Reduce Stigma for Pregnant People with SUDs

Introductory Paragraph

Reducing stigma and perception surrounding pregnancy and SUDs will increase access to care. Pregnant women with SUDs may face feelings of shame and guilt on top of their challenges with childcare, social service involvement, and access to care. These difficulties are amplified by stigma.

It should be noted that pregnant women with an SUD are not one uniform group in their behavior. Some are actively using, others are in recovery, and others my be engaged in harm reduction, such as medicated assisted treatment. Nonetheless, as a sub-population they face similar hardships around stigma.

Key Information

SAMSHA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMSHA lists health, home, purpose, and community as essential dimensions of support for a life in recovery. Stigma is a barrier in recovery. When a person with substance use disorder reaches out for help, he or she is often met with judgmental responses which are less than helpful. This is the result of stigma and can be overt or more subtle. Stigma comes in the form of language used, pity, disdain, silence, or rejection. Persons with mental health and substance use problems are exposed to an array of stigma components which interact to endanger their mental health. These components include stereotypes, prejudice, and discrimination.

Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people in recovery need -- especially those in early recovery. Outside stigma can become internalized, leading people in recovery to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. Women have different experiences with SUD both biologically as well as culturally, as they are seen as caregivers and mothers. Barriers and challenges include:

• Women are at highest risk for developing SUDs during reproductive years
• Poly-substance use is common
• Unintended pregnancy rate among women with SUD is approximately 80%
• Substance use in pregnancy is connected to many complications and negative health outcomes for mother and baby
• As many as 70% of women entering addiction treatment have children and primary responsibility for children
• Family responsibilities can interfere with regular attendance in treatment sessions, including challenges with childcare
• Hesitancy to seek treatment for fear of legal action or legal issues, including child protective services
• Covid-19 made barriers to access to care more challenging
• Transportation issues
• Past trauma may impact stigma and reaching out for care

Other areas of stigma for pregnant women with SUDs include those seeking medication-assisted treatment and those with HIV or other infectious diseases. Educating providers and communities about pregnancy and substance use can assist with reducing harm and facilitate pregnant women getting access to care and services.

Relevant Research

• This qualitative study used interviews to explore common factors that motivate pregnant women with SUD to seek comprehensive care during pregnancy and common hesitations and barriers to treatment.

• This guideline titled "Substance Use Disorder Treatment in Pregnant Adults," contains an extensive review of the literature. It was developed by the New York State Department of Health AIDS Institute in order to establish a statewide standard of care. The goal was to ensure that healthcare providers in New York provide appropriate options for SUD treatment during pregnancy.

• This article provides recommendations specific to expanding and improving treatment care for pregnant women with opioid use disorder.

Impactful Federal, State, and Local Policies

Policies surrounding pregnant women with SUD vary from state to state. These state-level policy variations include:

• Reporting and testing requirements
• Standards for child abuse
• Grounds for civil commitment
• Targeted program created
• Pregnant people given priority access in general programs
• Pregnant people protected from discrimination in publicly funded programs

The National Academy for State Health Policy has published a document titled, "State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder." This provides information on funding streams for state initiatives.

Available Tools and Resources

• SAMHSA's Addiction Technology Transfer Center Network (ATTC) has published "Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma." It has also created a downloadable Powerpoint presentation titled, "Reducing Stigma in Pregnant & Parenting Women with Substance Use Disorder."

• Safe Project:
  • "No Shame Pledge" is a SAFE Project campaign created to end stigma and support others in speaking up about their own disorders and to get help without judgement. Participants receive a certificate in acknowledgement of their commitment to saving lives by fighting stigma.
  • See the Wiki titled "Reduce Stigma" for more detailed information on the reduction of stigma for those experiencing substance use issues.

• "Supporting Substance-Using Caregivers: Pregnancy, Birth, and Early Childhood" is a Harvard Kennedy School Government Performance Lab written report that explores ways to better support substance using caregivers and their families on the journey to recovery.

• From Research to Recovery Town Hall brings together speakers from across the country to address mental health, substance use and other facets of behavioral and emotional health. One example includes this YouTube titled “Gender & Use, Misuse, Treatment and Recovery," by Dr. Mishka Terplan, MD, MPH, Professor of Obstetrics and Gynecology and Psychiatry and the Associate Director of Addiction Medicine at Virginia Commonwealth University. It addresses how developing addiction to opioids and other drugs vary across gender, and how expectations impact the conception of treatment and stigma around use.

Promising Practices

Maryland. "Refocus: Look Again" is a public education campaign from the Anti-Stigma Project within On Our Own of Maryland. It is designed to challenge misconceptions and assumptions associated with mental health and substance use. Their goal is to foster change through awareness and dialogue about the real and damaging impact of stigma. An example iof their online content is an anti-stigma interview with Adina Weissman titled, "Medicated Assisted Treatment and Pregnancy." They also have an online pledge to challenge perceptions, to speak out, and to become an agent of change.