“I was given a stack of papers, and I remember on a couple pieces of paper the words were blurry, this is how much copying was going on. They just said, ‘it’s a normal consent form; if something happens to you and the baby, if the baby’s heart stops beating or yours, do you want us to save you?’ Of course I do, so I signed the form, a bunch of forms.”

Get TalkPoverty In Your Inbox

Brewington said she was later told those papers included the consent forms that gave her providers permission to drug test her and her child. She said she never saw such consent plainly stated, even when she checked for it after the fact.

Drug testing pregnant and postnatal people and their infants without the patient’s informed consent is a common practice in the United States — but only among certain demographics. Several studies have found that Black women in particular are subjected to prenatal drug testing at higher rates than women in other racial and ethnic demographics, but do not have higher rates of positives. A study published in the February 2004 issue of Child Abuse & Neglect also found several other factors unrelated to drug use that led to higher testing rates, including single motherhood, tobacco use, a history of preterm labor, and a history of child services involvement, among others.

“I provided care in Black and brown communities, so [drug testing pregnant and postnatal patients] was routine, and it wasn’t until I got out and saw the difference in the way care was provided in communities that…were wealthier that it became clear that this is not routine, this is not what everybody does,” said Jamila Perritt, an OB-GYN in Washington, D.C., and the president and CEO of Physicians for Reproductive Health. Perritt also recounted that when she was pregnant, she was not drug tested despite being one of the more commonly-tested demographics (Perritt is a Black woman), which she attributed to her status as a physician.

Now activists are fighting back, saying the practice is rooted in racism and classism, and that it denies patients crucial agency over their care.

“Is our consent truly informed? It can’t be in those reams of paper that people are signing,” said Perritt. “What does it mean if we as physicians say informed consent is one of our core values? …Who would think you’re signing a form that could result in such severe consequences? The truth is that it is a violation of trust to not take the time to name that [drug testing consent is included] and its consequences.”

As Brewington’s case demonstrates, those consequences can be devastating. After her newborn son tested positive for opiates and cocaine, which Brewington admits to using once during the last term of her pregnancy, New York child services placed him into foster care. Although her two older children were out of the state at the time on a vacation with their father, child services ordered her to bring them back and placed them into foster care as well. They are home with their mother now, but Brewington is still fighting to regain custody of her son, who was awarded to his father.

“The medical profession, health profession, that is still one of the top three referrants [to child services],” said Jeyanthi Rajaraman, a parental defense attorney at Legal Services of New Jersey. Rajaraman added: “I’ve asked [at hospitals] when do you drug test and when do you not, and the information that comes out is that ‘if mom shows up and we’ve never seen her and she didn’t do a hospital tour and says she’s had no prenatal care and she’s by herself.’ What I really think they are also saying is Black and poor or no medical insurance because that is the majority of our clients who face and experience drug testing.”

Because child removal data is self-reported by the agencies, which do not track how many removals occur due to hospital drug tests, it is difficult to gauge how often these tests lead to severe consequences on a national level. One report by Movement for Family Power estimates that in 2017, in the Bronx borough of New York City alone, 60 babies under one month of age were removed because of maternal substance use. The United States child services system acknowledges that Black and Indigenous children are markedly overrepresented when it comes to system involvement; between 2000 and 2011, one in nine Black children and one in seven Native American children had been removed from their parents’ care, versus one in 17 white children.

Infants who do experience side effects due to in utero substance exposure, which can occur from both prescribed and non-prescribed substances, fare better when they are able to have close maternal contact. Removing newborns from parents like Brewington because of substance use — a common result of pre- and postnatal drug testing — can decrease feelings of bonding and the parenting sense of competence, and has been linked to some infant cognitive and memory impairment in animal studies. It also leads to decreased ability to breastfeed, which normally helps reduce symptoms of withdrawal in substance-exposed newborns and provides some protection against illnesses, including COVID-19.

