Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Ann Fam Med. 2024 Jul-Aug;22(4):271-278. doi: 10.1370/afm.3139.
Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices.
We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis.
We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making.
Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.
黑人生育父母及其新生儿被医疗保健专业人员（HCP）进行新生儿药物检测以筛查产前物质暴露的比例过高，这导致儿童保护服务（CPS）的报告、家庭分离和父母权利终止。本定性研究旨在通过探索 HCP 和 CPS 专业人员对结构种族主义对新生儿药物检测实践中不平等现象的影响的知识、态度和经验，探究主导权力结构。
我们对 30 名医生、助产士、护士、社会工作者和 CPS 专业人员进行了半结构化访谈，访谈内容由解释性框架指导，并进行了归纳性、反思性主题分析。
我们确定了 3 个主要主题：（1）医院结构之外的种族主义程度导致黑人新生儿药物检测率更高；（2）医院政策不一致导致州法律的种族化应用和下游 CPS 报告；（3）医疗保健专业人员对 CPS 报告对黑人家庭的好处和不成比例的危害的了解影响了他们的决策。
医疗保健专业人员认识到结构种族主义是新生儿药物检测不成比例的驱动因素。HCP 缺乏知识和技能限制是破坏权力结构的障碍，从而阻碍了系统层面的变革。制度变革应将重点从生物检测和报告转移到通过以家庭为中心的物质使用治疗来满足生育父母和孩子的共同需求。需要州和联邦政策的改变，以确保黑人家庭的健康公平，并在不存在虐待和忽视儿童的情况下消除因产前物质暴露而向 CPS 的报告。
