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Published on: January 12, 2018
Redefining Child Protection: Addressing the Harms of Structural Racism and Punitive Approaches for Birthing People,
Sarah E Wakeman1, Allison Bryant, Nzinga Harrison
1Department of Medicine, Massachusetts General Hospital, Mass General Brigham, Quality Patient Experience and Equity, Harvard Medical School, and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, and Eleanor Health, Waltham, Massachusetts.
Insights
Racial disparities exist in medication treatment access for pregnant individuals with opioid use disorder. This commentary proposes systemic changes to improve family-based support and reduce biased child welfare reporting.
Area of Science:
- Perinatal health
- Public health
- Social determinants of health
Background:
- Opioid use disorder (OUD) in pregnant individuals and infants is a growing concern.
- Effective medication treatment for OUD is standard care, yet racial disparities persist in access during pregnancy.
- Structural racism influences treatment access and child welfare reporting, disproportionately affecting Black individuals and newborns.
Purpose of the Study:
- To propose an alternative framework for family-based support for pregnant individuals with substance use disorders.
- To advocate for systemic changes in law, policy, clinical care, and ideology to address racial disparities.
- To promote equitable care for the birthing person-infant dyad.
Main Methods:
- This commentary proposes a shift in perspective and systemic changes.
- Recommendations include realigning around supporting the birthing person-infant dyad.
- Specific proposals involve anonymous data collection, limiting perinatal drug testing with informed consent, and integrated care models.
Main Results:
- Current child welfare models often overemphasize substance use as a sole indicator of risk for child abuse or neglect.
- Existing reporting practices contribute to racial disparities in child welfare involvement.
- The proposed changes aim to create a more supportive and less punitive system.
Conclusions:
- Substance use should not be equated with child abuse or neglect.
- Reforming legal, institutional, and clinical practices is crucial to support families equitably.
- Integrated care and hospital policies are needed to foster dyadic care and address systemic biases.
Abstract:
There has been growing attention on the effect of substance use, including opioid use disorder, on pregnant and birthing people and their infants. Although effective medication treatment for opioid use disorder is the standard of care, racial disparities are evident in access during pregnancy. Structural racism affects treatment access and approaches to reporting to child welfare services. Black people and their newborns are more likely to be drug tested in medical settings, and Black newborns are more likely to be reported to child welfare services. Child welfare models often focus on substance use as being the dominant issue that drives risk for abuse or neglect of a child, and current reporting practices, which vary by state, contribute to these disparities. This commentary proposes an alternate way of thinking about family-based support. We suggest changes to law, institutional policy, clinical care, and ideology. Specifically, we propose realigning around shared goals of supporting the birthing person-infant dyad and recognizing that substance use is not synonymous with abuse or neglect; creating an anonymous notification process outside of the child welfare system to meet federal data-collection requirements; limiting perinatal drug testing and requiring written, informed consent for parental and neonatal testing; and developing integrated care teams and hospital settings and policies that support dyadic care.
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