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

Carol Shetty; Lauren Oshman; Amanda Costa; Victoria Waidley; Emily Madlambayan; Madgean Joassaint; Katharine McCabe; Courtney Townsel; Justine P. Wu; Christopher J. Frank; P. Paul Chandanabhumma

doi:10.1370/afm.3139

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RE: An important piece!
Anthony N Fleg

Published on: 22 August 2024
RE: “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” by Shetty et al
Naomi S Kasturiarachi

Published on: 20 August 2024

Published on: (22 August 2024)
Page navigation anchor for RE: An important piece!
RE: An important piece!
Anthony N Fleg, Family medicine physician, University of New Mexico
Thank you for the article that highlights so well the different levels at which racism affects NDT, and for highlighting the disproportionate downstream consequences of that testing on Black families. If we were to move to universal testing, for instance, we would still have the racism of CPS and of the criminal justice system that would prevent this practice being equitable. As someone who studies and practices the importance of strength/asset-based approaches as a tool for antiracist practice, I am excited that you listed "deficit-based approaches" in your schematic. A place of intervention within HCP training programs is that we begin to teach and practice strength-based approaches among HCP. Our deficit-based approaches that focus on pathology and risk factors is steeped in white supremacy and serves to enforce and perpetuate structural racism. Let us begin to look at what people and communities, including pregnant parents do well, instead of focusing exclusively on risk factors, addictions, and disease.

Competing Interests: None declared.
Published on: (20 August 2024)
Page navigation anchor for RE: “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” by Shetty et al
RE: “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” by Shetty et al
Naomi S Kasturiarachi, Family Medicine Resident Physician, OhioHealth Riverside Methodist Hospital
“Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” shares a thorough qualitative analysis of how structural racism via disproportionate substances testing and subsequent child protective service (CPS) referrals impacts Black families. [1] Marijuana is a frequently highlighted substance in the article’s study. Black families were disproportionately tested for marijuana, leading to higher positive screens and negative downstream ramifications. The recent federal decriminalization of marijuana should be considered when enacting policy regarding substance testing. Doing so may aid in deconstructing racist policy for Black birthing families.

19% of Americans have used marijuana at least once. [2] Marijuana was disproportionately screened for in Black birthing families, though the article has shown that their white counterparts use it just as frequently. In May 2024, the federal government moved to decriminalize marijuana from a Schedule I to Schedule III substance. [3] Tobacco has similar prenatal risks compared to marijuana. Both substances are associated with increased rates of neonatal intensive care unit admissions, lower APGAR scores, lower birth rates, and higher incidence of stillbirths. [4] Since there is no national standard of policy that recommends substance testing on intrauterine tobacco exposure, there should not be for marijuana either. Current American College of Obstetrics and Gynecology...
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“Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” shares a thorough qualitative analysis of how structural racism via disproportionate substances testing and subsequent child protective service (CPS) referrals impacts Black families. [1] Marijuana is a frequently highlighted substance in the article’s study. Black families were disproportionately tested for marijuana, leading to higher positive screens and negative downstream ramifications. The recent federal decriminalization of marijuana should be considered when enacting policy regarding substance testing. Doing so may aid in deconstructing racist policy for Black birthing families.

19% of Americans have used marijuana at least once. [2] Marijuana was disproportionately screened for in Black birthing families, though the article has shown that their white counterparts use it just as frequently. In May 2024, the federal government moved to decriminalize marijuana from a Schedule I to Schedule III substance. [3] Tobacco has similar prenatal risks compared to marijuana. Both substances are associated with increased rates of neonatal intensive care unit admissions, lower APGAR scores, lower birth rates, and higher incidence of stillbirths. [4] Since there is no national standard of policy that recommends substance testing on intrauterine tobacco exposure, there should not be for marijuana either. Current American College of Obstetrics and Gynecology recommendations are simply to screen for tobacco use during pregnancy and to assist with cessation. [5] Marijuana use can be treated similarly, which would lead to decreased discriminatory substance testing and subsequent CPS referrals that place undue bias against Black birthing families.

With the decriminalization of marijuana, our efforts should focus on encouraging cessation with structured resources rather than punitive action with biased substance testing. Evidence-based interventions may include patient-centered motivational interviewing and cognitive behavioral therapy sessions. Shifting hospital policies to focus on support will overall reduce discriminatory CPS referrals for Black families. These actions will aid in the dismantling of racist policies in the newborn nursery.

References
1. Shetty, Carol, et al. “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.” The Annals of Family Medicine, vol. 22, no. 4, 1 July 2024, pp. 271–278, www.annfammed.org/content/22/4/271, https://doi.org/10.1370/afm.3139.
2. Substance Abuse and Mental Health Services Administration. “2021 NSDUH Annual National Report | CBHSQ Data.” Www.samhsa.gov, 4 Jan. 2023, www.samhsa.gov/data/report/2021-nsduh-annual-national-report.
3. “U.S. Drug Enforcement Administration Proposes Reclassification of Marijuana | Insights | Holland & Knight.” Www.hklaw.com, www.hklaw.com/en/insights/publications/2024/05/us-drug-enforcement-admin....
4. Zoorob, Roger, and Jeffrey D. Quinlan. “Cannabis Use during Pregnancy.” Family Practice Management, vol. 31, no. 4, 2024, pp. 19–21, www.aafp.org/pubs/fpm/issues/2024/0700/cannabis-during-pregnancy.html.
5. “Tobacco and Nicotine Cessation during Pregnancy.” Www.acog.org, www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/...
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Competing Interests: None declared.