In response to the police violence against black people, the uproar over America continues, we have reached for a moment for many Americans. As a nation, we are struggling to find a way forward. Several organizations have issued statements of solidarity and made promises of support as a first step. Individual practitioners and physician organizations have joined the effort, speaking out against police violence and naming racism as a public health issue or crisis. Organizations including the American Academy of Pediatrics, the American Medical Association and the American College of Physicians have issued statements calling for police vandalism, condemnation of violence against protesters, and inquiries into police violence cases against black people .
This is new territory for most medical organizations, which have traditionally been conservative, often self-described as non-partisan, and have historically shied away from public advocacy efforts focused on social justice. The medical profession has long emphasized its fairness, fairness and impartiality. But as a black woman and a doctor, I know that these depictions have never been accurate. In fact, all of medicine, including my chosen field of obstetrics and gynecology, has deep racist and exploitative roots. The notion that medical providers are fair and objective is to practice within a profession free from the legacy of racism, genocide, and white supremacy.
This egoistic scene has caused a lot of damage. In addition to preventing us from identifying and exposing racist beliefs and implicit prejudice in medical systems, it has allowed us to continue to quietly funnel our patients and their families into the criminal legal system to counter our statements of solidarity . It is not only interactions between black people and law enforcement outside the hospital that endanger our patients, it is also the criminalization of patients within the health care system. This criminalization can be particularly harmful in the context of pregnancy, childbirth and reproductive health.
Legislative and policy concerns regarding substance use during pregnancy have been debated since the 1980s. State policies mandating the reporting of mothers using drugs and alcohol during pregnancy became racialized during the “crack” cocaine epidemic in the 1990s. Black mothers were specifically targeted with punitive action for substance use during pregnancy. Their children were made villains as “superprinters” and despite the lack of medical evidence to support “crack baby syndrome”, they were written off for failing as criminals. As black women became the face of substance use during pregnancy, calls for a carcinal response were increased, and families and communities were disbanded.
Racial misinterpretation of substance use in pregnancy has continued to have far-reaching negative effects. Kali and indigenous women are more likely to investigate illegal substance use to women who care in pregnancy.1 Such tests – often ignored and performed without explicit consent – result in parents losing their children or becoming inconsistent. Even policies that implement universal testing as a solution do not eliminate bias in reporting or address underlying racism. Despite similar rates of substance use during pregnancy by Black and White women, racial disparities exist at all levels, including initiation of trials, reference to drug treatment programs, and reporting of child protection services (CPS). Health care providers are often the first point of contact between families and the criminal legal system, creating an avenue for entry into a system of state surveillance.
Justification for reporting someone to the CPS for investigation is tied to mandatory state reporting policies. Most compulsory communicators, such as physicians, have been taught that the child welfare system is a fair legal system that ensures the safety and welfare of children. In fact, the clues for reporting, the reasons for the removal of children and subsequent monitoring and surveillance are racially biased, subjective, and paternal. Black families are more likely to report and investigate child abuse and neglect, to have their cases confirmed and to have their children removed from their custody or care.2 In addition, many physicians are cut off from the result for families after referral to CPS. Once under foster care, black children remain in detention longer than white children and typically receive inferior services.3
Obstetrics-gynecologist’s visit to pregnancy care or delivery can be a criminal legal system for parents and an entry point into state custody for children. These referrals occur in a myriad of ways: physicians call CPS when a patient refuses to give consent for prenatal care or a medical procedure during delivery, when the patient is in foster care themselves, when the patient has a child Is included in the former foster system, when the patient is vaccinated, or when the patient has a disability. Such referrals increase the likelihood that children will be taken from families at the time of delivery, and they become a pathway for increased state surveillance. Social workers, state agents, and police are given access to the homes, relationships and lives of these families. After being reported, families remain under investigation, interrogation, segregation and punishment for many years.
Criminalization can also occur if the pregnancy does not end in a live birth. For someone with an abortion or fetal loss, seeking emergency care can lead to bedside inquiries, arrests, and jail time. Out of maliciousness or simply ignorance of reporting requirements, physicians have caused substantial harm to patients by calling law enforcement after pregnancy loss because they suspect the abortion was deliberately induced. Women of color, low-income people, young people, and immigrants are proportionally criminal under these circumstances. Legal Network If / When / How: Lawyer for Reproductive Justice has identified more than 19 states that have criminalized people suspected of ending their pregnancy or helping someone else. Most of these investigations were initiated by health care providers after taking care of someone. Whether or not the investigation causes far-reaching damage leads to them being encroached upon. Arrest records and even misconduct charges can result in job loss and stigma, even if no formal charges have been filed. These charges can be difficult or impossible to remove from state records.
Even when people try to induce their own abortions or seek medical care later, physicians have an ethical and legal responsibility to protect our patients’ health information.4 Instead of sending someone to jail or exposing them to abusive inquiries, we are obliged to ensure that although they decide to end the pregnancy, they can do so safely, effectively and with dignity and respect . Punitive attitudes prevent people from seeking health care, have discriminatory effects on those who are marginalized, and effectively criminalize pregnancy for some communities.
Medical professionals and the care we provide is not uniquely beyond the reach of racism. Nor are Ob / Gyns only putting physicians at risk for criminalization. From being deported after unsatisfied immigrants to criminalizing black men to taking care of themselves or their children and being made aware of their HIV status, medical providers often participate in these efforts. So while we have removed our #WhiteCoatsForBlackLives signs, we should not simply return to participating in the same racist practices and law grounded systems that we want to turn into law enforcement.
As we continue to object to police violence against black communities and work closely with our institutions to support the Black Life, we must also inquire into our active and passive complexity. We should look for ways to reduce our collusion with the carceral system. The effort involves using goals and techniques to reduce harm for patients with substance abuse disorders, including advocating the abolition of universal or mandatory drug testing in pregnant and postpartum people. This means primary prevention of substance use disorder, improved treatment, and family integration, which improves outcomes for families.
The effort should oppose policies that criminalize patients for health care, including self-managed abortions during pregnancy, pregnancy loss, and reporting suspicion of substance use. And we should educate ourselves, our colleagues and trainees about mandatory reporting, its racist history and the pitfalls of its disparate and discriminatory implementation.5
As more Americans call for the destruction or reform of the criminal legal system, we must raise full objection to policies and practices that increase the likelihood of entry into the casserole system through health care institutions. As physicians, we have an important role in this movement.
Herbert Needleman, MD, a physician-scientist whose lead in consumer products was removed due to research…
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