Eliminate Systemic Inequities for Black Mothers With SUD

Systemic inequities and biases within health care and social services significantly contribute to the disproportionate impact of punitive child welfare system (CWS) policies on pregnant Black women with SUD. Key factors include:

• Greater surveillance in publicly funded services: Black women are more likely to rely on publicly funded clinics and hospitals, which are subject to increased government oversight. This leads to heightened scrutiny from social service agencies, health care providers and law enforcement.
• Inconsistent drug screening criteria: The lack of standardized, nationwide drug screening protocols leaves room for bias in deciding which women and infants are tested for substances. States vary in their requirements for evidence of drug exposure to report a case to the child welfare system. Historical factors, such as media coverage of the 1980s “crack baby epidemic,” have reinforced stereotypes, resulting in the overscreening of Black women and their infants.
• More maltreatment reports: Punitive prenatal substance use policies are linked to a 19% increase in infant maltreatment reports, disproportionately affecting Black infants. In states with such policies, Black parents experience almost double the rate of infant maltreatment allegations compared to white parents.
• Systemic biases in response: Biases in how the child welfare system assesses and responds to parental substance use often result in overreporting of families of color, harsher interpretations of substance use, more punitive actions and less consideration for cultural factors or community support. Black families experience increased rates of custody loss, longer stays in foster care for their children, lower odds of reunification and higher rates of termination of parental rights.
• Disparities in access to services and outcomes: Black women face greater challenges in accessing appropriate treatment and support services.

SUDs often correspond with factors such as poverty, racial trauma and co-occurring mental health challenges. These combined issues intensify health disparities for Black mothers, who are already navigating systemic inequities and biases. Black mothers experience a higher incidence of maternal mental health issues, like postpartum depression and anxiety, compared to national averages. This is compounded by a lack of access to quality health care and mental health services in many Black communities, which exacerbates the problem of untreated co-occurring disorders.

Chronic stress from racism and discrimination increases Black women’s vulnerability to substance use and mental health challenges during pregnancy. The intersection of substance use and involvement in the criminal justice and child welfare systems creates compounding trauma for Black women, often perpetuating cycles of substance use, poverty and family separation across generations.

Socioeconomic challenges further contribute to these disparities, as Black women are disproportionately affected by poverty. This leads to limited access to health insurance for prenatal care and SUD treatment, reliance on publicly funded clinics and hospitals with greater government oversight, and fewer resources to afford legal representation in child custody cases.

Several promising strategies exist to address the inequities Black women with SUD face within maternal health care and child welfare systems. A key approach is to strengthen collaboration between child welfare agencies, substance use treatment programs and community partners, bringing in diverse perspectives to help reduce stigma, address disparities in social drivers of health and create a more coordinated, supportive system of care. Incorporating peer specialists and involving people with lived and living experience — particularly Black women — across health care and child welfare systems is another critical step to reduce systemic inequities, improve engagement and ensure culturally responsive care.

To build on these efforts, it is essential to provide regular training on culturally responsive SUD treatment within health care systems, as well as training for social service professionals on how to conduct comprehensive family assessments. Trainings should emphasize the role of implicit bias and the compounded inequities Black pregnant women with SUD often face. Additionally, expanded data-driven initiatives — and transparency around the findings — are needed to identify and begin to address disparities. Hospitals can collect race and ethnicity data on whom they drug test and report to child welfare agencies, while also ensuring that patients receiving medication for SUD are not penalized due to being reported.