The racialized logics of clinical policing of pregnant bodies in the United States

This research examines the racialized logics that underpin the clinical policing of pregnant patients suspected of using drugs. Clinical policing is the use of criminal-legal rationales and interventions in medical settings and includes using criminal suspicion to profile patients, non-clinically indicated drug testing, and reporting patients to punitive state agencies. Drawing upon N = 106 qualitative interviews with clinical and social service professionals across two Midwestern cities, I show that racial logics are mobilized to rationalize the use and expansion of punitive approaches and systems in unexpected ways. First, the history of reform within the child welfare system along with changing racial configurations of the opioid crisis, reinforce the illusion that the child welfare system is a benevolent service provider. Second, racial equity discourse is leveraged to justify expanding clinical policing through arguments for universal drug testing of patients. Finally, structural inequality is acknowledged but framed as warranting individualized behavioral modifications that blur the boundaries between clinical concern and carceral control. Taken together, these themes suggest that racial logics that are not overtly racist and may even appear to address racial inequity can be deployed to bar patients from medicalization and place them on a track of punitive surveillance, marking a clear case of stratified medicalization, where certain populations are deliberately excluded from beneficial medical resources while being subjected to heightened surveillance and punishment.