Faulty Hospital Drug Tests Disproportionately Flag Black Newborns to Law Enforcement, Analysis Finds
核心洞察
The Marshall Project (搜索)'s analysis of child welfare data from eight states found Black newborns are approximately 2.5 times more likely than White newborns to be referred to law enforcement over alleged pregnancy substance use.
Hospital urine drug tests used at childbirth are notoriously unreliable, producing false positive results up to half the time, yet routinely trigger child welfare and police referrals.
Over a seven-year period, more than 14,000 cases involving Black newborns were sent to law enforcement even though child welfare authorities did not conclude abuse or neglect occurred.
A sweeping new analysis by The Marshall Project (搜索) reveals that mothers of Black newborns are far more likely than those of White newborns to be referred to law enforcement over allegations of substance use during pregnancy—often based on unreliable hospital drug tests that produce false positive results as much as half the time.
The investigation, conducted in collaboration with CBS Sunday Morning, examined child welfare data from eight states and found that Black babies are approximately two and a half times more likely than White babies to be flagged to police over claims of substance exposure in the womb. Over a seven-year period spanning mid-2018 to mid-2024, child welfare agencies across 20 states referred the parents of more than 25,000 Black newborns to police or prosecutors over alleged pregnancy substance use.
"The referrals are often the result of unreliable hospital drug tests performed at childbirth that are easily misinterpreted and produce false positive results as much as half of the time, which can prompt incorrect reporting to child welfare and law enforcement authorities," the analysis found.
Racial Disparities Across All Eight States
In all eight states with sufficiently detailed data—California, Georgia, Kentucky, Minnesota, Ohio, Oklahoma, South Carolina, and Texas—referrals were more common when cases involved Black families. In Oklahoma, an estimated 1 in 11 Black babies were flagged to law enforcement over accusations of pregnancy substance use. In Minnesota, the families of Black newborns were estimated to be about three and a half times more likely than those of White newborns to be referred to police.
Critically, child welfare agencies can refer allegations to police or prosecutors even when their investigations clear the parents or find no evidence of an urgent threat. The Marshall Project (搜索) found that in the eight states analyzed, more than 14,000 cases involving Black newborns were sent to law enforcement agencies over seven years even though child welfare authorities did not conclude that child abuse or neglect occurred.
Among families referred to law enforcement, child welfare agencies were 25% more likely to dismiss or divert pregnancy substance use allegations made against Black families compared to White families. In Kentucky, child welfare workers were 38% more likely to close a case without a finding of abuse or neglect when the newborn was Black.
The Role of Unreliable Testing
Hospital urine drug tests—the pee-in-a-cup screens routinely administered to people giving birth—are notoriously imprecise. The Marshall Project (搜索)'s reporting documented how these tests can be triggered by legal substances, including prescribed medications, over-the-counter products, CBD gummies, and even poppy seeds.
Two cases from a single hospital near Myrtle Beach, South Carolina, illustrate the disparity. In July 2024, a Black mother and her newborn at Tidelands Waccamaw Community Hospital tested positive for THC. The hospital reported her to the state Department of Social Services, which referred her to law enforcement, and she was arrested days later on a charge of child abuse. Two months later, a White woman at the same hospital tested positive for the same substance. This time, a child welfare investigator told police the agency did not want to press charges after the patient explained she had consumed a single CBD edible purchased at a store.
Marijuana testing in particular floods the system with families unlikely to harm their children, according to Joseph Ryan, a professor of social work at the University of Michigan. Ryan co-authored a study finding that parents of Black newborns were more likely to be reported to child welfare over positive marijuana tests but rarely went on to commit child abuse or neglect. "There's really no reason to be testing for THC," Ryan said, noting that alcohol has far more detrimental effects on a developing fetus yet hospitals rarely screen for it.
Drivers of Disparity
The data does not spell out why cases against Black families are more common, but decades of research has shown racial disparities embedded through every step of the child welfare process. Black women are more likely than White women to be drug tested at childbirth and reported to child welfare authorities, more likely to be investigated, and more likely to be separated from their children, previous studies have found.
The Marshall Project (搜索) interviewed more than a dozen doctors, researchers, and parent advocates. Most pointed to the fact that hospitals disproportionately drug test and report Black mothers and babies. Racial bias and poverty also play a role, with providers more likely to report someone they perceive as lacking financial or social support.
"It's not about what you do, what substances you use, how much you're using, whether you're using, but it's about who you are," said Miriam Mack, senior legal counsel at the advocacy group Movement for Family Power (搜索). "It's about the simple fact that you are Black and you have given birth in the hospital."
Policy Landscape and Reform Efforts
Drug testing of pregnant women began in the 1980s during the crack epidemic, when fears of "crack babies" spurred state laws classifying substance use during pregnancy as child abuse or neglect. During the opioid epidemic in the early 2000s, hospital drug testing policies expanded again, with Congress directing states to identify all newborns "affected by" substance use, whether illegal or not. As a result, more parents are now reported to child welfare over positive tests triggered by legal substances.
Seven of the eight states included in the analysis have policies requiring child welfare to automatically share cases of pregnancy substance use with law enforcement, even if the allegations are unfounded. Those referrals typically occur before child welfare has completed its reviews of the cases.
Earlier this year, following The Marshall Project (搜索)'s reporting, New Jersey began requiring hospitals to confirm drug screens with more precise tests prior to sharing results with child welfare authorities. The state also instructed providers to obtain informed consent before drug testing pregnant patients and confirmed that a positive result alone does not constitute child abuse or neglect.
Leading medical groups advise against routine drug testing of pregnant women. Such tests do not prove that someone has an addiction and are often conducted without a patient's knowledge or consent. Instead of funding punishment through costly child welfare or criminal cases, advocates said officials should fund family support services, such as drug treatment programs that offer childcare and food assistance.
"The sheer fear of living with being investigated by the police, of living with being investigated by CPS—that in and of itself is the harm," Mack said. "The impact that that has on a person's body, a person's health, a person's well-being, that's the harm."