Rajaraman noted that she often encounters medical professionals who recognize this reality but are shockingly unaware of how their call impacts the family. “I’ve had many doctors say to me that by calling [child services] they don’t know the baby would be taken, they say ‘I was calling because I thought it would help get mom into [a] program, I would never recommend separation.’”

In 2021, New York State attempted but failed to pass a law that would ban drug testing of pregnant and postnatal people and their newborns without informed consent or a legitimate medical necessity.  Activists are planning to push the bill again during the 2022 legislative session. Should it pass, it would require that written consent be obtained at the time of testing and delivered to the patient in a manner that is clear and understandable. It must also include a statement that the testing is voluntary. Activists in Washington State also considered pursuing similar legislation, but decided to table the movement for the time being. Should New York succeed in passing the informed consent bill in 2022, it could pave the way for other states to take necessary action to protect pregnant and parenting people and their infants from non-consensual drug testing.

When Brown and her son met for the second time, the baby cried and did not immediately warm to his mother. Brown said she initially thought “he does not like me,” before conceding that, in reality, “he did not know me.”

Get Talk Poverty In Your Inbox

Until this summer, incarcerated people who gave birth in Minnesota had a maximum of 72 hours with their newborns before they were separated. (The length of time depended on the type of birth.) In many other states, the parent and child have as little as 24 hours. As Alysia Santo wrote in PBS Frontline, “giving birth means saying goodbye.”

But recently, stories such as Brown’s and the advocacy of organizations such as the Minnesota Prison Doula Project — an initiative that provides pregnancy and parenting support to incarcerated people in Minnesota — have driven a major policy change. As of August 2021, people who are serving a prison sentence in the state will no longer be separated from their newborns after giving birth.

The Healthy Start Act, which was signed into law by Governor Tim Walz in May, allows the Department of Corrections to place incarcerated pregnant or postpartum parents into community alternatives. These include halfway houses or residential treatment facilities where parents can access treatment for the duration of their pregnancy and bond with their newborns for up to one year after giving birth.

The bill is the next step in a broader push toward improving prenatal and postpartum care for people in prison nationwide. Thirty-two states have passed restrictions on pregnant shackling, seven states have ended solitary confinement for pregnant people, and a few localities have increased the budget for prenatal care. While there are nine prison nurseries in other states across the country that allow children to stay with their parents, the Healthy Start Act is first-of-its-kind legislation because it permits postpartum people to bond with their newborns outside of prison.

According to Safia Khan, Director of Government and External Relations at the Minnesota Department of Corrections, about half of all pregnant people who enter a Minnesota prison will leave while still pregnant. Among the other half that give birth in prison, the majority reach their release dates within six months after giving birth.

Kahn emphasized that while “the separation period is often temporary and short, it is hugely disruptive to bonding and hugely traumatizing for the mother and for the child.” The importance of parent-infant bonding for the early development of newborns and the mental and physical health of postpartum people has been well documented. It impacts everything from the development of connections between brain cells fundamental to learning to the ability to build loving, trusting relationships later in life.

The new law is particularly important for Native American communities: Despite making up only 1.4 percent of the state’s overall population, 34 percent of the people who were pregnant in Minnesota prisons between 2013 and 2020 were Native American. The bill’s passage is due in part to the leadership of Native American elected officials in the state. State Representative Jamie Becker-Finn and Lieutenant Governor Peggy Flanagan both championed the legislation. During the discussion of the Healthy Start Act before it passed in the state legislature, Representative Becker-Finn said the legislation represents “an incredible opportunity to disrupt cycles of trauma.”

“At first, it was a difficult transition” when Jennifer initially reunited with Elijah. But “since then, our bond has grown so much,” she said, as she has been able to witness some of his milestones, including crawling and walking.

While Jennifer was in prison, she would often find herself wondering what her son looked like. Now, she can detail the mundanities that come with a shared bond: the types of food he likes (watermelon) and dislikes (tomatoes); the sound of his laugh; and his quickness to smile.

But the reality is, Trump’s proposal is essentially a tax break for the wealthy disguised as a child care plan.

