The research also suggests that those reports are also more likely to move forward even when child welfare investigators find no abuse or neglect.
The analysis comes from The Marshall Project, a nonprofit newsroom covering the criminal justice system. The report first appeared in partnership with CBS News, Mother Jones and Reveal.
Reporters obtained seven years of records, spanning mid 2018 through mid 2024 from the National Data Archive on Child Abuse and Neglect. This data contains cases that state child welfare agencies submit to the federal Children’s Bureau.
What The Marshall Project Found
Across 20 states that reported referral data, child welfare agencies sent the parents of more than 25,000 Black newborns to police or prosecutors over alleged substance use in pregnancy.
Eight states had detailed enough records to compare rates by race. In all eight, researchers noted that referrals more commonly involved Black families.
Using state birth data, the reporters estimated that Black babies had a 2.5 greater chance than White babies to be flagged to law enforcement over claims of suspected substance exposure before birth.
In Oklahoma, an estimated 1 in 11 Black babies were flagged. In Minnesota, families of Black newborns were roughly three and a half times more likely to be referred than families of White newborns.
The eight states were California, Georgia, Kentucky, Minnesota, Ohio, Oklahoma, South Carolina and Texas. The data did not contain information on newborns of other races and ethnicities, so the analysis compares only Black and White newborns.
Not everyone accepts the numbers. Oklahoma officials called the analysis misleading and inaccurate. They disputed the methodology behind the state level comparison.
The Marshall Project ran a follow up analysis in response and reported that the overrepresentation of Black newborns in referrals held.
Readers should also note that the outlet itself cautions against ranking states against one another. The underlying birth data limits how precisely rates can be calculated.
Why Hospital Drug Tests Produce False Positives
The referrals often begin with a drug test performed at childbirth. The Marshall Project has previously reported that these preliminary screens are easily misread and can return false positive results as much as half the time.
That matters because a screening result is not a diagnosis. Preliminary immunoassay screens flag chemical patterns, often triggered by legal and everyday substances. These include prescribed medications, over the counter products, hemp derived items and poppy seeds. Confirmatory laboratory testing exists precisely because officials deem a first pass screen unreliable on its own.
Unfounded Reports Still Reach Law Enforcement
In seven of the eight states studied, policy requires child welfare agencies to share pregnancy substance use cases with law enforcement automatically. Those referrals typically happen before the agency has finished reviewing the case.
Over the seven year period, more than 14,000 cases involving Black newborns went to law enforcement in the eight states even though child welfare authorities did not conclude that abuse or neglect had occurred.
Among families referred, agencies had 25 percent greater likelihood to dismiss or divert allegations against Black families than against White families. Kentucky had the widest gap, at 38 percent.
What Doctors and Advocates Recommend
The Marshall Project interviewed more than a dozen doctors, researchers and parent advocates. Most pointed to the fact that hospitals disproportionately test and report Black patients and their newborns.
Leading medical groups, including the American Medical Association and the American College of Obstetricians and Gynecologists, advise against routine drug testing of pregnant patients, in part because a positive result does not establish that someone has a substance use disorder.
Joseph Ryan, a professor of social work at the University of Michigan, questioned cannabis screening in particular.
“There’s really no reason to be testing for THC,” he said. He co-authored research finding that parents of Black newborns had higher odds of being reported over positive cannabis tests but rarely went on to commit abuse or neglect.
Earlier this year, following the outlet’s reporting, New Jersey began requiring hospitals to confirm drug screens with more precise testing before sharing results with child welfare. They wanted to obtain informed consent before testing pregnant patients and to treat a positive result as something other than proof of abuse or neglect.
What This Means for Treatment Seekers
Fear of losing a child remains one of the most powerful reasons people delay addiction treatment during pregnancy. This data suggests that fear is not evenly distributed.
Advocates and clinicians quoted in the reporting warn that the stress of an investigation often trigger a return to substance use and can push people away from prenatal care altogether.
For anyone researching options now, know that voluntary treatment and hospital reporting are separate systems.
Ask a program directly about its reporting practices, its confidentiality protections and whether it offers family focused care. Raise these questions during intake. Asking does not mean admission of taking anything.
Finding the Right Rehab
If you or someone you love wants addiction treatment during pregnancy or the postpartum period, a few steps make the search more manageable.
Compare programs that specifically serve pregnant and postpartum patients rather than general admission facilities.
Ask whether medication for opioid use disorder is available, since buprenorphine and methadone comprise the standard of care in pregnancy.
Verify how the program handles insurance, including Medicaid, which covers substance use treatment in every state under varying rules. Ask whether children can stay on site or whether childcare is provided.
Rehab.com’s directory lists verified treatment centers nationwide, including programs built for pregnant and postpartum patients and facilities that accept Medicaid. Call
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