Substance Use During Pregnancy and the Postpartum Stage: Addressing Stigma and Improving Care

Substance use during pregnancy remains a major issue in the U.S. According to the 2021 National Survey on Drug Use and Health, 19.6% of pregnant women reported using illicit drugs, tobacco products, or alcohol in the past month. A 2022 JAMA study found that from 2017 to 2020, over 1,200 pregnant and postpartum women in the U.S. died from overdoses. Interactions between providers and patients are essential for connecting them to health care services throughout pregnancy and postpartum. However, pregnant women and mothers with substance use disorder (SUD) often face stigma, which creates significant obstacles to accessing services and support, resulting in adverse outcomes for both parent and infant.

Stigma directed towards pregnant women and mothers with SUD is primarily fueled by societal notions, particularly the concept of motherhood. These deeply ingrained norms have painted SUD as a moral failing rather than as a health concern, disregarding the intricate complexities and obstacles pregnant individuals face. 

Stigmatization of Pregnant Individuals Impedes Access to Treatment

Studies suggest pregnant and postpartum women, particularly of color and/or living in rural areas, struggle to access addiction treatment and harm reduction services. They are increasingly stigmatized and prosecuted, leading to financial, emotional, and legal ramifications. The pregnancy-associated death ratio for drug-related causes was highest among decedents identified as Non-Hispanic American Indian or Alaska Native, followed by Non-Hispanic white and Non-Hispanic Black, according to a 2022 study published by the American College of Obstetricians and Gynecologists.

Negative perceptions among health care workers can have a harmful impact on the quality of care and on treatment outcomes these women receive. Using medically inaccurate language can contribute to views of blame toward the mother, increase maternal shame, and prevent disclosure of substance use. It is critical to recognize the importance of language while discussing addiction. In a January 2023 JAMA study, researchers examined the prevalence of stigmatizing language regarding SUD in clinical notes. According to the study, 61% of patients with SUD received at least 1 medical note that included stigmatizing language (e.g., "alcoholic," "user"). Stigmatizing language can perpetuate the shame felt by pregnant women and discourage them from seeking treatment beneficial for both themselves and their child. 

Stigmatizing pregnant individuals also can have adverse effects on their relationships with others, mental health, and self-esteem. This is a significant health concern because those who receive prenatal care have healthier babies and are more likely to benefit from various health interventions, compared to those who don't. Many pregnant women with SUD fear punitive actions (e.g., criminalization, involvement of child protective services) if their condition is detected by health care providers. 

Improving Care for Pregnant and Postpartum Individuals

Addressing substance use requires a comprehensive approach that emphasizes compassion, understanding, and evidence-based care to combat the stigma associated with pregnancy and substance use. To achieve this goal, JBS collaborated with the National Institute on Drug Abuse to develop a valuable resource called "Your Words Matter–Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder." This language guide equips health care professionals with the necessary tools to reduce stigmatization and to promote a more compassionate approach when discussing addiction and SUD among pregnant individuals, thus increasing their likelihood of seeking health care and of accessing treatment or prenatal care.