Taking Action in Communities to Improve Behavioral Health Services and Supports During Pregnancy

Women in the United States are dying at a higher rate from pregnancy-related causes than in any other developed nation,¹ and more than 1 in 5 women experienced a mental health condition in the past year, such as depression or anxiety.  Additionally, substance use disorders (SUDs) among women continue to rise, and the pandemic exacerbated these issues, particularly for women of color and those living in rural communities.^{2,3,4,5,6,7,8}

Of particular concern is the rise in substance use during pregnancy, including opioid use. Between 2010 and 2017, opioid use–related diagnoses at delivery increased 131 percent.⁹ Drug overdose deaths for pregnant people increased 81 percent from 2017 to 2020.¹⁰ Babies born to pregnant people who have SUD may face a range of health problems, including neonatal abstinence syndrome (NAS). In fact, 1 baby is diagnosed with NAS every 24 minutes in the United States.¹¹

Pregnant people with SUD face significant barriers in accessing care, largely due to a lack of providers knowledgeable about substance use treatment and to stigma from the healthcare community.¹² Other barriers include a legal system that may penalize pregnant people who disclose their substance use to their healthcare provider and the potential for child welfare system involvement if they disclose substance use or treatment during pregnancy.¹²

Bridging the Gap: Working With Communities to Support Pregnant Individuals With Behavioral Health Needs

Empathetic, non-stigmatizing, trauma-informed care is essential to supporting the complex needs of people with mental health or substance use disorders during pregnancy. A community response that integrates a full range of services (e.g., obstetrics/gynecology; mental health; substance use treatment, including medications for opioid use disorder [OUD]; care coordination) can lead to improvements in the health and well-being of both mother and baby.

For over 4 years, JBS International (JBS) has supported the Health Resources and Services Administration’s (HRSA) Rural Communities Opioid Response Program (RCORP) by delivering technical assistance (TA) to rural communities on how to develop strong service systems to prevent, treat, and support recovery for persons with SUD, including OUD. In recognition of the impact of substance use during pregnancy, HRSA has funded two specialized cohorts of RCORP awardees focused specifically on reducing NAS and on increasing the range and quality of services to pregnant people who use drugs. JBS has provided expert TA for these grantees. This vital work has resulted in expanded treatment and prevention services for pregnant people in rural communities. 

Also, in 2022, JBS launched the Maternal and Child Health Tele-Behavioral Health Programs TA Innovation Center. The MCHB TA Innovation Center provides comprehensive, customized TA to assist the implementation and success of Pediatric Mental Health Care Access and Screening and Treatment for Maternal Depression and Related Behavioral Disorders programs that support mental and behavioral health integration in pediatric primary care and maternal health. 

Through these and other initiatives, JBS is supporting long-term, sustained efforts that will translate to improved health for pregnant people with substance use treatment and mental health needs, particularly in rural and underserved communities.

¹ The White House. (2022, June). White House blueprint for addressing the maternal health crisis. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf, p. 1.
² Office on Women's Health. (2021, February 16 updated). Mental health. U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary of Health. https://www.womenshealth.gov/mental-health
³ Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). National Survey on Drug Use and Health (NSDUH). HHS. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
⁴ Pollard, M. S., Tucker, J. S., & Green, H. D., Jr (2020). Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Network Open, 3(9), e2022942. https://doi.org/10.1001%2Fjamanetworkopen.2020.22942
⁵ Ali, M. M., Nye, E., & West, K. (2022). Substance use disorder treatment, perceived need for treatment, and barriers to treatment among parenting women with substance use disorder in US rural counties. The Journal of Rural Health, 38(1), 70–76. https://doi.org/10.1111/jrh.12488
⁶ Devoto, A., Himelein-Wachowiak, M., Liu, T., & Curtis, B. (2022). Women's substance use and mental health during the COVID-19 pandemic. Women's Health Issues, 32(3), 235–240. https://doi.org/10.1016%2Fj.whi.2022.01.004
⁷ Panchal, N., Garfield, R., Cox, C., & Artiga, S. (2021, August 12). Substance use issues are worsening alongside access to care. KFF. https://www.kff.org/policy-watch/substance-use-issues-are-worsening-alongside-access-to-care/
⁸ Gramlich, J. (2022, January 19). Black men hit hardest by drug overdose deaths in recent years. Pew Research Center. https://www.pewresearch.org/short-reads/2022/01/19/recent-surge-in-u-s-drug-overdose-deaths-has-hit-black-men-the-hardest/
⁹ Hirai, A. H., Ko, J. Y., Owens, P. L., Stocks, C., & Patrick, S. W. (2021). Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017. JAMA, 325(2), 146–155. https://doi.org/10.1001/jama.2020.24991
¹⁰ Bruzelius, E., & Martins, S. S. (2022). US trends in drug overdose mortality among pregnant and postpartum persons, 2017–2020. JAMA, 328(21), 2159–2161. https://doi.org/10.1001%2Fjama.2022.17045
¹¹ Centers for Disease Control and Prevention. (2023, March 21 last reviewed). Data and statistics about opioid use during pregnancy. HHS. https://www.cdc.gov/pregnancy/opioids/data.html
¹² SAMHSA. (2023, May). Evidence-based, whole-person care for pregnant people who have opioid use disorder. HHS. https://store.samhsa.gov/sites/default/files/pep23-02-01-002.pdf