According to the Substance Abuse and Mental Health Service Administration (SAMHSA) and the National Survey on Drug Use and Health (NSDUH) as of 2022 approximately 10% of pregnant women use illicit substances. Pregnancy, usually a time of joy and anticipation for most expectant mothers, can be a time of intense struggle for pregnant women battling substance use disorder. This topic sparks controversy placing these women in the crossfires of stigma and judgement.

This stigma within our society and system has led health care providers to believe these women are “selfish and morally flawed”.

The recent New York Times article “Pregnant, addicted and fighting the pull of drugs” by Jan Hoffman, explored the challenges faced by pregnant women addicted to drugs and other substances and how treating addiction compassionately can lead to better outcomes.

The Impact of Stigma

Studies have found that one of the main reasons expectant mothers who suffer from substance use delay prenatal care is their fear of judgment and of being reported to the authorities. This fear of seeking care then influences the quality of care they receive and leads to mistrust, reduced access to prenatal care and ultimately poorer health outcomes for both the mother and the child. Stigmatization can also manifest in social settings, where pregnant women may face isolation and condemnation from their communities and families. This isolation can worsen feelings of shame and guilt, making it even harder for them to break free from addiction.

In response to these challenges, the New York Times article highlighted the establishment of Great Moms (Grand Rapids Encompassing Addiction Treatment and Maternal Obstetric Management). Founded in 2018 by Dr. Cara Poland, this clinic provides coordinated obstetric and addiction care during pregnancy and the critical year after birth, when women are highly susceptible to relapse and overdose. The staff, including a nurse-midwife and a social worker, work closely with social service agencies, ensuring a comprehensive support system.

The urgency of such programs has increased with the rise of illicit fentanyl and new addictive substances. The National Institute on Drug Abuse reported a sharp increase in overdose deaths among pregnant and postpartum women in 2021 compared to 2018, with rates more than tripling for women aged 35 to 44. In addition, the proportion of pregnant women who reported current use of illicit drugs, including marijuana, rose from 5% in 2020 to nearly 10% in 2022.

The Importance of Support and Effective Approaches

Comprehensive support and treatment during and after pregnancy can significantly improve health outcomes for both mother and child. Integrating addiction treatment, mental health support, and social services into prenatal and postpartum care helps manage both pregnancy and substance use disorders effectively. Health care providers should adopt a compassionate, non-judgmental approach, creating a safe space for women to disclose their substance use without fear of legal repercussions. This holistic approach not only addresses the immediate health needs but also contributes to breaking the cycle of addiction. Integrated programs that combine prenatal and postpartum care with addiction treatment are crucial, addressing both the physical and psychological aspects of addiction. When pregnant women have access to the care they need, they are better equipped to provide a stable and nurturing environment for their children, reducing the risk of future substance abuse in the next generation.

Supportive care empowers women to take control of their health and lives, and programs that offer a non-judgmental approach and focus on long-term recovery help women build resilience, self-esteem, and the skills needed to maintain sobriety. Educating the public about the complexities of addiction and pregnancy can help reduce stigma, and advocacy for policies that support rather than punish pregnant women with substance use disorders can lead to more compassionate and effective care. By fostering empowerment and long-term recovery, these programs create a positive ripple effect, enhancing the well-being of families and communities.

Supporting pregnant women who struggle with substance abuse is not just a matter of compassion; it is a public health imperative. By shifting our approach from judgment to support, we can help ensure that these women receive the care they need to lead healthy lives and raise healthy children. It is time to break the stigma and build a healthcare system that recognizes the humanity and dignity of all women, regardless of their struggles.

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References:

Weber, A., Miskle, B., Lynch, A., Arndt, S., & Acion, L. (2021). Substance Use in Pregnancy: Identifying Stigma and Improving Care. Substance abuse and rehabilitation, 12, 105–121. https://doi.org/10.2147/SAR.S319180

National Institute on Drug Abuse. (2022). Stigma and discrimination. https://nida.nih.gov/research-topics/stigma-discrimination

Ripple, M. (2023). Prenatal substance use, healthcare interventions, and social stigma: A scoping review. https://doi.org/10.7916/ab0b-hp69

Hoffman, J. (2024). Pregnancy, drug addiction and stigma. The New York Times. https://www.nytimes.com/2024/06/16/health/pregnancy-drug-addiction.html

Substance Abuse and Mental Health Services Administration (2022). National Survey on Drug Use and Health Detailed Tables. https://www.samhsa.gov/data/report/2022-nsduh-detailed-tables