indigenous children are markedly overrepresented when it comes to system involvement; between 2000 and 2011, one in nine Black children and one in seven Native American children had been removed from their parents’ care, versus one in 17 white children.

Infants who do experience side effects due to in utero substance exposure, which can occur from both prescribed and non-prescribed substances, fare better when they are able to have close maternal contact. Removing newborns from parents like Brewington because of substance use — a common result of pre- and postnatal drug testing — can decrease feelings of bonding and the parenting sense of competence, and has been linked to some infant cognitive and memory impairment in animal studies. It also leads to decreased ability to breastfeed, which normally helps reduce symptoms of withdrawal in substance-exposed newborns and provides some protection against illnesses, including COVID-19.

Rajaraman noted that she often encounters medical professionals who recognize this reality but are shockingly unaware of how their call impacts the family. “I’ve had many doctors say to me that by calling [child services] they don’t know the baby would be taken, they say ‘I was calling because I thought it would help get mom into [a] program, I would never recommend separation.’”

In 2021, New York State attempted but failed to pass a law that would ban drug testing of pregnant and postnatal people and their newborns without informed consent or a legitimate medical necessity. Activists are planning to push the bill again during the 2022 legislative session. Should it pass, it would require that written consent be obtained at the time of testing and delivered to the patient in a manner that is clear and understandable. It must also include a statement that the testing is voluntary. Activists in Washington State also considered pursuing similar legislation, but decided to table the movement for the time being. Should New York succeed in passing the informed consent bill in 2022, it could pave the way for other states to take necessary action to protect pregnant and parenting people and their infants from non-consensual drug testing.

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