A federal investigation found that Lovelace Women's Hospital in Albuquerque, New Mexico singled out pregnant Native American women for COVID-19 testing based on their zip code, and then separated some of them from their newborns without proper consent until the test results came back, according to New Mexico In Depth and ProPublica.

The state Health Department's investigation, which launched after an earlier article by New Mexico In Depth and ProPublica, found that the hospital violated patients' rights by implementing an "informal policy to target patients that live on Native American reservations for COVID testing, and [to] separate mother and baby while test results were pending." Investigators also found that the hospital "did not provide clear options for these patients to request or refuse COVID testing and separation from their babies."

Native communities have been hit especially hard by the pandemic and have pushed for more support from the federal government. A report from the U.S. Centers for Disease Control and Prevention found that the incidence of confirmed COVID-19 cases among American Indian and Alaska Native people was 3.5 times that among white people.

Lovelace Women's Hospital hasn't admitted to any wrongdoing, and it rejects investigators' findings that mothers were separated from their newborns. Lovelace spokeswoman Whitney Marquez told ProPublica and New Mexico In Depth: "At no time during the pandemic has any mother been separated from their baby without her consent or approval. Those who chose to be separated while their COVID results were pending were then roomed-in with their mother once the COVID test results were returned."

Lovelace has declined to reveal how many mothers were separated from their newborns between late April and May 28, when the hospital halted the practice, but multiple people told investigators they weren't given the option to refuse COVID testing and that their zip code was part of why they had been singled out.

One Native American mother said she was separated from her baby for a day pending her COVID test results. Though investigators found that she hadn't been screened as high risk, her "home ZIP code was on the hospital's list," and she said that she wasn't given the option to decline COVID testing. She also told investigators she did not sign a consent form, ProPublica reported.

"They told me that I could keep her with me, but it would be better to send her to the NICU to keep her safe, because they didn't know if I had COVID or not," the mother told investigators.

Another mother described her experience as "traumatic," saying that she was only given the option to decline testing after labor had been induced and a nurse-midwife told her her baby would be separated from her after the birth until her test results came back.

"I told her, 'You are not going to do that, and you are not going to take my baby,'" she told investigators. "I was already in active labor. She then offered the waiver."

ProPublica reported that clinicians described the informal ZIP code policy as racial profiling and said it created a "stressful birth experience." The policy, they say, was inconsistently applied more to Native patients, who have long faced health care disparities as a result of decades of racism and racial profiling in medical care.

As a result of these disparities, pregnancy-related maternal mortality for Black, American Indian and Alaska Native women older than 30 was "four to five times as high as it was for white women," according to 2019 CDC data. Institutional racism has been directly linked to both maternal and infant mortality—and a 2018 Center for American Progress report found that it persists regardless of income.

In addition to suspending the ZIP code policy, Lovelace told investigators it will regularly conduct internal audits to "ensure compliance" with guidance on COVID-19 screening. But one clinician told ProPublica and New Mexico In Depth that's not enough: "Regardless of their intentions, the investigation confirms Native patients were treated differently under the informal ZIP code policy and I am disappointed that Lovelace hasn't reached out to the community to assure them they are committed to repairing trust."

This investigation illustrated how much harm systemic racism can do in maternity wards and how much the medical establishment can learn by simply listening to the mothers they are treating. The moms in this investigation spoke up about harmful practices and advocated for themselves, similarly to how mothers and birth workers in New York fought back earlier in the pandemic when birth support people were banned from some hospitals. When something isn't right mothers can fight.

If you are pregnant and are concerned about being separated from your baby due to COVID testing, know this: You are a decision-maker and can advocate for yourself. Ask questions, and if you determine that you should not be separated from your child, you should be heard. If you fall ill and believe it is best to be separated from your baby while you recover, know that you can still pump to provide breast milk. This is your birth, your baby and you are in charge.