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Objective: Improve racial equity with routine universal drug screening / Study Design: Commentary on the medicolegal and social history of the United States and the field of obstetrics and gynecology regarding drug screening policy / Results: Critical aspects to inform an equitable drug screening policy include (1) racial bias and stigma related to substance use, (2) the legislative history surrounding substance use during pregnancy, (3) the relationship between substance use and mass incarceration which disproportionately affects persons of color, (4) propensity toward punitive measures for Black mothers with substance use, including termination of parental rights, (5) the role of the medical field in fostering mistrust among our patients / Conclusion: new practices in screening for substance use during pregnancy are needed. Key Points Increasing demand for racial justice warrants reframing the issue of urine drug screening. The current legal constructs continue to disproportionately impact women of color. Routine verbal screening can replace urine drug screening and diminish implicit biases. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Urine drug screens (UDS) during pregnancy can perpetuate racial disparities that extend far past medical outcomes and into the autonomy of birthing persons and their family unit. METHODS: This retrospective cohort study compared pregnant patients admitted to the labor floor from September 1, 2020 to June 1, 2022, with UDS collected for no prenatal care ("NPNC") to those collected for all other indications including altered mental status, use of nonprescribed substances, medications for opioid use disorder, suspicion of abruption, unexplained hypertension, or fetal demise ("Other Cohort"). Chi-squared analysis and Student's t -test were used for statistical analyses. RESULTS: Of 7,022 births, 127 (2%) had UDS collected. Patients who identified as Black were significantly more likely to have UDS collected (P <.0001). Of 127 UDS, 29 were sent for NPNC alone, and 98 were sent for other indications. There was no difference in age, race, or insurance status between the two groups. Among the NPNC cohort, 8 were positive for marijuana alone (28%), 3 (10%) for opioids (two provided by the care team), 1 for benzodiazepine (provided by the care team), and the rest were negative (59%). Significantly more patients were positive for opioids or other substances (not marijuana alone) in the "other cohort" compared to the NPNC cohort (P =.002). CONCLUSION: The majority of UDS for NPNC were negative, or positive for marijuana alone. Our findings show potential for harm, and no added utility, when using NPNC as an indication for collecting a UDS as reporting marijuana alone to government agencies may have disproportionately negative effects for Black patients. [ABSTRACT FROM AUTHOR]

Background: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access., Methods: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state., Results: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM., Conclusions: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)