Overview
In 2020, when Movement for Family Power released a report documenting the child welfare system as ground zero of the drug war, almost 950 New York City mothers with newborns faced an ACS investigation alleging parental drug use. By last year, that had dropped by almost 80%.
For Black mothers of newborns, the shift has been even starker, with cases alleging substance use falling to 65 in 2024 from almost 600 in 2017, a reduction of nearly 90%.
Falling reports of drug use have led to a stunning decline in investigations and removals of newborns overall:
- ACS cases involving newborns fell almost 50% between 2017-2024.
- Newborn foster care entries also fell by 37% between 2019-2023.
- For infants, ACS involvement fell less dramatically but substantially, with reports dropping by approximately 20% from 2019-2023 and foster care entries declining by 23%.
There is no evidence that newborns and infants are less safe because of reduced ACS involvement. Child maltreatment fatalities of children under 6 months and under 1 are rare in NYC and have remained stable since 2017.
Behind these numbers are two policy changes driven by advocacy.
First, in 2020, NYC’s public hospitals ended a practice of drug testing pregnant patients without their consent; written consent is now required. Marijuana legalization in 2021 also contributed to changes in attitude, although cannabis use in pregnancy is not recommended. Of course, evidence of drug exposure is not required to report risk of abuse or neglect, and restrictions on drug testing do not preclude screening and support. The American College of Obstetricians and Gynecologists urges physicians to universally screen by talking with pregnant people about drug use.
Second, there’s been a growing effort in NYC for family-serving institutions, including hospitals, to directly connect parents to support, rather than relying on child welfare as a middleman. Under federal law, a positive toxicology test alone—or disclosure of past or current drug use—does not constitute neglect and does not require a report to the SCR. In 2020, ACS and NYC’s Department of Health and Mental Hygiene issued updated guidance and, in recent years, the hospital system has made new efforts to connect new mothers to treatment directly. ACS’ Family Support Line to advise mandated reporters on how to “support, not report” families also took more than 3,500 calls last year, up from a few hundred four years ago.
These efforts are helped by the city’s uniquely strong treatment options for new mothers. Four residential mother-child treatment programs can accept mothers and their babies straight from the hospital. The ACS preventive program Family Treatment and Rehabilitation also provides in-home treatment for substance use and/or mental health needs, and The Motherhood Center specializes in treatment for postpartum depression.
Beyond treatment, a citywide expansion of doula care and efforts to better coordinate and expand home visiting programs have added new layers of care. Material support for these families also has increased. The Bridge Project offers $1,000/month in guaranteed income to expecting parents in many low-income NYC neighborhoods, and a new state Baby Benefit will give an $1,800 bonus to expectant parents who receive public assistance.
Despite these reductions, newborns and infants who come to the attention of the child welfare system in NYC remain much more likely to enter foster care after an investigation than older children. In NYC and nationally, these children are less likely to return home and more likely to be adopted, especially newborns. Further expanding care options for families of newborns and infants is key to continuing to reduce family separation, especially permanent family separation.
Even amidst federal cuts to maternal health, NYC can go further to ensure continuity and supportive care for vulnerable new families. Mother-child treatment programs don’t allow older children, a treatment gap. NYC also could develop hospital-based mother-child postpartum psychosis treatment, a new model of intensive care. Research shows that fear of being reported to child welfare can be a significant barrier to prenatal care, particularly for those who use drugs and alcohol, and newborn and infant ACS involvement is concentrated in a few neighborhoods where fear of ACS is prevalent. Parent peer support, harm reduction outreach, economic support and early legal defense could be locally sited and coordinated along with doula care and midwifery.
Data analysis by Cat Pisciotta and text by Nora McCarthy, with thanks to Mahima Golani. All data is provided by the Administration for Children's Services (ACS) unless otherwise noted.
Note: "Newborns" refers to children to under 31 days old, while "infants" refer to babies between 31 days-1 year old. Most data in this brief covers the time period 2019-2023, while a subset of data covers 2017-2024 because of how ACS tracks certain data points internally. Data also reflects duplicate children in some instances and unique children in others, and some differences in inclusion of non-city zip codes. For explanations of any jargon, use this guide. Contact info@familypolicynyc.org with any questions.
Reductions in Allegations of Parental Substance Abuse Have Driven the Drop in Newborn Cases
The number of newborns in ACS cases involving allegations of parental drug use fell 80% between 2017 and 2024.
These data visibly reflect that NYC’s public hospitals ended the practice of drug testing pregnant patients without their consent in 2020. Prior to the policy shift, in 2019, more than half of newborn investigations included allegations of parental substance abuse. Fewer than a third of newborn cases included these allegations in 2023. For infants, the percent of cases including parental substance use allegations also dropped, but more modestly—to 23% from 29%.
This policy shift reflects the work of the NY Informed Consent Coalition to end test-and-report practices. However, the Maternal Health, Dignity and Consent Act to require informed consent for drug testing of all newborns and pregnant or postpartum parents statewide has not been passed by the State Legislature.
Note: ACS cases involving newborns and infants also were more likely than other cases to include allegations related to lack of basic needs. For children under 1, 12% of cases alleged a lack of food, clothing or shelter, compared to 8% of cases involving all children.
