Black pregnant patients were more likely to receive a urine toxicology test during labor and delivery than white patients—regardless of their history of substance use—according to a new research letter published in JAMA Health Forum. 

Researchers reviewed electronic medical records of more than 37,000 patients with a live or stillbirth over a 3-year period in a large health care system in Pennsylvania. While Black patients were tested more often, white patients with a history of substance use were more likely to have a positive test than Black patients with similar histories.

“There’s no medical reason for Black patients to have a higher rate of testing than white patients,” said Marian Jarlenski, PhD, of the University of Pittsburgh School of Public Health, the lead author of the letter. “People deserve to have a supportive, dignified birth experience, without biased and unnecessary testing.”

Urine toxicology tests are often performed without explicit consent of patients. They can trigger an array of consequences, from criminalization of birthing people to involvement of the child welfare system and separating parents from their children. These burdens fall most heavily on Black people and other people of color.

“These testing policies don’t improve health outcomes for parents and babies,” said Sarah Roberts, DrPH, of Advancing New Standards in Reproductive Health at the University of California, San Francisco, a co-author of the research letter. “The threat of punishment scares people away from getting the care they need to have healthy pregnancies.”

State legislatures in California and New York are considering laws to require informed consent for testing pregnant people and newborns for substances. To address racial biases, health care systems should examine their drug testing policies and adhere to evidence-based practices.