“Treating me like a criminal”: A qualitative study of birthing parents' perspectives on racism and biases in newborn drug testing for substance exposure during pregnancy

Abstract

Introduction

Black birthing people are more likely to have their newborns undergo testing for drug exposure with subsequent reporting to Child Protective Services (CPS) and termination of parental rights compared to White birthing people. The study aim was to describe the experiences of people who gave birth regarding newborn drug testing (NDT) and explore the impact of racism and other biases. A secondary aim was to elicit participant recommendations for policy changes to address racial inequities in NDT and CPS reporting.

Methods

This qualitative study is the third and last phase of an explanatory sequential mixed methods study (quantitative phase followed by qualitative phase). We conducted semi-structured interviews with 15 participants who had given birth within the last 12 months at a single academic hospital in the midwestern United States. We purposefully sampled racial minorities and those who went through NDT to ensure their perspectives were represented. Our interview guide, data collection, and reflexive thematic interpretation were informed by the Public Health Critical Race Praxis and the Levels of Racism framework. A six member Participatory Council and two external antiracist research consultants provided guidance on study activities and data interpretation.

Results

We identified four major themes: 1) being honest about substance use with healthcare providers can lead to punishment and CPS reporting; 2) historical and contemporary racism perpetuate negative stereotypes about Black patients, contributing to racial disparities in NDT; 3) the medical and legal risks of recreational cannabis use in pregnancy were not clearly explained by healthcare providers; 4) participants advocated for non-punitive, respectful, and early care for substance use during pregnancy, including a clear explanation of local NDT and CPS reporting policies.

Conclusions

Our findings highlight the need for policy changes to decriminalize newborn drug testing and address systematic racism and bias against Black parents throughout the process. Participants identified a need to improve early access to non-judgmental substance use counseling and treatment that includes clear and consistent guidance about NDT and in particular, the health and legal implications of cannabis use during pregnancy.