Lawsuits Allege Unlawful Surveillance of Pregnant Patients

Lawsuits in New Jersey and Vermont raise state constitutional questions about surveillance of pregnant patients, illustrating that pregnant people may be subjected to intense scrutiny and surveillance while bringing a pregnancy to term, even in states that protect abortion rights.

Nonconsensual Drug Testing in New Jersey

In September 2024, the New Jersey attorney general filed a lawsuit against hospital network Virtua, alleging that pregnant patients were drug tested without their knowledge and that their (sometimes false) positive results were reported to child protective services, resulting in monthslong investigations of new mothers.

The complaint highlights the stories of two women who tested positive because each had recently eaten poppyseed bagels. Urine tests are commonly given to pregnant patients to check their protein levels. Both women assumed their urine was being taken for that reason, not to be tested for drugs.

In addition to ingestion of poppy seeds, the use of blood pressure drugs like ephedrine and phenylephrine can result in positive urinalysis test results, the Marshall Project reports. Yet prescribed drugs can trigger a report to the state child protection agency; Virtua must report any substance exposure during pregnancy “regardless of the reasons for which infants may experience exposure,” the complaint alleges. Additionally, according to the Marshall Project, doctors and social workers often do not have experience in reading drug test results, which may lead to inaccurate reporting.

There is no national standard for drug testing of pregnant patients, the complaint explains, but the larger medical community does not recommend blanket drug testing. Instead, the American College of Obstetricians and Gynecologists, the American Society of Addiction Medicine, and the World Health Organization recommend verbal screening to assess a patient’s potential exposure to drugs.

Virtua reported the false test results to New Jersey’s child protection agency, the complaint says, which opened investigations into potential child abuse. New parents were subjected to intense scrutiny, including unannounced home visits and interviews, and they lived with fear that their newborns could be taken from them at any moment.

The complaint alleges that Virtua’s universal testing of pregnant patients and regular practice of not obtaining their consent — without comparable policies or practices for anyone else admitted to the hospital — violates New Jersey’s Law Against Discrimination. Hospitals are “places of public accommodation,” the complaint explains, which may not discriminate on the basis of any of the classifications in the law, including sex, pregnancy, and breastfeeding. The complaint also alleges that Virtua’s failure to obtain consent violates the state constitution’s guarantee of the right to privacy and substantive due process.

Within weeks of the attorney general’s lawsuit, Virtua announced that it was no longer performing blanket drug testing of pregnant patients.

Vermont’s List of Pregnant People Deemed Unsuitable for Parenthood

Another lawsuit brought this year by the ACLU of Vermont and Pregnancy Justice illustrates a different kind of surveillance of pregnant people by health care and social services providers. The complaint — filed on behalf of an anonymous plaintiff known as A.V. against the Vermont Department for Children and Families, Copley Hospital, and family services and treatment provider Lund — alleges that after the department received unverified reports about A.V.’s mental health during her pregnancy, it began an investigation into her parental capacity without notifying her.

Over the course of its investigation, the agency received confidential information from Lund and Copley about A.V.’s pregnancy, including her medical records and birth plan, the complaint alleges. According to the complaint, the agency determined that A.V. was not fit to care for the as-yet unborn child, and unbeknownst to A.V., it filed an emergency ex parte order requesting custody while she was in labor. 

After the child was born, A.V. alleges that she was not allowed to touch or hold her baby. The state took immediate custody of the newborn, she says, which was not returned to her until seven months later. No mental health evaluation was ordered or performed, and “no court ever found that [the plaintiff] lacked parental capacity,” she claims.

The complaint further alleges that the state agency “maintains a ‘high-risk pregnancy docket’ or ‘high-risk pregnancy calendar’ to target and track pregnant Vermonters it deems supposedly unsuitable for parenthood.” These determinations are made based on confidential information obtained by the agency from “medical providers and social services organizations,” the complaint says, even when no allegation of child abuse or neglect has been made against the pregnant person.

The complaint alleges that these actions violated A.V.’s state constitutional rights to bodily and medical autonomy and freedom from unreasonable searches and seizures. It further states that the use of a “high-risk pregnancy docket” violates the Vermont Constitution’s right to privacy, reproductive autonomy, due process, and protection against sex discrimination. The complaint further alleges that the defendants’ actions also ran afoul of the state Freedom of Choice Act — which “encompasses the choice of whether, when, and how to give birth” — and the Vermont Fair Housing and Public Accommodations Act by discriminating against A.V. on the basis of her perceived mental impairment. 