For Black Parents, Allegations of Drug Use in Newborn Cases Fell Almost 90%
Research shows that Black mothers are tested more frequently for drug use, so would be most impacted by policies to end testing.
Black-led grassroots community groups and NYC’s Health Department also have expanded access to programs that support birth justice. Racial disparities in birthing care, birth outcomes and infant and maternal mortality in NYC are well documented, particularly for Black women.
The Citywide Doula Program, started in 2022, expanded access to free doula services in low-income neighborhoods through trusted community doula services organizations, such as Ancient Song and Bx (Re)Birth. A 2025 audit found that Black and Latina mothers supported by the program experienced significantly better birth outcomes than other Black and Latina mothers. In addition, the Health Department has established Birth Justice Hubs to support reproductive health and justice.
Black Children and Families Continue to Be Overrepresented in Newborn and Infant Cases
ACS cases involving Black newborns and their families fell by 53% between 2019 and 2023, outpacing reductions for Latino (45%), Asian (26%) and white children (39%).
Even so, Black children and families made up about 45% of newborns and infants involved with ACS in 2023, despite representing 24% of the population. In 2019, Black children made up 50% of these reports.
Note: Reports for children with a race/ethnicity of “other” fell 37%. Race/ethnicity in 2023 is based on unique children; it was based on duplicate children in 2019.
Newborn Reports by Medical or Mental Health Reporters and Social Service Reporters Fell More Than 50%
Reports by medical or mental health reporters decreased 68% and social service reports decreased 55% between 2019 and 2023.
New York State narrowly defines substance-affected infants for whom Plans of Safe Care are required under federal law. However, NYC hospitals are making new efforts to connect new mothers to support.
The Bridge Program at Mt. Sinai, for instance, has been part of a culture shift of coordinating care and connecting mothers to substance use treatment without calling in ACS. New motherhood is a time when women using substances are highly motivated to change. The program provides case management and nurtures mothers throughout pregnancy and after birth.
Note: The “Social Services” reporter type very frequently includes social workers and others based in health care settings, such as hospitals. Reporter types received by ACS from the SCR are categorized by the reporter’s job role as shared with the SCR, rather than in relation to their affiliated organization or institution.
Few Reports Involving Newborns and Infants Are Routed to CARES
In 2023, 46 newborns (6%) and 294 infants (9%) were routed to CARES, a safety assessment for lower-risk cases, compared to 737 newborns and 2,834 infants in investigations.
Download: Image; Data: 1 and Older, Under 1
Note: Some media coverage of child maltreatment fatalities, including newborn and infant deaths, has implied that CARES assessments have been unsafe. No child maltreatment fatalities have been associated with CARES.
Newborns and Infants Are Overrepresented at Every Stage of ACS Involvement
For newborns, 62% of investigations were indicated and, for infants, 41% of investigations were indicated in 2023.
Children under 1 and their families also were twice as likely to enter court supervision than other families. About 13% of newborns and 11% of infants and their families entered court-ordered supervision in 2023. For all other children, about 5.6% entered court-ordered supervision.
Note: This does not include preventive services. About 7% of families with newborns and infants enroll in preventive services after an indicated investigation.
The Number of Newborns and Infants Entering Foster Care Dropped by 30%
Newborn foster care entries fell by 37% between 2019-2023. For infants, foster care entries declined by 23%. These reductions outpaced foster care declines for older children. For all NYC children, foster care entries dropped 12% between 2019-2023.
There is no evidence that newborns and infants were less safe because of reduced family separation. Child maltreatment fatalities of children under 6 months and under 1 are rare in NYC and have remained stable since 2017.
Despite These Reductions, 1 in 4 Newborns Entered Foster Care After an ACS Case
Infants also were more than twice as likely than older children to enter foster care after an ACS case.
Efforts to provide intensive prevention and reunification supports include the Bronx Defenders’ Healthy Mothers, Healthy Babies program, for pregnant parents with an older children in foster care, and the Strong Starts Court Initiative, a court in every borough focused on children 0-3 years old.
1 in 6 Children Who Entered Foster Care Was Under 1 Year Old
Newborns made up about 1.1% of all ACS cases but 7.2% of foster care entries and babies (all under 1) made up 5.7% of all ACS cases but almost 16.2% of foster care entries.
Children under 5 made up only 26% of children in all ACS cases but 38% of children entering foster care (though down from 43% in 2019).
Terminations of Parental Rights Primarily Involve Children Who Were Under Age 3 at Removal
Family court data from 2018-2020 shows that children who were birth to age 3 at the time of initial court filing were overrepresented in every negative court outcome—removals, filings to terminate parental rights and terminations of parental rights.
Children with an initial filing age 0-3 made up 44% of NYC children removed from their families but 72% of NYC children whose parents’ rights were terminated. Older children were more likely to reunify as well as to remain in foster care or age out.
In New York state, nearly 1 in 50 Black children will experience termination of both of their parents’ rights by age 18.
For families facing termination of parent rights, the Preserving Family Bonds Act would give children and parents the chance to stay in contact when it’s in a child’s best interest. Passed three times, it has been vetoed repeatedly by the governor.