Reduce Stigma for Pregnant People with SUDs

Introductory Paragraph

Pregnant women with a substance use disorder (SUD) may face feelings of shame and guilt which can be reinforced by stigma and is a barrier to care. For those pregnant with SUDs there may be difficulty in managing the recovery process while facing the barriers to care with pregnancy including perceptions, concerns about the legal system and the potential for social service involvement, access to care and challenges with childcare. Reducing stigma and perception surrounding pregnancy and SUDs will reduce the barrier to access to care.

Key Information

“SAMSHA’s working definition of recovery states that recovery is “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 finally reaches out for help, he or she is often met with responses that are less than helpful or are judgmental and this is often the result of stigma. Many examples of stigma are not overt and are 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 that 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 --and early recovery especially -- need. 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
• Polysubstance use is common
• Unintended pregnancy rate among women with SUD is ~80%
• Substance use in pregnancy connected to many complications/negative health outcomes for mom & 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
• May be more hesitant to seek treatment for fear of legal action or legal issues including child protective services
• Covid 19 has 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

Treatment for substance use disorders in pregnant women: Motivators and barriers

Substance Use Disorder Treatment in Pregnant Adults

Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment

Impactful Federal, State, and Local Policies

States policies surrounding pregnant women with SUD vary by State. This variation includes:

• Child Abuse

• Grounds for Civil Commitment

• Reporting

• Testing

• Targeted Program Created

• Pregnant People Given Priority Access in General Programs

• Pregnant People Protected from Discrimination in Publicly Funded Programs

The Guttmach Institute provides State Policies on Substance Use During Pregnancy by individual State.

They indicate currently:

• 24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment.
• 25 states and the District of Columbia require health care professionals to report suspected prenatal drug use, and 8 states require them to test for prenatal drug exposure if they suspect drug use.
• 19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs.
• 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people.

The National Academy for State Health Policy State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder provides funding streams by State initiatives.

Available Tools and Resources

Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma

Reducing Stigma in Pregnant & Parenting Women with Substance Use Disorder A presentation by The Mountain Plains Addiction Technology Transfer Center & SAMHSA

Your Safe Solutions Reduce Stigma

YouTube: Dr. Mishka Terplan, MD, MPH -- “Gender & Use, Misuse, Treatment and Recovery

National Academy for State Health Policy State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder

Promising Practices

Safe Project No Shame Pledge

Medicated Assisted Treatment and Pregnancy: An Anti-Stigma Interview with Adina Weissman

Distorted perceptions Take the Pledge to end Stigma

Special Connections Program in Colorado Special Connections provides gender-responsive treatment for pregnant and parenting women who are Medicaid eligible in order to maximize the chance of a healthy birth and to provide postpartum treatment services in order to maintain gains made during pregnancy. Special Connections providers offer pregnancy risk assessments, care coordination services, group counseling sessions, individual counseling sessions, health education groups, and residential substance use disorder treatment in a women-only setting.