Get TalkPoverty In Your Inbox

There is a real child care crisis in the United States. The current system doesn’t work for anyone: Parents are shelling out more for child care than they’ll need to pay for in-state college tuition, and providers are still closing their doors due to lack of funding. Low-income and middle class families need help affording quality child care, but the Trumps have something different in mind.

Here are five reasons why Trump’s child care plan doesn’t cut it:

1. It provides the biggest benefit to wealthy people

The Trump child care plan was written by Ivanka, for Ivanka. It’s centered around a tax deduction, which would let families earning up to $500,000 per year deduct their child care costs from their taxable income up to the average cost of child care in the state.

Unlike a refundable tax credit, which would give money to anyone who is eligible, a tax deduction lowers peoples’ taxable income and increases their tax refund at the end of the year. That benefits high-earners more than lower and middle-income families—under Trump’s plan, 70 percent of benefits would go to families earning at least $100,000.

2. It doesn’t help people when they actually need it

Under Trump’s plan, families would need to pay upfront for child care each week or month, and then wait until tax season to get a small deduction. Most families don’t have that kind of liquid income—a parent working full time at a minimum wage job would have to spend anywhere from 62.9 percent of their income (if they live in South Dakota) to 183.5 percent of their income (if they live in Washington D.C.) to pay for child care for an infant and a four year old.

If Trump was serious about helping middle class Americans, his proposal would provide support for families throughout the year, when they need it. For example, proposals for a High-Quality Child Care Tax Credit—where a family would contribute between 2 and 12 percent of its income on a sliding scale—would advance money to families on a monthly basis so that they would never need to pay full price out of pocket.

3. It won’t improve child care quality

Providing high-quality child care is expensive. Around 60 percent of funding for child care providers comes directly from parents, so providers depend largely on tuition to cover the cost of staff salaries, classroom materials, and building maintenance. So, high-quality providers tend to have higher tuition prices. That creates a gap in the type of care kids ultimately get—children whose parents have money get high-quality care, and kids whose parents don’t settle for less.

Trump’s plan doesn’t address the fact that access to high-quality early childhood education depends on a family’s income. That perpetuates the achievement gap that plagues students later on. Without access to high-quality early childhood education, low-income students and children of color start kindergarten behind their peers in math and reading. They struggle to make up the difference later on.

4. It won’t create more child care options

Many parents have trouble even finding a licensed child care provider in their community. A recent study found that across eight states, 42 percent of children live in child care deserts where child care supply does not meet demand. The problem is particularly pronounced in rural areas, where the majority of children—55 percent—live in child care deserts.

Trump’s plan doesn’t create incentives for new providers to enter the child care market, which would increase the availability of child care for families. A meager tax deduction is not enough to build a child care infrastructure, especially in rural areas where there is the greatest need for child care.

5. It doesn’t support the early childhood workforce

Trump’s plan does not even mention the 2 million—mostly female—early childhood educators that care for the nation’s youngest children every day. The median annual salary for child care workers is just $20,320, which is less than the median for animal caretakers and parking lot attendants. Almost half of child care workers rely on some form of public assistance, and they often lack basic benefits like health insurance. That has consequences for the children in their care.

Early childhood is a critical period when children grow, learn, and develop rapidly. In order to thrive, children need careful attention from adults that make eye contact, engage in dialogue using age-appropriate language, and respond to their expressions of emotion. High levels of stress—like the kind caused by economic insecurity—interfere with an educator’s ability to give a child the meaningful attention that they require throughout the day.

Last night we heard President Trump say that he wants to help financially-strapped families, but families cannot work unless they have affordable child care. Trump’s child care proposal won’t meet most families’ needs—it’s little more than a tax windfall for wealthy people like him. If he understood the child care crisis that low-income and middle class families face each day, he’d put forward a complete plan that addresses child care affordability, quality, and access.

Yet we also have much unfinished business, in part because so many of the administration’s promising initiatives—such as comprehensive immigration reform, a significant investment in child care and early childhood education, and a major youth employment initiative—were not enacted. And unfortunately, the ideas currently proposed by leaders in Congress and the President-elect’s transition team would tear apart not only President Obama’s successes but also the core of our safety net.