The state moved to dismiss the lawsuit last month, asserting that the agency acted within its authority and that A.V.’s state constitutional interests were adequately protected by the statutory procedures the agency followed. With respect to the “pregnancy docket” allegations, the state noted only generally that it “disputes Plaintiff’s characterizations of [the agency’s] practices in these regards” and argued that A.V. lacked standing “because she was never a part of a pregnancy calendar.”

Rights Contraction for Pregnant People in States that Protect Abortion Rights

Voters in Vermont amended the state constitution to enshrine the right to obtain an abortion in 2022. New Jersey protects abortion by statute, and the state supreme court has ruled that the state constitution guarantees the “fundamental right of a woman to control her body and destiny,” even absent explicit abortion protections.

But the interventions described in the lawsuits seemingly violate the tenets of bodily autonomy that undergird the right to abortion. The conduct alleged shows that even in states that protect the choice to end a pregnancy, the same animating principles of bodily autonomy and privacy do not extend to a pregnant person once they decide to carry a pregnancy to term. Indeed, the Vermont agency argues in its motion to dismiss that the “plaintiff does not claim that she ever sought to terminate a pregnancy, so statutory and constitutional provisions prohibiting the State from interfering in such decisions are simply irrelevant here.” Once a person forgoes the option to terminate a pregnancy, the state seems to presume that it is permitted to surveil and interfere with the pregnancy and attendant health care decisions.

Professor Khiara M. Bridges describes a similar dynamic in her book The Poverty of Privacy Rights. The book outlines the intense scrutiny that poor parents, in particular, are subject to during pregnancy because they rely on government assistance. If you need government assistance, the reasoning seems to go, you give up your right to make health decisions and your right to privacy because you have “invited” the care of a state actor.

What’s more, the defendants in both the New Jersey and Vermont cases appear animated by logic reminiscent of fetal personhood: ascribing rights to a fetus in utero, often at the expense of the pregnant person. Fetal personhood laws take many forms. In states like Alabama, Mississippi, Oklahoma, and South Carolina, the definition of child abuse has been expanded to include behavior of the pregnant person during pregnancy. In 2024, the Alabama Supreme Court famously decided that frozen embryos have the same protection as born children under a state wrongful death law.

Bias Against Patients of Color

While the concept of fetal personhood has attracted more extensive attention after the U.S. Supreme Court eliminated the federal right to abortion in Dobbs v. Jackson Women’s Health Organization, the movement dates back to the 1970s — just as the Court recognized the right to abortion in Roe v. Wade. As Dana Sussman of Pregnancy Justice told NPR in the wake of the Alabama Supreme Court decision, fetal personhood “did not gain traction until . . . the late 80s and early 90s . . . when the war on drugs was on a collision course with the war on abortion.”

Any discussion of the war on drugs must include its disastrous effects on communities of color. The war on drugs fueled a national panic about crack cocaine use by pregnant people, resulting in wildly disproportionate levels of state intervention and incarceration of Black parents. In a similar vein, limits on reproductive health care and state surveillance always hit poor and marginalized communities the hardest, to say nothing of the disparate outcomes Black parents face in receiving maternal health care in this country.

Although neither lawsuit mentions racial bias, the reality is that communities of color are over-tested, over-policed, and over-surveilled — and pregnancy is no exception. A study published in JAMA Health Forum in 2023 states, “Black patients, regardless of history of substance use, had a greater probability of receiving a [Urine Toxicology Testing] at delivery compared with White patients and other racial groups.” However, the study went on, “Black patients did not have a higher probability of a positive test result than other racial groups.”

Similarly, Black parents are much more likely than other racial groups to have their children removed by state agencies, as was the case for the Vermont plaintiff. “National estimates suggest that 53% of Black children will experience [child protective services] contact by age 18, as compared to 28% of White children,” one study found. Some scholars have noted that Black families are “disproportionately likely to be involved with [child protective services] because they [are] disproportionately likely to be poor,” and poverty is sometimes confused with neglect. 

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As these two lawsuits illustrate, true reproductive freedom requires more than access to abortion. The rights of pregnant people across the country may be curtailed even in states that seemingly protect reproductive rights, privacy, and bodily autonomy.

Julia R. Livingston is an attorney in private practice.

Suggested Citation: Julia R. Livingston, Pregnancy Surveillance Prevalent Even in States Committed to Protecting Right to Abortion, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ(Apr. 23, 2025), https://statecourtreport.org/our-work/analysis-opinion/pregnancy-surveillance-prevalent-even-states-committed-protecting-right