Every 15 minutes, a baby is born suffering from opioid withdrawal. At least, that was the number in 2014. Given the apparent spike in drug abuse during the Covid-19 pandemic, it’s unlikely that the problem of prenatal drug exposure has improved. And thanks to activists in New York City, we will probably be learning a lot less about it.
According to a new policy, the city’s public hospitals will not be able to test new or expectant mothers for drug use without explicit permission. Private hospitals may follow suit by reducing testing.
Like seemingly every other child-welfare innovation these days, this one, arising from an inquiry by the city’s Commission on Human Rights, is aimed at addressing alleged racial bias. Advocates say that drug testing leads to unnecessary investigations, worsening racial disparities in the child-welfare system. Private hospitals have come under scrutiny because of racial disparities in testing and reporting to child-welfare agencies. Whether these differences are the result of racial bias is an open question, but the notion that we need less testing amid a nationwide drug crisis is deeply misguided.
Doctors and hospital staff currently enjoy broad discretion in deciding whether to test mothers and babies. The federal government doesn’t mandate specific circumstances for drug testing, but the Child Abuse Prevention and Treatment Act requires states to develop criteria for testing and for ensuring that children are safe when they are released from the hospital. In 2019, New York City reported 760 newborns with positive tests to authorities, a tiny fraction of the approximately 120,000 children born. Of those reported, child-welfare authorities found 486 cases, or two-thirds of the total, credible—suggesting that doctors are making reasonable determinations about whom to test.
Lisa Sangoi, co-director and co-founder of the Movement for Family Power, told WNYC that drug testing “targets black and brown communities for policing, surveillance and for control in a way that white and wealthy people who also use drugs at the same rate are rarely if ever policed.” To determine whether this is really true, we’d have to know the precise criteria for testing. Does a parent have to appear intoxicated, smell of alcohol or marijuana, have needle marks on their arms, or admit to recent drug use?
No evidence exists that racial bias is informing decisions about whom to test, but some evidence is suggestive about the kinds of parents that medical professionals report to child-welfare authorities after a positive test. As reported in a 2016 Pediatrics study of California births, “After adjusting for sociodemographic and pregnancy factors, we found that substance-exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance-exposed white infants.” Perhaps hospitals tested only the severest cases of substance abuse in white children. Substance exposure in black or Hispanic infants might also raise fewer alarms, and in that case, perhaps we should worry about racial bias—not in the “targeting” way that Sangoi suggests, but in fact the opposite sense. Do we simply assume that substance abuse is normal in these families? Or do we have a lower standard for the safety of nonwhite infants than for white ones?
It is certainly reasonable to mandate that hospitals get permission before testing, though this could be a form presented at intake rather than a separate process that would make mothers less likely to agree. A good argument can also be made for increasing testing or even making it universal—especially if hospitals are being selective about whom they report to child welfare. The tests could present an opportunity to offer mothers more in the way of counseling and medical help for addiction.
Advocates regularly champion the use of preventive services to ensure that families never need come to the attention of child-welfare authorities in the first place. Prenatal and infant testing could help determine whether these services are effective. Positive tests could result in referrals to rehab programs, counseling, or visits from social workers or nurses in the first few weeks of a child’s life. These kinds of interventions, especially when offered at a life-changing moment for a woman who might want a fresh start for herself and her child, can make all the difference. But if no one knows about the drug problem, then no one can help.
Over the past year, in the Covid context, we’ve been told repeatedly that cutting back on testing won’t make the problem go away. That logic applies equally to prenatal drug exposure.