Get TalkPoverty In Your Inbox

Here are five areas where the Obama administration sought to drive progress for children and families—and what we expect from the next administration.

Expanding Health Insurance

Children’s health insurance has increased dramatically under the current administration. Thanks largely to the Affordable Care Act (ACA), about 1.7 million children gained coverage from 2013 to 2015. Now more than 95% of children are insured—a record high.

These improvements in health insurance have long-term positive consequences. There are obvious benefits like reductions in infant mortality and childhood deaths, improved health, and reduced disability. But there are subtler effects, too: expanding health coverage for low-income children improves high school and postsecondary success, and also employment over the long haul. Plus, children’s life chances are improved when parents are able to get the care they need, like treatment for depression (which is widespread among low-income mothers of young children).

Despite the mounting evidence of lifetime benefits for children, President-elect Trump and Republican leaders in Congress have vowed to repeal the ACA. If they succeed, the number of uninsured children will double—even without accounting for the additional cuts now being discussed for Medicaid, which is especially important to low-income families.

Reducing Child Poverty

During the worst of the Great Recession, more than 21% of children lived in poverty—15.6 million in total. By 2015, the number had dropped by about one million, and the child poverty rate was down to 19.7%. While that rate is still far too high, the improvement reflected an economic recovery that helped all families.

The Obama administration fought to protect key safety net programs that support families when they are most economically vulnerable—such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps)—and successfully expanded the Earned Income Tax Credit (EITC) and Child Tax Credit (CTC). These programs are crucial for low-income children—in 2015, SNAP reduced child poverty by 2.7 percentage points and the EITC and CTC together reduced it by 6.5 percentage points. As with health insurance, these programs pay off for a lifetime: children getting this help have improved health, education, and employment outcomes.

Despite this strong evidence, Congress and others have argued to sharply cut SNAP or change its structure to a block grant—a fixed amount of money that states can spend for various purposes. That fixed dollar amount—which doesn’t increase during tough economic times—leaves families and communities without resources when they need them the most.

Addressing Disparities for Children of Color

Despite some progress, disparities for children of color remain stark. About 1 in 3 African American children and 3 in 10 Hispanic children live in poverty, even with high levels of household work effort. That’s more than double the poverty rate for white children. Fixing these disparities matters more than ever to the nation’s future, because of who today’s children are: almost half are children of color (a milestone already reached for young children), and about one-quarter are children of immigrants.

The Obama administration made important commitments to build ladders of opportunity for children and families of color, though the work remains unfinished. The administration made strides on educational equity, beginning with early childhood education up through improved access to postsecondary education and job training. It also focused on justice reform, with the goal of reducing interactions between students of color and law enforcement in schools.

In addition, more than 5 million U.S. children have at least one parent who is an unauthorized immigrant. In an effort to keep these families together, the administration issued an executive action providing temporary protected work status for parents of children who are American citizens or long-term residents—but court action blocked it. Now these children remain at risk of separation from their parents, which creates high levels of stress and undercuts their development and their families’ economic security.

Fair Wages and Working Conditions for Families

About two-thirds of poor children live with a working adult. These families typically must confront a combination of low wages, volatile and inadequate work hours, and insecure jobs.

Over the past eight years, dozens of states and cities have passed paid sick time, paid family leave, and scheduling laws that make a big difference to these families. The administration’s commitment to paid leave—including strong support for the federal Healthy Families Act and its “Lead on Leave” campaign—helped fuel change at the local and state level. Moreover, the administration’s paid sick days and minimum wage executive orders for government contractors and the overtime rule are crucial expansions of labor protections that could benefit millions of workers.

But while bills to take the paid leave, scheduling, and minimum wage provisions nationwide were introduced, none has passed the divided Congress—and the President-elect’s announcement of a Labor Secretary who is sharply critical of regulations to help low-wage workers suggests the modest steps taken so far could be rolled back.

