In New York City, your birth and postpartum experiences are shaped by the hospital door you walk through. Policies and practices on consent and routine testing often differ significantly by institution. While some hospitals obtain informed consent before conducting drug or alcohol testing during pregnancy or after delivery, others perform these tests without patient consent or clearly explaining the purpose and potential consequences.
For many New Yorkers, particularly Black families who are disproportionately reported to the Administration for Children’s Services, a positive test can trigger an investigation even when there is no evidence of abuse or imminent harm. As a result, what should be one of the most joyful moments can instead become one marked by fear, confusion, and surveillance — all stemming from a nonconsensual test.
As a family medicine physician and addiction medicine fellow — and as a mother who has experienced the city’s hospital system as a patient — I know how crucial it is to provide and receive care that is evidence-based, respectful, and compassionate. Pregnant women who use substances are no exception.
Taking a better approach to drug testing during pregnancy could save lives. Overdose is the leading cause of pregnancy-related death in the city and being connected to compassionate, trusted care can be the difference between life and death. When hospitals perform nonconsensual drug testing, they turn a window of opportunity for healing into a portal for policing — driving away the patients who are in most need of help.
This is why I urge the Legislature to pass the Maternal Health, Dignity, and Consent Act. This bill ensures that no pregnant or postpartum women, or their newborns, be drug tested without their informed, written consent. It is only a piece of the treatment puzzle, but it’s an important one.
The challenges faced by people who use substances are not accidental; they are the result of failures at every level of our social fabric. Systemically, we are still living under the architecture of the “War on Drugs,” which has effectively merged the healthcare system with the carceral state, despite overwhelming evidence that people are more likely to seek prenatal care and be honest with providers when they feel safe doing so.
In practice, many hospitals still rely on subjective “risk-based” screening criteria for drug testing that serve as a thinly veiled proxy for race and poverty, such as late prenatal care, perceived behavioral concerns, or socioeconomic indicators. These policies disproportionately impact Black and Brown patients, even though substance use rates are similar across racial groups.
Following a 2020 investigation by the NYC Commission on Human Rights, NYC Health + Hospitals (H+H), moved to require explicit informed consent for drug testing, which proved that prioritizing patient autonomy does not compromise child safety. Instead, it strengthens the trust necessary for effective prenatal care.
Unlike H+H, private institutions often still rely on “risk-based,” nonconsensual testing. These practices have a chilling effect — leading parents to stop seeking medical care or mental health support because they fear an honest conversation about substance use could lead to life-altering consequences. This destroys the trust necessary for public health to function and forces the most vulnerable families into the shadows, exacerbating the very health inequities the city claims to be fighting.
If New York wants to be a leader in maternal health, it must treat all parents with the dignity they deserve, and ensure that consent is not a luxury, but a standard of care for every New Yorker.
Renn is an addiction research fellow and family medicine physician in New York City.