Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals

Area of Science:

• Medical Sociology
• Public Health
• Health Equity

Background:

• Black birthing parents and newborns face disproportionately high rates of drug testing for prenatal substance exposure.
• This practice by healthcare professionals (HCPs) contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights.

Purpose of the Study:

• To explore knowledge, attitudes, and experiences of HCPs and CPS professionals regarding structural racism's influence on inequities in newborn drug testing.
• To interrogate dominant power structures contributing to racial disparities in newborn drug testing.

Main Methods:

• Conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals.
• Utilized an explanatory framework and inductive, reflexive thematic analysis.

Main Results:

• Identified three primary themes: racism beyond hospital structures, inconsistent policies leading to racialized law application and CPS reporting, and HCPs' awareness of CPS reporting harms influencing decisions.
• Structural racism contributes to higher drug testing rates for Black newborns.

Conclusions:

• HCPs recognize structural racism as a driver of disproportionate newborn drug testing.
• Barriers to change include HCPs' limited knowledge and skills.
• Institutional and policy changes are needed to focus on family-centered care and eliminate unnecessary CPS reporting for prenatal substance exposure.