Stalled Budget Investments in Children

Unfortunately, what has not improved nearly enough in these eight years is public investment in children through child care and Head Start, as well as youth development activities and career opportunities (with the exception of modest increases in Pell grants).

The administration’s strong budget proposals to provide all low-income infants and toddlers with access to high-quality care, and to expand other early learning programs, were never enacted. In fact, even though Congress did enact important bipartisan measures to improve the major federal program that helps low-income parents with child care—such as streamlining rules so parents can keep child care support despite unstable work hours, and strengthening training for child care workers—it never provided funding to support the changes. Today, less than 1 in 6 eligible children receive child care assistance, less than half of eligible preschoolers benefit from Head Start, and Early Head Start serves less than 7% of eligible infants and toddlers. This lack of action flies in the face of resounding evidence that early childhood investments pay off both for children and the economy over the long run.

Overall, the agenda being discussed by Congressional leaders and the President-elect’s transition team fails to build on the administration’s accomplishments. It also proposes denying basic help like health care and nutrition to a generation of children, which would have lifelong consequences. All Americans need to fight back against these devastatingly shortsighted choices, which would place children’s own healthy development, education, and work success at risk—along with our nation’s economic future.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

Get TalkPoverty In Your Inbox

This has serious consequences, both for the individual children and for the country as a whole. The infant and toddler years are a critical time period for child development, and they can shape a person’s outcomes for the rest of their lives.  And since our country is growing more diverse every year—the majority of young children are now children of color—the soaring poverty rates among children from diverse backgrounds is risking our long-term economic stability.

Home visiting programs, which connect families with trained professionals who help create healthy and safe home environments, are proven to directly address many of the harmful impacts of poverty before the effects take hold. The benefits are dramatic—families who voluntarily participate in these programs have improved child and maternal health, increased school readiness, prevented child abuse and neglect, and reduced participation in the juvenile justice system.

Here’s how it works

When parents bring their baby home from the hospital, they don’t come with a handbook. Home visiting aims to be the next best thing, by connecting parents and families with professionals—who may be nurses, social workers, or other trained parent educators—in their own homes through regular visits. Home visitors partner with parents to develop strong parenting skills, ensure child and family safety, and access other community resources and social services.

The services families receive during a home visit can vary depending on the specific needs of the family. A home visitor may work with a new mom to help her understand the importance of breastfeeding, or how praising a child can reinforce positive behavior. They may screen for signs of child abuse and neglect or domestic violence, and refer families to other health and social services. Home visitors will also help parents to set goals for the future—they might work together to develop a plan to go back to school, look for a job, or identify safe and reliable child care.

The results are impressive

Home visiting programs have been proven to benefit everything from child and maternal health, to increasing school readiness, to reducing child abuse and neglect. In 2014, 70% of federal home visiting program grantees saw reductions in the rate of tobacco, alcohol, and illicit drug use among enrolled mothers.  Similarly, 79% of grantees saw an increase in the household income of families participating in home visiting, and 76% saw an increase the rate at which women and families are screened for domestic violence.

These programs are so effective that they end up saving taxpayers money in the long-run. For example, improved health among participating families can lead to Medicaid savings by reducing health care costs, and improved school readiness can boost a child’s academic achievement later in life and lower participation rates in special education. In fact, for every dollar invested in these programs, we see a return of up to $5.70 in reduced federal and state costs and social benefits.

But it doesn’t reach enough people

Home visiting only reaches a small portion of families living in poverty. In 2015, 145,500 children and parents—less than 10% of families in poverty across the US—received federally-funded home visits. Even when home visiting services are available, many of the people who would benefit are unaware that they exist or unfamiliar with how they work.

What’s worse, federal funding is at risk of expiring if Congress fails to act. The Maternal, Infant, and Early Childhood Home Visiting, or MIECHV, program is the single largest funding source for home visiting—it’s the only guaranteed source of funding in all 50 states, and it provides $400 million per year to expand evidence-based programs. Since it was established in 2010, MIECHV has expanded home visiting programs so that they now reach families in every state, the District of Columbia, and 5 territories across the United States. After the original authorization ended in 2014, MIECHV received two short-term reauthorizations—the most recent of which is slated to run out at the end of September 2017.

Where do we go from here?

Without action from policymakers, the families who currently participate in the federal home visiting program may lose a critical source of support. Worse yet, millions of others will never benefit from a highly effective program. In many states, MIECHV is the only source of financial support for home visiting, and without it services would disappear.

Rather than letting a highly effective program expire, Congress should increase MIECHV funding and extend the program for a minimum of five years. That way the program will reach more of the families who need it, and states will be able to focus on providing services rather than worrying about finding sustainable funding.

As we see from last week’s Census data release, there are still too many young children and children of color bearing the burden of poverty. In the long run, this will only exacerbate inequality and harm our country’s economic outlook. Home visiting has the potential to address inequality before its effects are realized—if the program is given a chance to succeed.

Despite what some conservatives might have you believe, there are very few financial supports in place for families with young children that assist with the purchase of baby supplies. Families with low incomes are doubly penalized in that they have fewer resources to spend, and therefore pay more for basic supplies because they can’t buy in bulk or purchase memberships at wholesale stores.  In contrast, I have annual memberships with Costco and Amazon Prime and a car that allows me to shop around to find the best deals.

I decided to spend a week tracking just how much my husband and I save on baby supplies due to economic privilege. I tallied what we spent and compared our costs to what a low-income parent would need to spend for the same items at stores in our neighborhood.

Diapers and wipes

I’m able to purchase diapers for $0.22 apiece through a discounted online delivery service that requires a monthly fee for subscription. By comparison, a small package of diapers costs $0.36 per diaper at the local grocery store. At 60 diapers per week, I save $8 per week on diapers. Similarly, we buy our wipes at Costco and save $1.00 per week.

Additional cost for low-income parents: $9

Food

We buy our formula at a big box store and stock up when they have a sale. Recently, they had a $25 rebate for shopper who spend $100 or more. A great bargain for us, but $100 is easily a quarter of what a minimum wage worker makes in a week. Our total for formula comes to $20 per week, compared to $29 per week at our local grocery store. Breast milk is also far from free. A pump, bottles, and other supplies can easily cost hundreds of dollars per month. And that assumes that a minimum wage job provides adequate breaks to pump and a place to store the milk, neither of which is common among low-wage jobs.

Solid food for babies is much cheaper to puree at home than to buy at the grocery store. I have a food processor, dish washer, refrigerator, and storage containers that make baby food production relatively easy. For $5, I bought enough food for a one-week supply of meals. To buy the same amount of jarred food at the grocery store costs $18.

Additional cost for low-income parents: $22

Baby supplies

I have a credit card that allows me to accrue points that I can spend on Amazon, which provides $30 to $50 per month (or about $10 per week) in free goods. In the last six months alone, I’ve gotten swaddles, laundry detergent, diaper cream, and bottles—all for free. Many parents in poverty do not have the necessary credit or income to qualify for a credit card, let alone one that provides rewards. And as a result of credit discrimination, people of color often have lower credit scores that might otherwise facilitate credit cards with these kinds of perks.

Additional cost for low-income parents: $10

All told, my family saved about $41 per week compared to what a minimum wage worker would likely spend. While that might seem like a small amount for a family with a lot of disposable income, it adds up to more than $2,000 a year and over 10 percent of total annual income for a family of three living at the poverty line. That means in D.C., where the minimum wage is $10.50 per hour, a worker earning that amount would need to work approximately 200 additional hours a year just to buy the same items.

Last year, the Center for American Progress proposed a Young Child Tax Credit that would invest in families when income matters most for children’s long-term outcomes and family budgets are often most strained. Representatives Nancy Pelosi and Rosa DeLauro introduced legislation that would create such a credit, as did Senator Michael Bennet.

This kind of reform would not only help all families afford the critical items they need to thrive, it would also mark a step forward in ensuring that people in poverty no longer have to pay more than other consumers for the things that all families need.